US of the Intrinsic and Extrinsic Wrist Ligaments and Triangular Fibrocartilage Complex—Normal Anatomy and Imaging Technique

Abstract

Injuries of the intrinsic and extrinsic wrist ligaments can lead to chronic wrist pain and carpal instability, while injuries of the triangular fibrocartilage complex are a frequent cause of ulnar-sided wrist pain. Currently, magnetic resonance (MR) arthrography is the preferred imaging modality for the evaluation of these structures, but good results can also achieved with MR imaging without preceding arthrography and computed tomographic (CT) arthrography. Promising results have been published on ultrasonography (US) and sonoarthrography of the intrinsic wrist ligaments and the triangular fibrocartilage complex and on US of the majority of extrinsic wrist ligaments. Visualization of these structures can be achieved by using high-frequency linear transducers. US has the advantages of MR imaging and MR arthrography: lower cost, no known contraindication for imaging, and real-time technique with possible dynamic evaluation. This technique does not require imaging guided intraarticular injection of contrast medium prior to MR arthrography or CT arthrography and does not use ionizing radiation; however, US is operator dependent, which can be compensated for by using standardized imaging techniques. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.e44/-/DC1.

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

“…Both wrists of patients and controls were imaged according to previously described imaging guidelines [6,9,10]. Using a 5-cm cylindrical wrist support [10], we imaged both the palmar and the dorsal sides of the wrist along the course of each ligament, using wrist bones as anatomical landmarks.…”

“…Proper balance of the wrist is related not only to the integrity of bone articular surfaces, but also to that of the supporting capsular and ligamentous structures. The extrinsic wrist ligaments, which are often affected [4][5][6], ensure both stability and flexibility. They arise outside the carpus, and attach to the wrist bones along their course [6].…”

“…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.…”

High-resolution ultrasound of the extrinsic carpal ligaments

“…The structural equilibrium of the wrist balance derives from the integrity of the articular surfaces of the bones as well as that of the supporting capsular and ligamentous structures [21,22].…”