AJR:200, May 2013 1089 OBJECTIVE. Although much attention is paid to the scapholunate ligament, lunotrique- tral ligament, and the triangular fibrocartilage complex, additional intrinsic and extrinsic lig- aments in the wrist play an important part in carpal stability. With improved MRI techniques, the radiologist can increasingly visualize these ligaments. CONCLUSION. The anatomy, MRI appearance, and clinical significance of the scaph- olunate ligament, lunotriquetral ligament, triangular fibrocartilage complex, carpal metacar- pal ligaments, and volar and dorsal extrinsic ligaments are reviewed. Bateni et al. Imaging of Wrist Ligaments Musculoskeletal Imaging Review the scapholunate ligament, lunotriquetral lig- ament, and scaphotrapeziotrapezoid ligament. The volar extrinsic ligaments we will discuss include the volar radioscaphocapitate, volar radiotriquetral, volar ulnolunate, volar ulnotri- quetral, and volar radioulnar. The dorsal ex- trinsic ligaments we will describe include the dorsal intercarpal ligament, dorsal radiotrique- tral, and dorsal radioulnar. For the thumb, we will discuss the superficial anterior oblique ligament, deep anterior oblique ligament, and dorsoradial ligament. Intrinsic Ligaments of the Wrist Radiologists and clinicians typically fo- cus on the “big three” intrinsic ligamentous complexes—the scapholunate ligament, lu- notriquetral ligament, and triangular fibro- cartilage complex. Multiple anatomic re- search studies have shown that it is not injury solely to these ligaments that can lead to car- pal instability, but that each of them has inti- mate relationships with other extrinsic liga- ments that we will discuss further. The scapholunate ligament has three com- ponents—volar, dorsal, and interosseous. The dorsal and volar represent true ligaments, whereas the interosseous component is fibro- cartilage. A volar radioscapholunate ligament joins the volar scapholunate ligament and also separates the large interosseous component and the volar component [1]. Given their inter- relationship, it is not surprising that injury to one may be associated with injury to the other. The volar aspect of the scapholunate ligament typically is obliquely oriented and measures, Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know Cyrus P. Bateni 1 Roger J. Bartolotta 2 Michael L. Richardson 3 Hyojeong Mulcahy 3 Christopher H. Allan 4 Bateni CP, Bartolotta RJ, Richardson ML, Mulcahy H, Allan CH 1 Department of Radiology, University of California Davis Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95817. Address correspondence to C. P. Bateni (cyrus.bateni@ucdmc.ucdavis.edu). 2 Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY. 3 Department of Radiology, University of Washington Medical Center, Seattle, WA. 4 Department of Orthopedics, University of Washington Medical School, Seattle, WA Musculoskeletal฀Imaging฀•฀Review CME/SAM This article is available for CME/SAM credit. AJR 2013; 200:1089–1095 0361–803X/13/2005–1089 © American Roentgen Ray Society M any radiologists who interpret MRI examinations of the wrist for evalu- ating ligamentous integrity often focus on three ligamentous com- plexes—the scapholunate ligament, lunotriqu- etral ligament, and triangular fibrocartilage complex. Although these ligaments are the most clinically significant ligaments of the wrist, oth- er intrinsic and extrinsic ligaments provide im- portant stability to the carpal bones. We con- sulted with our orthopedic colleagues and we will emphasize the ligaments we think to be of greatest clinical and surgical importance. In this article, we will review not only the three ligamentous complexes on which most radiologists focus, but also other important ligaments that should be evaluated. Although this article is not an exhaustive review of all ligaments of the wrist, it will highlight liga- ments that ought to receive special attention. After having talked with our orthopedic col- leagues, we will discuss our experience in visualization and assessment of the integri- ty of these ligaments. We will also address pathologic conditions and consequences of injury to these respective ligaments. We have divided our discussion of pertinent ligaments of the wrist into several broad catego- ries: the intrinsic ligaments, the volar extrinsic ligaments, the dorsal extrinsic ligaments, and the ligaments of the thumb. Intrinsic ligaments of the wrist are ligaments that attach solely to the carpal bones in the wrist, whereas extrin- sic ligaments have additional attachments to the forearm, retinacula, or tendon sheaths. We will address the following intrinsic ligaments: Keywords: dorsal extrinsic wrist ligaments, intrinsic wrist ligaments, MRI, volar extrinsic wrist ligaments DOI:10.2214/AJR.12.9738 Received July 31, 2012; accepted after revision November 4, 2012. Downloaded from www.ajronline.org by 52.73.204.196 on 05/16/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved