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Wilms LM, Radke KL, Abrar DB, Frahm J, Voit D, Thelen S, Klee D, Grunz JP, Müller-Lutz A, Nebelung S. Dynamic assessment of scapholunate ligament status by real-time magnetic resonance imaging: an exploratory clinical study. Skeletal Radiol 2024; 53:791-800. [PMID: 37819279 PMCID: PMC10858828 DOI: 10.1007/s00256-023-04466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Clinical-standard MRI is the imaging modality of choice for the wrist, yet limited to static evaluation, thereby potentially missing dynamic instability patterns. We aimed to investigate the clinical benefit of (dynamic) real-time MRI, complemented by automatic analysis, in patients with complete or partial scapholunate ligament (SLL) tears. MATERIAL AND METHODS Both wrists of ten patients with unilateral SLL tears (six partial, four complete tears) as diagnosed by clinical-standard MRI were imaged during continuous active radioulnar motion using a 1.5-T MRI scanner in combination with a custom-made motion device. Following automatic segmentation of the wrist, the scapholunate and lunotriquetral joint widths were analyzed across the entire range of motion (ROM). Mixed-effects model analysis of variance (ANOVA) followed by Tukey's posthoc test and two-way ANOVA were used for statistical analysis. RESULTS With the increasing extent of SLL tear, the scapholunate joint widths in injured wrists were significantly larger over the entire ROM compared to those of the contralateral healthy wrists (p<0.001). Differences between partial and complete tears were most pronounced at 5°-15° ulnar abduction (p<0.001). Motion patterns and trajectories were altered. Complete SLL deficiency resulted in complex alterations of the lunotriquetral joint widths. CONCLUSION Real-time MRI may improve the functional diagnosis of SLL insufficiency and aid therapeutic decision-making by revealing dynamic forms of dissociative instability within the proximal carpus. Static MRI best differentiates SLL-injured wrists at 5°-15° of ulnar abduction.
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Affiliation(s)
- Lena Marie Wilms
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany.
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Jens Frahm
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, D-37077, Goettingen, Germany
| | - Dirk Voit
- Biomedical NMR, Max Planck Institute for Multidisciplinary Sciences, D-37077, Goettingen, Germany
| | - Simon Thelen
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
- Department of General Pediatrics, University Dusseldorf, Medical Faculty, University Children's Hospital, Heinrich-Heine-University Dusseldorf, Moorenstrasse 5, Düsseldorf, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Wurzburg, D-97080, Würzburg, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Moorenstrasse 5, D-40225, Dusseldorf, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, D-52074, Aachen, Germany
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Trentadue TP, Lopez C, Breighner RE, Fautsch K, Leng S, Holmes III DR, Moran SL, Thoreson AR, Kakar S, Zhao KD. Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases. J Wrist Surg 2023; 12:248-260. [PMID: 37223378 PMCID: PMC10202581 DOI: 10.1055/s-0042-1758159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/15/2022] [Indexed: 02/11/2023]
Abstract
Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.
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Affiliation(s)
- Taylor P. Trentadue
- Mayo Clinic Medical Scientist Training Program and Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Ryan E. Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Kalli Fautsch
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Shuai Leng
- Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota
| | - David R. Holmes III
- Biomedical Imaging Resource Division, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew R. Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Mack ZE, Kamal RN, Best GM, Wolfe SW, Pichora DR, Rainbow MJ. The Intercalated Segment: Does the Triquetrum Move in Synchrony With the Lunate? J Hand Surg Am 2022; 47:762-771. [PMID: 34627631 DOI: 10.1016/j.jhsa.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 06/20/2021] [Accepted: 08/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the relative motion between the lunate and triquetrum during functional wrist movements and to examine the impact of wrist laxity on triquetral motion. METHODS A digital database of wrist bone anatomy and carpal kinematics for 10 healthy volunteers in 10 different positions was used to study triquetral kinematics. The orientation of radiotriquetral (RT) and radiolunate rotation axes was compared during a variety of functional wrist movements, including radioulnar deviation (RUD) and flexion-extension (FE), and during a hammering task. The motion of the triquetrum relative to the radius during wrist RUD was compared with passive FE range of motion measurements (used as a surrogate measure for wrist laxity). RESULTS The difference in the orientation of the radiolunate and RT rotation axes was less than 20° during most of the motions studied, except for radial deviation and for the first stage of the hammering task. During wrist RUD, the orientation of the RT rotation axis varied as a function of passive FE wrist range of motion. CONCLUSIONS The suggestion that the lunate and triquetrum move together as an intercalated segment may be an oversimplification. We observed synchronous movement during some motions, but as the wrist entered RUD, the lunate and triquetrum no longer moved synchronously. These findings challenge the assumptions behind models describing the mechanical function of the carpals. CLINICAL RELEVANCE Individual-specific differences in the amount of relative motion between the triquetrum and lunate may contribute to the variability in outcomes following lunotriquetral arthrodesis. Variation in triquetral motion patterns may also have an impact on the ability of the triquetrum to extend the lunate, affecting the development of carpal instability.
