Imaging in carpal instability
Dynamic MSK ultrasound may demonstrate dynamic instability and kinematic dysfunction in case of a scapholunate ligament tear. The reported sensitivity for MSK ultrasound diagnosis of tears of the dorsal band of the scapholunate ligament varies from 46%–100%, with specificities of 92%–100%. In the image at the bottom of this post, you can see how the scapholunate ligament should be scanned with MSK ultrasound as proposed by the European Society of Musculoskeletal Radiology.
The scapholunate interosseous ligament (SLIL) is an intra-articular C-shaped ligament composed of three distinct components: dorsal, volar, and proximal. The distal aspect of the scapholunate articulation remains bare.
The dorsal SLIL is a taut structure composed of transverse, parallel collagen fibers and contributes the majority of tensile strength. The volar segment is similar in length and width but is approximately half as thick as the dorsal component and contains obliquely oriented fibers with interspersed neurovascular bundles.
The proximal portion is histologically distinct because it is composed of anisotropic fibrocartilage, which blends with the articular cartilage of both the scaphoid and the lunate. At the junction of the proximal and volar components, the SLIL merges with the distal radioscapholunate ligament, which contains the terminal branches of the anterior interosseous nerve.
Video: Scapholunate instability on musculoskeletal ultrasound
Video: Wrist ligament surgery
Moreover, you can find a Youtube playlist of several Scapholunate ligament and Wrist videos here!
> From: Ramamurthy et al., J Hand Surg Eur Vol 41 (1970) 22-34. All rights reserved to The Author(s). Click here for the Pubmed summary.