Abstract
Purpose
Carpal ligaments can be classified as intrinsic and extrinsic. Extrinsic ligaments are often involved in carpal instability. The purpose of this article is to describe the sonographic appearance of extrinsic carpal ligaments on high-resolution ultrasound (HRUS) using magnetic resonance arthrography (MR arthrography) as a reference standard.
Materials and methods
We studied both wrists in 18 healthy volunteers (ten men, eight women, age range 18–58 years, mean age 34 years) with a Philips iU22 US scanner equipped with a high-resolution linear-array broadband transducer (5–17 MHz). The scans were performed along the long axis of the extrinsic dorsal and ventral ligaments to assess their course, thickness and structure. Ten subjects were also studied with MR arthrography of the wrist.
Results
In all patients, the ligament components could be appreciated as thin fibrillar hyperechoic structures. The course of seven extrinsic carpal ligaments and their relationships with surrounding articular structures could be studied. The radioscapholunate and the ulnar collateral ligaments were not visible on US. MR arthrography depicted all ligaments except for the ulnar collateral, which was never visualised.
Conclusions
The results obtained are consistent with those reported in the literature. HRUS provides good anatomical detail of the extrinsic carpal ligaments, but the role of US in planning the treatment of carpal instability disorders is yet to be demonstrated.
Riassunto
Obiettivo
I legamenti del carpo sono suddivisi in intrinseci ed estrinseci. Questi ultimi sono spesso coinvolti nella patogenesi dell’instabilità carpale. L’obiettivo di questo studio è descrivere l’aspetto ecografico dei legamenti estrinseci del carpo mediante ecografia ad alta risoluzione, utilizzando l’artrografia a risonanza magnetica (artro-RM) come metodica di riferimento.
Materiali e metodi
Abbiamo studiato entrambi i polsi di 18 soggetti volontari sani (10 maschi, 8 femmine, range 18–58 anni, età media 34 anni) mediante un apparecchio Philips iU22 con trasduttore lineare ad alta risoluzione (5–17 MHz). Sono state effettuate scansioni lungo l’asse lungo dei legamenti estrinseci dorsali e ventrali per poterne valutare il decorso, lo spessore e l’ecostruttura. In 10 casi è stato inoltre eseguito un esame artro-RM di polso.
Risultati
In tutti i soggetti è stato possibile riconoscere le componenti legamentose come sottili strutture fibrillari iperecogene. È stato possibile individuare il decorso di sette legamenti estrinseci del carpo ed i rapporti con le strutture articolari circostanti. I legamenti radioscafolunato e collaterale ulnare non sono risultati visibili ecograficamente. Le immagini artro-RM hanno dimostrato tutti i legamenti estrinseci ad eccezione del legamento collaterale ulnare, mai visualizzato.
Conclusioni
I dati ottenuti concordano con quelli presenti in letteratura. L’ecografia ad alta risoluzione ci permette di studiare i legamenti estrinseci del carpo con un buon dettaglio anatomico ma il ruolo dell’ecografia nell’iter terapeutico delle patologie da instabilità del carpo rimane da dimostrare.
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Lacelli, F., Muda, A., Sconfienza, L.M. et al. High-resolution ultrasound anatomy of extrinsic carpal ligaments. radiol med 113, 504–516 (2008). https://doi.org/10.1007/s11547-008-0269-2
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DOI: https://doi.org/10.1007/s11547-008-0269-2