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Affiliation(s)
- Zoe E Mack
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Gordon M Best
- Department of General Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical Centre, New York, NY
| | - David R Pichora
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; Division of Orthopaedic Surgery, Queen's University, Kingston, ON, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
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Toh AL, Mat Jais IS, McGrouther DA, Wong YR. Measuring intra-articular synovial fluid pressure in cadaveric scapholunate joints under radioulnar deviation. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen YR, Wu YF, Tang JB, Giddins G. Contact areas of the scaphoid and lunate with the distal radius in neutral and extension: correlation of falling strategies and distal radial anatomy. J Hand Surg Eur Vol 2014; 39:379-83. [PMID: 24127465 DOI: 10.1177/1753193413507810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The functional neutral of wrist movement is about 10° extension yet the distal radius has a volar tilt. This has not previously been explained. Assuming that the contact area between the carpus and the distal radius increased in wrist extension this would also help stabilize the carpus on the distal radius in positions where typically there is greater loading. To test this hypothesis we reconstructed three-dimensional structures of the carpal bones and distal radius using computed tomography scans of 13 normal wrists. The contact areas of the scaphoid with the distal radius were measured and were found progressively increased from flexion 20°, neutral, extension 20°, to extension 40°. The maximal increases in the contact area of the scaphoid and the distal radius was at full wrist extension. No significant changes in the contact areas of the lunate with the distal radius were found between the different positions. The contact characteristics provide greater stability to the carpus on the distal radius, and to help spread forces from impact to the wrist reducing the transmitted peak forces and thus the risk of distal radius and carpal injuries.
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Affiliation(s)
- Y R Chen
- 1Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China
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Neo PY, Mat Jais IS, Panknin C, Lau CC, Chan LP, An KN, Tay SC. Dynamic imaging with dual-source gated Computed Tomography (CT): Implications of motion parameters on image quality for wrist imaging. Med Eng Phys 2013; 35:1837-42. [DOI: 10.1016/j.medengphy.2013.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 04/17/2013] [Accepted: 05/18/2013] [Indexed: 11/15/2022]
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Chen YR, Tang JB. In vivo gliding and contact characteristics of the sigmoid notch and the ulna in forearm rotation. J Hand Surg Am 2013; 38:1513-9. [PMID: 23796715 DOI: 10.1016/j.jhsa.2013.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 04/11/2013] [Accepted: 04/12/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate shifting of the contact center over the surfaces of 2 opposing bones of the distal radioulnar joint during forearm rotation. METHODS We recruited 8 volunteers and used their right wrists. Serial computed tomography scans were obtained with the forearm at neutral position and 6 other positions of forearm rotation. We reconstructed 3-dimensional images and mapped contact regions of both the sigmoid notch and ulnar head by calculating the shortest distance between the 2 opposing bones. The center of contact was also defined and plotted against the distal radioulnar joint rotation to determine the sliding distance over the surfaces of the 2 bones. RESULTS During forearm rotation, the maximal sliding of the sigmoid notch over the ulnar head was 7.4 mm in forearm pronation and 9.2 mm in forearm supination, which occurred in volar-dorsal direction primarily. Sliding of the ulnar head over the sigmoid notch was more limited, measuring 4.7 mm during pronation and 2.3 mm during supination. Most of the motion occurred between 30° pronation and 60° supination. In the proximal-distal direction, the contact site of the sigmoid notch with the ulnar head translated distally 1.6 mm during pronation and proximally 0.7 mm during supination. CONCLUSIONS During forearm rotation, the sigmoid notch slides substantially against the ulnar head at each part of the forearm rotation arc. The sliding of the ulnar head over the sigmoid notch is smaller, most of which is at the range from moderate forearm pronation to slight supination. The contact site of the sigmoid notch with the ulnar head moves slightly distally during forearm pronation and proximally during supination. CLINICAL RELEVANCE The in vivo findings provide more detailed information and insight into distal radioulnar joint motion kinematics.
