Ultrasonographic Study of Wrist Ligaments: Review and New Perspectives

Abstract

Imaging strategy for wrist injury usually begins with standard radiographs. When a ligamentous disorder is suspected clinically, the next step is arthrographic computed tomography or arthrographic magnetic resonance imaging. When the diagnosis remains unclear, magnetic resonance imaging (MRI) is the preferred examination. Ultrasonography is usually used to assess structures like tendons and bone surface, but thanks to the performances of high-frequency transducers, it can also enable visualization of the main ligaments of the wrist. Ultrasonography could thus replace MRI because of its lower cost, as recently reported in the literature. However, a good knowledge of normal and pathological wrist anatomy is required to avoid false negatives. Wrist ligaments comprise interosseous and capsular ligaments as well as the triangular fibrocartilaginous complex. All these ligaments may be involved in carpal instability. Clinical examination has a major role to play in helping radiologists orient their procedures. A few studies have reported that ultrasonography of the triangular fibrocartilaginous complex is reliable compared with arthrography or MRI, but most of these studies were limited to the radioulnar ligaments. In this article we propose a more extensive protocol.

Normal Anatomy of the Extrinsic Capsular Wrist Ligaments by 3-T MRI and High-Resolution Ultrasonography

“…Imaging of the extrinsic capsular wrist ligaments is achieved by high-resolution magnetic resonance (MR) imaging 10,[15][16][17][18][19][20][21] and/or high-resolution ultrasonography. 11,[22][23][24] Both 1.5-T MR imaging 10,[16][17][18][19][20] and MR arthrography 15,21 with the use of the appropriate imaging coils, small field of view, thin typically 2-mm slices on two-dimensional sequences and 1 mm or thinner slices on three-dimensional gradient echo sequences, 10 most of the time allow satisfactory visualization of the extrinsic capsular wrist ligaments. On MR imaging and MR arthrography, the extrinsic capsular wrist ligaments have a fasciculate or striated appearance composed of alternating bands of low and high signal intensity.…”

“…High-resolution ultrasonography using high-frequency linear transducers (typically 10 MHz) allows good visualization of most of the extrinsic capsular wrist ligaments. 11,[22][23][24] On ultrasonography, these ligaments may appear as echogenic bands and/or fibrillar structures (►Figs. 4B, 5B, 6B, 7B, 8B, 9B, 10B, 11B, 12B, 13B, 14B, 16B, and 16D).…”

High-resolution ultrasound of the extrinsic carpal ligaments

“…These features make them important for wrist stability [10,12]. The extrinsic ligaments are subdivided into the dorsal ligaments, the volar (or palmar) ligaments, and the collateral ligaments.…”

High-resolution ultrasound evaluation of extrinsic wrist ligaments in patients affected by rheumatoid arthritis

“…Ultrasound performed with high-resolution linear probes is an excellent tool for the evaluation of superficial ligaments [6][7][8][9][10][11] because of its high spatial resolution. The ability of ultrasound to evaluate the normal anatomy of extrinsic wrist ligaments has already been demonstrated [6][7][8][9][10][11].…”

“…The ability of ultrasound to evaluate the normal anatomy of extrinsic wrist ligaments has already been demonstrated [6][7][8][9][10][11]. However, little is known about the status of these ligaments in RA patients and the role of ultrasound in their evaluation.…”