Diagnosis and Treatment of Chronic Lunotriquetral Ligament Injuries

Wagner, Eric R.; Elhassan, Bassem T.; Rizzo, Marco

doi:10.1016/j.hcl.2015.04.006

Cited by 12 publications

(10 citation statements)

References 26 publications

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“…The gold standard remains diagnostic arthroscopy for the hand surgeon. 77 As in the SL ligament, isolated asymptomatic proximal defects are common, often bilateral, and increase with age, with a 30 to 50% prevalence of communicating LT ligament defects in patients > 50 years of age. 13 However, even if central lesions have no biomechanical importance, they can cause focal synovitis and may therefore be painful.…”

Section: Ulnar-sided Ligaments (Lunotriquetral Ligament Complex)mentioning

confidence: 99%

Extrinsic and Intrinsic Ligaments of the Wrist

Shahabpour

Abid

Overstraeten³

et al. 2021

Semin Musculoskelet Radiol

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Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called “scapholunate complex” has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).

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Section: Ulnar-sided Ligaments (Lunotriquetral Ligament Complex)mentioning

confidence: 99%

Extrinsic and Intrinsic Ligaments of the Wrist

Shahabpour

Abid

Overstraeten³

et al. 2021

Semin Musculoskelet Radiol

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“…The diagnosis of extensively arched carpus and medially rotated scaphoid is based on clinical examination and radiographic evaluation, which may show an increased scapholunate angle, an increased scaphocapitate angle, and an abnormal alignment of the carpal bones [ 13 , 16 ]. The treatment of extensively arched carpus and medially rotated scaphoid depends on the symptoms and functional impairment of the patient, and may include conservative measures, such as splinting, physiotherapy, and medication, or surgical interventions, such as osteotomy, arthrodesis, or arthroplasty [ 10 , 13 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Pure traumatic unstable radiocarpal dislocation over pre-existing ulnar impingement syndrome, extensively arched carpus and medially rotated scaphoid: An exceptional and complex case report

Chabihi,

Aalil,

Demnati

et al. 2024

Trauma Case Reports

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“…Lesions of the intrinsic carpal ligaments and the triangular fibrocartilage complex (TFCC) are often concomitant findings in both traumatic or degenerative conditions of the wrist. Tears of the scapholunate ligament are present in 10% of distal radius fractures 2 , while injuries of the lunotriquetral ligament are more infrequent 3 , 4 . Lesions of these fine stabilizers correspond with changes in the biomechanics of the wrist and eventually invoke osteoarthritis and chronic pain 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

One-stop-shop CT arthrography of the wrist without subject repositioning by means of gantry-free cone-beam CT

Luetkens

Grunz

Paul

et al. 2022

Sci Rep

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Modern cone-beam CT systems are capable of ultra-high-resolution 3D imaging in addition to conventional radiography and fluoroscopy. The combination of various imaging functions in a multi-use setup is particularly appealing for musculoskeletal interventions, such as CBCT arthrography (CBCTA). With this study, we aimed to investigate the feasibility of CBCTA of the wrist in a “one-stop-shop” approach with a gantry-free twin robotic scanner that does not require repositioning of subjects. Additionally, the image quality of CBCTA was compared to subsequent arthrograms on a high-end multidetector CT (MDCTA). Fourteen cadaveric wrists received CBCTA with four acquisition protocols. Specimens were then transferred to the CT suite for additional MDCTA. Dose indices ranged between 14.3 mGy (120 kVp/100 effective mAs; full-dose) and 1.0 mGy (70 kVp/41 effective mAs; ultra-low-dose) for MDCTA and between 17.4 mGy (80 kVp/2.5 mAs per pulse; full-dose) and 1.2 mGy (60 kVp/0.5 mAs per pulse; ultra-low-dose) for CBCTA. Subjective image quality assessment for bone, cartilage and ligamentous tissue was performed by seven radiologists. The interrater reliability was assessed by calculation of the intraclass correlation coefficient (ICC) based on a two-way random effects model. Overall image quality of most CBCTA was deemed suitable for diagnostic use in contrast to a considerable amount of non-diagnostic MDCTA examinations (38.8%). The depiction of bone, cartilage and ligaments in MDCTA with any form of dose reduction was inferior to any CBCTA scan with at least 0.6 mAs per pulse (all p < 0.001). Full-dose MDCTA and low-dose CBCTA were of equal quality for bone tissue visualization (p = 0.326), whereas CBCTA allowed for better depiction of ligaments and cartilage (both p < 0.001), despite merely one third of radiation exposure (MDCTA–14.3 mGy vs. CBCTA–4.5 mGy). Moderate to good interrater reliability was ascertained for the assessment all tissues (ICC 0.689–0.756). Overall median examination time for CBCTA was 5.4 min (4.8–7.2 min). This work demonstrates that substantial dose reduction can be achieved in CT arthrography of the wrist while maintaining diagnostic image quality by employing the cone-beam CT mode of a twin robotic X-ray system. The ability of the multi-use X-ray system to switch between fluoroscopy mode and 3D imaging allows for “one-stop-shop” CBCTA in minimal examination time without the need for repositioning.

show abstract

Diagnosis and Treatment of Chronic Lunotriquetral Ligament Injuries

Cited by 12 publications

References 26 publications

Extrinsic and Intrinsic Ligaments of the Wrist

Extrinsic and Intrinsic Ligaments of the Wrist

Pure traumatic unstable radiocarpal dislocation over pre-existing ulnar impingement syndrome, extensively arched carpus and medially rotated scaphoid: An exceptional and complex case report

One-stop-shop CT arthrography of the wrist without subject repositioning by means of gantry-free cone-beam CT

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