Tensioning of the radioscaphocapitate and long radio-lunate ligaments for dynamic radiocarpal instability

Rubensson, Carin; Johansson, Torsten; Adolfsson, Lars

doi:10.1177/1753193418756805

Cited by 3 publications

(9 citation statements)

References 16 publications

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“…In the arthroscopic portals set up, we suggest that any difficulty in inserting the arthroscopic cannula into the 3–4 portal is a hint to reconfirm the diagnosis of radiocarpal instability when the wrist is in the semiflexion position in the traction tower and the carpal bones are pushed backwards to facilitate normalising the scope cannula insertion. In addition, the scaphoid displaced out of the scaphoid fossa is also a sign of radiocarpal instability [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Post-traumatic radial-sided wrist pain is a common issue in clinical practice [ 1 , 2 ]. Fractures or dislocations can be identified on radiographs or in other detailed imaging examinations.…”

Section: Introductionmentioning

confidence: 99%

“…However, these radio-volar ligaments are occasionally only partially injured, and the translation of the carpus may not be observed. Nevertheless, the injured ligaments would not be stable enough to maintain radial-side radiocarpal stability, and therefore, cause dynamic radiocarpal instability, which in turn causes symptoms, such as radial wrist pain, weakness, and clicking sounds during wrist activity [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…A diagnosis of dynamic radiocarpal instability is difficult because image examination may not provide enough information. The main diagnostic method is a physical examination [ 2 , 8 ]. Regarding treatment, ligament tensioning can be effective if the diagnosis can be confirmed [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The main diagnostic method is a physical examination [ 2 , 8 ]. Regarding treatment, ligament tensioning can be effective if the diagnosis can be confirmed [ 2 ]. However, accurate localisation of the key ligaments for open tensioning treatment would be difficult because the border of the outer layers cannot be easily defined, especially in scarred conditions after injury.…”

Section: Introductionmentioning

confidence: 99%

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Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability

Hung

Wang

Huang

et al. 2022

BMC Musculoskelet Disord

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Background Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments responsible for dynamic radiocarpal instability are the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments. Tensioning of these 2 ligaments could be a method of treatment for dynamic carpal instability. We proposed a method for arthroscopic thermal shrinkage of these 2 ligaments, and for setting a landmark arthroscopically to facilitate identification of these 2 ligaments during the combined open suture tensioning procedure. Methods Between January 2016 and May 2020, 12 patients treated with this method were enrolled. The mean age was 33.3 years (range, 18–57 years), and the mean duration from injury to operation was 7.8 months (range, 3–25 months). The diagnosis was mainly depended on the physical examinations and confirmed under arthroscopy. The mean follow-up was 17.7 months (range, 12–26 months). Results All the patients had marked improvement of pain, grip strength, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the radiocarpal stability. The wrist range of motion showed significant decrease around 5o in both flexion and extension and around 4o in the ulnar deviation at the final follow-ups. All patients were able to return to their previous full level of work and activities. Conclusions We conclude that arthroscopic thermal shrinkage combined with open suture tensioning can be effective in treating dynamic carpal instability, while the arthroscopic-assisted landmark setting can help identify the accurate location of the RSC and LRL ligaments without dissecting too much soft tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability

Hung

Wang

Huang

et al. 2022

BMC Musculoskelet Disord

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Radio-Carpal and Midcarpal Arthroscopy

Zhao

Geissler

Shung

et al. 2021

Arthroscopy and Endoscopy of the Hand, Wrist and Elbow

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Radial Midcarpal Instability Treated with Radioscaphocapitate Ligament Recession: A Case Report

Chin-Yi Liao,

Meng Kiat Tan

2023

J Wrist Surg

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Background Midcarpal instability is an uncommon entity characterized by pain and clunking as the wrist moves from radial deviation to ulnar deviation. Management is primarily nonoperative. In patients with persistent symptoms, operative treatments are divided into soft tissue reconstruction and limited midcarpal arthrodesis. Case Description We present a rare case of radial midcarpal instability associated with radioscaphocapitate (RSC) ligament injury. A 20-year-old man presented with radial-sided wrist pain and clunking with radial deviation after a fall. Wrist arthroscopy confirmed the pathology of an RSC ligament injury resulting in an extended posture of the scaphoid and a catch-up clunk from sudden flexion of the scaphoid in radial deviation. His RSC ligament was recessed and he had excellent outcome at 1 year follow-up. Literature Review Midcarpal instability was reported by Lichtman et al as a painful wrist click in ulnar deviation and classified according to the direction of the subluxation. Radial midcarpal instability was later described by Caputo et al in patients with rotatory subluxation of the scaphoid. We present a previously unreported form of radial midcarpal instability as it does not quite fit into the type III midcarpal instability with ligament laxity of the scaphotrapeziotrapezoid joint and type IV with scapholunate ligament disruption. The painful wrist click occurs in radial deviation as the result of an RSC ligament injury. Clinical Relevance We performed arthroscopic thermal capsulorrhaphy of the ulnar arcuate ligaments and dorsal capsule and an open proximal recession of the RSC ligament. The elimination of pain and clunking accompanied by the restoration of scaphoid flexion and return to load-bearing activities validates the pathology and suggests the potential of this soft tissue procedure in the treatment of radial midcarpal instability.

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Tensioning of the radioscaphocapitate and long radio-lunate ligaments for dynamic radiocarpal instability

Abstract: IV.

Cited by 3 publications

References 16 publications

Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability

Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability

Radio-Carpal and Midcarpal Arthroscopy

Radial Midcarpal Instability Treated with Radioscaphocapitate Ligament Recession: A Case Report

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