Our Summary

The stability of the wrist depends on the health and integrity of various ligaments within the wrist joint. This paper discusses the role of different ligaments on both the thumb-side (radial) and pinky-side (ulnar) of the wrist, and how they can be imaged using advanced methods like magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI).

In recent years, hand surgeons have begun to view a group of these ligaments as a single structure, similar to the way the triangular ligament is now known as the triangular fibrocartilage complex (TFCC). This group of ligaments, known as the “scapholunate complex,” includes several different ligaments in the wrist. This complex is particularly important because it is often involved in wrist injuries.

For a long time, the best way for doctors to examine these ligaments was through a surgical procedure called arthroscopy. However, to avoid surgery, doctors are increasingly using advanced MRI techniques to look for injuries or conditions like sprains, tears, and chronic inflammation in these ligaments. The article demonstrates how these imaging techniques can be used, showing images with both three-dimensional and two-dimensional views.

FAQs

  1. What is the scapholunate complex and why is it significant in wrist injuries?
  2. What advanced imaging techniques are doctors now using to examine wrist ligaments and avoid surgery?
  3. How has the understanding of wrist ligaments changed among hand surgeons in recent years?

Doctor’s Tip

In some cases, wrist arthroscopy may be recommended to diagnose or treat certain wrist conditions. During this minimally invasive procedure, a small camera is inserted into the wrist joint through a small incision, allowing the doctor to see inside the joint and potentially fix any issues.

One helpful tip a doctor might tell a patient about wrist arthroscopy is to follow their post-operative instructions carefully to ensure proper healing and recovery. This may include keeping the wrist elevated, avoiding certain activities, and attending follow-up appointments as scheduled. It is also important to communicate any concerns or changes in symptoms to your doctor promptly.

Additionally, physical therapy may be recommended after wrist arthroscopy to help improve strength, flexibility, and range of motion in the wrist. Following the guidance of your healthcare team and staying diligent with your rehabilitation exercises can help optimize your recovery and long-term outcomes.

Suitable For

Patients who are typically recommended wrist arthroscopy are those who have persistent wrist pain, swelling, stiffness, or instability that has not improved with conservative treatments such as rest, physical therapy, or medications. These patients may have a suspected ligament injury, tear, or other structural problem within the wrist joint that needs further evaluation and potentially surgical treatment. Wrist arthroscopy can also be recommended for patients with conditions such as arthritis, ganglion cysts, or carpal tunnel syndrome that are not responding to other treatments. It is important for patients to undergo a thorough evaluation by a hand surgeon or orthopedic specialist to determine if wrist arthroscopy is the appropriate course of action for their specific condition.

Timeline

Before wrist arthroscopy:

  1. Patient experiences wrist pain, swelling, stiffness, and limited range of motion.
  2. Doctor conducts a physical examination and may order imaging tests such as X-rays or MRI to diagnose the issue.
  3. Treatment options such as rest, immobilization, physical therapy, or medications are explored.
  4. If conservative treatments are not effective, doctor may recommend wrist arthroscopy to further evaluate and potentially treat the wrist condition.

After wrist arthroscopy:

  1. Patient undergoes wrist arthroscopy procedure, which involves inserting a small camera and instruments into the wrist joint through small incisions.
  2. Surgeon identifies and repairs any damaged ligaments, removes inflamed tissue, or addresses any other issues found during the procedure.
  3. Patient may experience some pain, swelling, and stiffness in the wrist post-operatively.
  4. Doctor provides post-operative care instructions, including wound care, pain management, and rehabilitation exercises.
  5. Patient gradually resumes normal activities and undergoes follow-up appointments to monitor recovery and assess the effectiveness of the procedure.

What to Ask Your Doctor

Some questions a patient should ask their doctor about wrist arthroscopy may include:

  1. What specific ligaments in my wrist are being targeted for arthroscopic evaluation?
  2. What are the potential risks and benefits of undergoing wrist arthroscopy?
  3. How will wrist arthroscopy help diagnose or treat my specific condition or injury?
  4. What alternative treatment options are available, and why is wrist arthroscopy recommended in my case?
  5. What is the recovery process like after wrist arthroscopy, and what kind of physical therapy or rehabilitation will be necessary?
  6. How long will it take for me to see improvements in my wrist function after the procedure?
  7. Are there any potential complications or long-term effects associated with wrist arthroscopy that I should be aware of?
  8. Will I need any follow-up appointments or additional treatments after the arthroscopic procedure?
  9. Can you explain the imaging techniques, such as MRA or contrast-enhanced MRI, that will be used to evaluate my wrist ligaments before deciding on arthroscopy?
  10. Are there any specific lifestyle changes or precautions I should take post-arthroscopy to ensure optimal healing and recovery?

Reference

Authors: Shahabpour M, Abid W, Van Overstraeten L, Van Royen K, De Maeseneer M. Journal: Semin Musculoskelet Radiol. 2021 Apr;25(2):311-328. doi: 10.1055/s-0041-1731653. Epub 2021 Aug 9. PMID: 34374066