Diagnosis and Management of Ligament Injuries of the Wrist

Ki-Tae Na; Joo-Yup Lee

doi:10.12671/jkfs.2016.29.2.160

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Na and Lee: Diagnosis and Management of Ligament Injuries of the Wrist

Review Article

Journal of the Korean Fracture Society 2016; 29(2): 160-170.

Published online: 19 April 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.2.160

Diagnosis and Management of Ligament Injuries of the Wrist

Ki-Tae Na, M.D., Joo-Yup Lee, M.D., Ph.D.

Department of Orthopedic Surgery, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea.

Address reprint requests to: Joo-Yup Lee, M.D., Ph.D. Department of Orthopedic Surgery, The Catholic University of Korea, St. Vincent's Hospital, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel: 82-31-249-8301, Fax: 82-31-254-7186, jylos1@gmail.com

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Wrist joint, Ligament injuries, Triangular fibrocartilage

Figures and Tables

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.

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.

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.

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.

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.

Fig. 6

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

Notes

^{Financial support} None.

^{Conflict of interest} None.

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