High-resolution ultrasound of the extrinsic carpal ligaments

Abstract

KEYWORDSUltrasound; Extrinsic carpal ligaments; Rheumatoid arthritis; Wrist; Wrist instability.Abstract Thanks to its intrinsic high spatial resolution, ultrasound is an ideal imaging modality for examining very thin, superficial structures, and this makes it very helpful in the evaluation of extrinsic carpal ligaments. These structures, which arise from the radius and ulna and insert on the carpal bones, are extremely important for wrist stability. Previous studies have assessed the use of ultrasound to study the extrinsic carpal ligaments in cadavers, healthy asymptomatic subjects, and patients with rheumatoid arthritis. In the present report, we review the normal anatomy, biomechanics, and ultrasound appearance of these ligaments.Sommario L'ecografia è una metodica di imaging che, grazie alla sua elevata risoluzione spaziale, appare ideale nella valutazione di strutture superficiali anche molto sottili. Questa ca-ratteristica la rende una metodica estremamente valida nella valutazione dei legamenti estrinseci del carpo. Tali strutture originano dal radio e dall'ulna e si inseriscono sulle ossa della filiera carpale dando così un contributo fondamentale alla stabilità del carpo. Solo due studi in letteratura hanno descritto l'utilizzo dell'ecografia nella valutazione dei legamenti estrinseci del carpo su cadavere e in pazienti sani asintomatici. Un terzo studio ha invece decritto l'aspetto di tali legamenti in pazienti affetti da artrite reumatoide. Nel presente studio è riportata una revisione dell'anatomia normale, della biomeccanica, e dell'aspetto ecografico dei legamenti estrinseci del carpo. ª

Anatomical and ultrasound navigation of intra joint injections

“…В работе D. Orlandi и соавт. (2013) [30] точность инъекций в лучезапястный сустав при применении УЗ-контроля оказалась выше таковой при использовании «слепого» метода. Ряд авторов подчеркивает, что это имеет важное практическое значение, особенно при использовании гиалуроновой кислоты, поскольку ее эффективность максимальна только при точном введении непосредственно в полости сустава [31,32].…”

Diagnostic performance of high-resolution ultrasound in the evaluation of intrinsic and extrinsic wrist ligaments after trauma

“…Particularly, MRA is the best imaging method to visualize wrist ligament and assess related injuries [6,7], although it is expensive and often unavailable in the setting of acute trauma. Preliminary results have been published on ultrasound (US) of wrist ligaments, which is cost-effective, non-invasive and largely available [8][9][10][11][12][13]. Additionally, latest generation US systems allow for visualization of small superficial structures of the wrist with high resolution [14,15].…”

“…Additionally, latest-generation US systems allow for the visualization of small superficial structures of the wrist with high resolution [14,15]. However, most US studies to date have focused on the evaluation of wrist ligaments in normal subjects [8,9,10,11,12,13] or cadavers [16].…”

Comparative anatomy of the ligaments and muscles of the radiocarpal joint in chimpanzees and humans

“…The DRC ligament tightens during flexion and wrist radial deviation (Rainbow et al, 2012), restricting these movements and helping to stabilize the lunate (Rainbow et al, 2012; Ringler & Murthy, 2015). The radial region of the radiocarpal joint capsule is reinforced by the radial collateral (RC) ligament (Figures 1 and 2), which extends between the radial styloid process and the scaphoid (Orlandi et al, 2012; Ringler, 2013) and which tightens during wrist ulnar deviation. Some authors consider the RC ligament to be a part of the RSC ligament and not a differentiated ligament (Apergis, 2013; Ringler & Murthy, 2015).…”

“…Finally, the ulnar region of the radiocarpal joint capsule is reinforced by the ulnar collateral (UC) ligament (Figures 1 and 2), which extends between the ulnar styloid process, the pisiform and the triquetrum. Some authors believe that the UC ligament should be considered a thickening of the joint capsule of the TFCC and not a differentiated ligament (Brown et al, 1998; Orlandi et al, 2012).…”