Ligament Injuries

The precise evaluation of major intrinsic ligaments remains a challenge. Obvious and large lesions can be demonstrated indirectly on standard views or directly by US. An SLL tear may appear as a widened SL space filled with fluid and an absent SL ligament, juxta-articular BMO, and at a later stage, subchondral cysts. Dynamic diastasis in the SSL joint space due to an elongation of the SLL can show very subtle signal changes of the SLL. Tears in the SLL may or may not change after an indefinite period of time. On the contrary, large SLL tears may be replaced by wide, ill-defined, heterogeneous scar tissue. Arthrosynovial cysts are very often associated with SLL tears. A lesion of this even smaller intrinsic ligament can be suspected on standard PA views. Indirect signs, such as sclerotic margins at the LT joint, indicate a response to abnormal mobility. Additional MRI examination should include the entire horseshoe-shaped ligament from dorsal to palmar. Fine images in at least two orthogonal directions can show the extent of the LTL lesion. The ligament is usually torn in the L. The palmar part of the LTL is most significant. TFCC is a unit of multiple and very different parts. The location of the tear and its extent are assessed on at least two perpendicular images, usually coronal and axial. A frequent pitfall is the brighter signal of the small area of cartilage adjacent to the sigmoid notch. Isolated rupture of the scaphotrapezial ligament is a very rare finding. An arthrosynovial cyst may also develop here. The exact evaluation of extrinsic multidirectional ligaments remains an even greater challenge, partly because of their anatomical location in the capsule. The striated aspect is erased and replaced by a higher and more homogeneous signal, possibly with small cyst components. Stretching and/or partial tearing give rise to oedema between the low-signal stripes and/or with partial tearing of the low-signal stripes, respectively. The ligamentous lesion may be accompanied by a bony detachment. More often, periosteal stripping at the carpal attachments leads to focal BMO.