J Korean Fract Soc.  2016 Apr;29(2):160-170. 10.12671/jkfs.2016.29.2.160.

Diagnosis and Management of Ligament Injuries of the Wrist

• Na KT
• Lee JY

• KMID: 2162018
• DOI: http://doi.org/10.12671/jkfs.2016.29.2.160

Abstract

The wrist joint is formed by the distal end of the radius and ulna proximally, and eight carpal bones distally. It has many ligaments to maintain stability of the complex bony structures. The incidence of ligament injuries of the wrist has increased due to sports activities. However, diagnosis and management of these injuries are sometimes difficult because of the anatomic complexity and variable injury patterns. Among them, scapholunate ligament injury and triangular fibrocartilage tears are the two most common injuries resulting in chronic disabling wrist pain. Thorough understanding of the wrist anatomy and physical and radiologic examination is mandatory for proper diagnosis and management of these conditions. This article will briefly discuss the wrist joint anatomy and biomechanics, and review the diagnosis and management of the scapholunate ligament injury and triangular fibrocartilage injury.

Keyword

Wrist joint; Ligament injuries; Triangular fibrocartilage

MeSH Terms

Carpal Bones
Diagnosis*
Incidence
Ligaments*
Radius
Sports
Tears
Triangular Fibrocartilage
Ulna
Wrist Joint
Wrist*

Figure

• 

  Fig. 1 Watson's scaphoid shift test. The examiners grasp the wrist with their thumb over the scaphoid tubercle and they will feel a clunk when the patient's wrist is moved from ulnar to radial deviation.

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  Fig. 2 Radiologic findings of the scapholunate dissociation. A wide scapholunate gap, cortical ring sign in the posteroanterior view, and dorsal intercalated segmental instability pattern in the lateral view can be seen.

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  Fig. 3 Brunelli's scapholunate ligament reconstruction using flexor carpi radialis (FCR) tendon. (A) Visible gap between scaphoid and lunate. (B) Harvesting the half-slip of FCR tendon. (C) Tendon passed through the scaphoid bone tunnel. (D) Tendon sutured to the lunate and dorsal intercapal ligament.

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  Fig. 4 Magnetic resonance imaging findings of the triangular fibrocartilage complex (TFCC) tear. (A, B) Subluxation of the ulnar head and flexor carpi ulnaris tendon. (C, D) Foveal tear of the TFCC.

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  Fig. 5 Open repair for a triangular fibrocartilage complex foveal tear. (A) Exposing the distal radioulnar ligament. (B) Masson-Allen type suture to the ligament. (C) Making a bone hole to the fovea. (D) Inserting a suture anchor.

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  Fig. 6 Arthroscopic repair of the triangular fibrocartilage complex using double Fiberwire® suture.

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