|ESSR 2016 / P-0092||
|Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: how to make it simple|
Intrinsic and extrinsic ligaments of the wrist stabilize the carpal bones during movement, acting as a guide with respect to the forearm bones and metacarpals, and transmitting motion from one carpal bone to another. They are intracapsular, extrasynovial structures, termed for the origin and insertion bones, proximal to distal and radial to ulnar. Extrinsic ligaments connect the carpus with the forearm bones or distal radioulnar ligaments; intrinsic ligaments are entirely situated within the carpus and connect adjacent bones within the proximal or distal row (interosseus ligaments), or pass over the midcarpal joint (midcarpal ligaments).
Lesions of wrist ligaments have been demonstrated to occur largely, mostly in patients with history of wrist trauma and carpal instability. In the setting of acute trauma, the prevalence of extrinsic and intrinsic ligament injury has recently been reported as 75% and 60%, respectively, being higher in case of concomitant osseous lesions. Carpal ligament abnormalities may also occur as a result of chronic, progressive diseases, such as rheumatoid arthritis. Early diagnosis is crucial to ensure optimal clinical management. Arthroscopy is regarded as the reference standard, but it is invasive and may be complicated by injuries of adjacent tendons, nerves, and vessels. Thus, imaging plays an essential role in the evaluation of wrist ligaments. Wrist ligaments are effectively examined with MR imaging and MR arthrography, which are however relatively expensive and burdened by artefacts if metallic implants are present; further, they are often unavailable in the context of acute trauma. Promising results have been published on US of carpal ligaments. Currently, this examination is not performed in routine clinical practice, maybe due to its technical feasibility considered as quite complex. Doubtless, more energy should be invested in this diagnostic tool that is inexpensive and largely available and, more importantly, allows to address the clinical question quickly with a focused examination of the injured structure.
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