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

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.
Arthroscopy ; Classification ; Debridement ; Joint Instability ; Joints* ; Osteotomy ; Recurrence ; Tears ; Triangular Fibrocartilage* ; Wrist

BACKGROUND: This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. METHODS: The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. RESULTS: The modified Mayo wrist score in groups A, B, and C was 74.5 +/- 8.9, 73.9 +/- 11.6, and 61.3 +/- 10.2, respectively (p < 0.05). The DASH score in groups A, B, and C was 15.6 +/- 11.8, 19.3 +/- 11.9, and 33.2 +/- 8.5, respectively (p < 0.05). The average Chun and Palmer grading score in groups A and B was 85.7 +/- 8.9 and 84.7 +/- 6.7, respectively. The difference in the Mayo wrist score, DASH score and Chun and Palmer grading score between group A and B was not significant (p > 0.05). CONCLUSIONS: Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable.
Adult ; Aged ; *Arthroscopy ; *Debridement ; Female ; Humans ; Joint Diseases/surgery ; Male ; Middle Aged ; Orthopedic Procedures/methods ; *Osteotomy ; Triangular Fibrocartilage/*surgery ; Ulna/*surgery ; Wrist Joint/*surgery

PURPOSE: Extensor carpi ulnaris (ECU) subluxation has a low incidence rate, to date, there has only been a few studies evaluating the operative treatment for type of injury. The purpose of this study was to retrospectively analyze 11 patients with ECU subluxation who underwent operative treatment. MATERIALS AND METHODS: Between March 2005 and February 2015, 11 patients received operative treatment. Magnetic resonance imaging and dynamic ultrasound were used to make the diagnosis. ECU subluxation patterns were classified by the Inoue's classification system. There were two cases of type A, one case of type B, five cases of type C, and three cases unfit for Inoue's classification. We also found two cases of radial subluxation and one case of ulnar locked subluxation. In type A and B cases, ECU tendons were relocated then sheaths repair was performed, and the extensor retinaculum reconstruction was performed. In type C cases, the fibro-osseous sheaths were fixed. In the three unclassified cases, extensor retinaculum reconstruction was performed. In all cases, fibro-osseous sheaths were fixed using the anchor suture technique. We compared the clinical results based on the following: motion range of the wrist joint; grip strength; visual analogue scale (VAS) score; quick disabilities of the arm, shoulder and hand (Q-DASH) score; and Mayo wrist score. RESULTS: The median age of patients at the time of the operation was 32 years, and the average follow-up period was 11.2 months. There were five cases of triangular fibrocartilage complex tear, two cases of distal radioulnar joint instability, three cases of ECU split tear as accompanying injury. There were significant differences in the clinical results. The average motion range of the wrist increased compared with the preoperative value (84.7% to 92.4% compared to contralateral normal side). The postoperative VAS score, Q-DASH score and Mayo wrist score showed better results compared with the respective preoperative values (6.0 to 1.1, 40.9 to 12.4, 75.9 to 86.4). CONCLUSION: ECU subluxation is a rare occurrence. Dynamic ultrasound is useful in diagnosing ECU tendon subluxation. Satisfactory results can be obtained with the use of a proper technique, which depends on the type of subluxation.
Arm ; Classification ; Diagnosis ; Dislocations* ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Incidence ; Joint Instability ; Magnetic Resonance Imaging ; Retrospective Studies ; Shoulder ; Suture Techniques ; Tears ; Tendons* ; Triangular Fibrocartilage ; Ultrasonography ; Wrist ; Wrist Joint

BACKGROUNDThe injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese.

METHODSFourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists.

RESULTSTriangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr.

CONCLUSIONHigh-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

Adult ; Cross-Sectional Studies ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Triangular Fibrocartilage ; anatomy & histology ; diagnostic imaging ; Wrist ; anatomy & histology ; diagnostic imaging ; Wrist Joint ; anatomy & histology ; diagnostic imaging

OBJECTIVETo investigate three-dimensional kinematics of the superficial and deep portion of triangular fibrocartilage complex (TFCC) in different parts of the forearm rotation.

