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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Ligaments of the Wrist


- Volar Wrist Ligaments:
    - ligaments of wrist are most highly developed on palmar side of wrist;
    - palmar wrist ligaments originate laterally from radial styloid, & are directed in a distal ulnar direction;
    - intrinsic ligaments:
            - radial ligaments arise on palmar facet of radial styloid passing on to capitate;
            - ulnar sided intrinsic ligaments:
                   - capitohamate ligaments:
                           - three distinct ligaments: dorsal, volar, and deep portions;
                   - lunotriquetral ligaments:
                           - c-shaped ligament with three parts: the dorsal, volar (most important), and intramembranous portions;
            - between these arcades, is space of Poirier;
            - thru this interval escapes of distal carpal row from lunate in perilunar dislocation;
    - palmar ulnar extrinsic ligaments
            - ulnotriquetral (medial)
            - ulnolunate (medial)
                   - this is a key ligament along w/ the TFC;
                   - on occassion, may avulse from its insertion on lunate, and this injury will allow dye extension both into distal RU joint and into mid-carpal joint;
                   - references:
                          - An anatomical study of the ligaments of the ulnar compartment of the wrist
                          - An anatomic study of the ligamentous structure of the triangular fibrocartilage complex.
    - palmar radial extrinsic ligaments:
             - ref: MRI of Wrist Ligaments


- Dorsal Wrist Ligaments:
    - dorsal extrinsic ligaments are seen after incising extensor retinaculum and retracting the extensor tendons;
    - superficial layer: dorsal approach to the wrist: splits the dorsal radiotriquetral ligament proximally and the dorsal intercarpal ligament distally; 
            - dorsal transverse intercarpal (trapezoidal-triquetral ligament):
                     - this ligament has some fibers which insert on the dorsal ridge of scaphoid but none that insert on the distal pole of the scaphoid;
                     - major portion of the ligament originates on the trapezium, runs radially and inserts on the dorsal ridge of scaphoid  the trapezium, and the trapezoid;
                     - deep portion of ligament augments the scapholunate and lunotriquetral ligaments;
            - dorsal radiocarpal ligament: (dorsal oblique radiotriquetral ligaments)
                     - arises from the distal radius at Lister’s tubercle
                     - it attaches to the dorsal horn of the lunate and then attaches to superficial component courses to attach to the dorsum of the triquetrum;

                     - references:
                             - The Incidence of Dorsal Radiocarpal Ligament Tears in Patients Having Diagnostic Wrist Arthroscopy for Wrist Pain 
    - deep layer:
            - scapholunate interosseous ligament;
            - lunotriquetal interosseous ligament;
            - scaphocapitate and scaphotrapezium-trapezoid ligaments: attach to distal pole of the scaphoid and resists scaphoid flexion;
    - references:
            - The dorsal ligaments of the wrist: anatomy, mechanical properties, and function.  
            - The dorsal ligaments of the wrist.
            - MRI of Wrist Ligaments



- Wrist Ligament Injuries: (see carpal instability);
    - most of tension injuries to wrist occur w/ wrist hyperextenion;
    - radiocarpal ligaments will exceed their normal elastic limits w/ extreme hyperextension;
    - injuries that result may be characterized as part of spectrum of injuries including scapholunate dissociation and perilunar dislocation;
    - interosseous ligaments of distal row seldom fail clinically



The Ligaments of the Wrist

Disruption of the ulnolunate ligament as a cause of chronic wrist pain

Wrist Ligamentous Anatomy and Pathogenesis of Carpal Instability

The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions

The anatomy of the ligaments of the wrist and distal radioulnar joints

Biomechanical function of the distal radioulnar and ulnocarpal wrist ligaments



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, October 16, 2013 2:53 pm