• Dorsal and Volar ganglion
• Scapholunate ligament injury
• Dorsal capsulitis & Impingement
• Carpal boss
Injuries to the scapholunate ligament (SLL) are an uncommon cause of radial sided wrist pain.
The scapholunate ligament is a U shaped structure with strong dorsal, volar and weak central components.
The ligament ensures the integrity of the proximal carpal row in conjunction with the lunotriquetral ligament.
Acute injuries occur as a consequence of forced rotation of the scaphoid against a fixed lunate.
Injuries may affect the ligament itself or cause an avulsion fracture from the dorsal aspect of the lunate
Chronic ligament injuries are degenerate in aetiology.
With increasing age, the central third frequently becomes incompetent
This allows communication between the radiocarpal and midcarpal spaces. .
Injuries to the scapholunate ligament can be detected on plain films
Widening of the distance between the scaphoid and lunate is present.
Quoted values for the upper limit of normal are between 3mm and 4mm.
Static plain films may be negative
A Dynamic image series include radial/ulnar deviation, clenched fist PA and lateral
MRI and most frequently MR Arthrography are sensitive
Wrist MR arthrograms can be carried out by a variety of methods.
Injecting all three compartments with subtraction techniques provides most detail
More limited injections can be used if the clinical indication directs
Communication between the RCJ and DRUJ indicated a defect in the TFC
Detailed assessment needed to differentiate disk perforations from peripheral attachment tears
Communication between the RCJ and MCJ indicated a defect in the scapholunate or lunotriquetral ligament
Differentiation between a scapholunate ligament or lunotriquetral ligament defectrequires careful assessment.
Unidirectional tears are reported to occur but are rare and require three compartment injection for diagnosis.
T1 weighted images with and without fat saturation are useful in the detection of intrinsic ligament tears.
T2 weighted images with fat saturation to exclude associated injuries.
Occasionally following RCJ injection, contrast will enter the mid carpal space despite an initial negative arthrograms.
The reason and significance of this phenomenon are not fully elucidated.
Ganglion cysts arise from this ligamental usually from the posterior aspect.
This is common wrist mass is more fully described elsewhere
PROGRESSION Stage I: dorsal migration of the proximal pole of the scaphoid with injury to the scapholunate ligament.
Stage II: extension, ulnar deviation and supination
Stage III: lunotriquetral ligament injury
• Stage IV: Tear of the dorsal radiocarpal ligament leads to lunate dislocation.
DORSAL CAPSULITIS OR IMPINGEMENT
• capsular thickening
• dorsal compartment 2 tenosynovitis
• bony fraqmentation
• Dorsal osteophytes