METHODSSix wrists of 6 volunteers were used to obtain CT scans at different positions of the wrist. The wrists were scanned from 90 degrees of pronation to 90 degrees of supination at an interval of 30 degrees. The 3-dimensional radius and ulna were reconstructed with customized software and changes in length of the superficial and deep portion of TFCC during forearm rotation.

RESULTSIn forearm pronation, the superficial dorsal portion and the deep palmar portion of the TFCC were tight. While the superficial palmar portion and the deep dorsal potion of the TFCC were lax. In supination, the changes in length of all these fibers were reverse.

CONCLUSIONSIn forearm rotation one portion fibers of dorsal TFCC and one portion fibers of palmar TFCC are tight, and this mechanism controls stability during DRUJ rotation.

Adult ; Biomechanical Phenomena ; Female ; Forearm ; physiology ; Humans ; Imaging, Three-Dimensional ; Male ; Pronation ; Radiography ; Radius ; diagnostic imaging ; Supination ; Triangular Fibrocartilage ; diagnostic imaging ; Ulna ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

The authors report the case of a patient with the combination of a Type I Monteggia equivalent lesion and Essex-Lopresti injury. This combination of injury is very rare, and an associated distal radioulnar injury is often missed. We hope our experience illustrates the need to examine the wrist joint carefully and to be aware of the potential for distal radioulnar joint instability in all patients with type I Monteggia equivalent lesions.
Humans ; Joint Instability ; Wrist Joint

To study why the palmar capsular connections between radius and lunate remain intact in perilunate ligamentous injury of the wrist joint, and to compare the material properties of the short radiolunate, long radiolunate, and radioscaphoid region of the radioscaphocapitate ligaments (as the extrinsic ligaments) with those of the intrinsic ligaments of the previous papers, the anatomical and mechanical characteristics of those three palmar radiocarpal ligaments of twenty cadavers were measured and tested by a servo-hydraulic test machine. In spite of its small cross-sectional area (24% of short radiolunate ligament), the radioscaphoid ligament demonstrates a failure load of 58% and a stress of 260% of the short radiolunate ligament, and toughness similar to both the short and long radiolunate ligaments. This suggests that the radioscaphocapitate ligament may contribute as an initial constraint to perilunate injury. The failure load of the scapholunate ligament might be smaller than previously reported due to testing strain rate, which coupled with its short initial length may make it more vulnerable to injury at lower applied loads. The short radiolunate ligament, in spite of the largest width and cross-sectional area, has a failure load and toughness similar to the long radiolunate ligament. The material properties of short and long radiolunate ligaments may explain why the rest of the carpals persistently dislocate or fracture about lunate.
Cadaver ; Ligaments* ; Radius ; Wrist Joint ; Wrist*

the hand and wrist. This action during sonographic examination not only help to diagnosis to examiner to the anatomic structures, but also localize the pathologic process to a target organ. This chapter will describe the sonographic findings associated with the most common hand and wrist pathologic conditions.
Diagnosis* ; Hand* ; Ultrasonography ; Wrist Joint* ; Wrist*

The distal radioulnar joint is not only the main load-bearing joint in the wrist, but also the pivot of the rotation of the forearm. It is one of the most important and unique joints in the body. Maintaining the stability of the distal radioulnar joint is very important for our daily life. The tissue to stabilize the distal radioulnar joint includes bone structures and soft tissue structures. Although the contribution of soft tissue structures to its stability is far exceeding that of bone structures, the influence of abnormal bone structure on the distal radioulnar joint cannot be ignored. By reviewing the relevant literatures, this article divides the bone structural abnormalities into congenital and acquired bone structural abnormalities. The effects of congenital and acquiredbone structural abnormalities on the distal radioulnar joint stability are analysized and collated in this article, and its clinical symptoms, clinical grading, clinical treatments are also summerized. The problems of distal radioulnar joint instability in clinical practicing and its future researching directions are briefly described in order to provide some suggestions for future clinical applications.
Forearm ; Humans ; Joint Instability ; Rotation ; Ulna ; Wrist ; Wrist Joint