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Affiliation(s)
- Yan Rong Chen
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Chen YR, Tang JB. Changes in contact site of the radiocarpal joint and lengths of the carpal ligaments in forearm rotation: an in vivo study. J Hand Surg Am 2013; 38:712-20. [PMID: 23474161 DOI: 10.1016/j.jhsa.2013.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/12/2013] [Accepted: 01/14/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the contact site of the radiocarpal joint and lengths of carpal ligaments at different forearm rotations in vivo. Rotation of the forearm could exert noteworthy influence on mechanics of the wrist, and understanding how forearm rotation influences wrist mechanics may help treat carpal disorders because wrist position closely relates to forearm rotation. METHODS We obtained computed tomography scans of the wrists of 8 volunteers at the following 7 positions of forearm rotation: neutral; 30°, 60°, and 90° of pronation; and 30°, 60°, and 90° of supination. Three-dimensional images of the carpals and distal radius and ulna were reconstructed with software. Subsequently, the contact site of the scaphoid and lunate on the radial articular surface and the lengths of 8 carpal ligaments between their respective origin and insertion points were measured and compared among different positions of forearm rotation. RESULTS We found that the contact site of the scaphoid on the distal radius moved between 0.2 and 2.0 mm during forearm rotation. The lengths of the 3 ulnar carpal ligaments (ie, ulnocapitate [UC], ulnolunate [UL], and ulnotriquetral [UT] ligaments) showed the greatest and significant change. From neutral position to pronation, the UC, UL, and UT ligaments shortened significantly. From neutral position to supination, the UT ligament lengthened significantly, but the radioscaphocapitate, UC, UL, and dorsal intercarpal ligaments decreased significantly. CONCLUSIONS During forearm rotation, the contact site of the scaphoid and the lunate on the distal radial articular surface changed minimally. The lengths of 3 ulnar carpal ligaments (UC, UL, and UT ligaments) changed substantially. CLINICAL RELEVANCE Our findings will help elucidate carpal biomechanics during forearm rotation. The findings may inform decisions about how to reduce the load to these carpal ligaments when treating the carpal disorders.
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Affiliation(s)
- Yan Rong Chen
- Department of Orthopedics, First Affiliated Hospital of Soochow University, Jiangsu, China
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Tang JB, Chen YR. In vivo changes in contact regions of the radiocarpal joint during wrist hyperextension. J Hand Surg Am 2012; 37:2257-62. [PMID: 23101521 DOI: 10.1016/j.jhsa.2012.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal radius and scaphoid fractures commonly occur after a fall with the hand outstretched and wrist hyperextended. We investigated contact characteristics of the radiocarpal joint in neutral position, hyperextension, and hyperextension combined with radial deviation in vivo. METHODS Eight volunteers without a known history of wrist injury were enrolled. We obtained computed tomography scans with 3-dimensional reconstructions of the subjects' right wrists in neutral, hyperextension, and hyperextension with 10° of radial deviation. The contact regions of the radiocarpal joint were mapped. The direction and distance of changes in the contact region centers were recorded and analyzed. RESULTS From neutral position to hyperextension, the contact of the scaphoid substantially shifted from the middle to the dorsal part of the articular surface of the radius in 5 of the 8 wrists. With these wrists further deviated radially, the contact shifted to the surface over the radial styloid. In the other wrists, the contact of the scaphoid remained in the center of the radial articular surface. In all wrists, the contact of the radius on the scaphoid shifted from the proximal lateral surface of the scaphoid to the proximal dorsal surface of the scaphoid, and the contact of the radius on the lunate shifted dorsally. CONCLUSIONS During wrist hyperextension, the contact of the scaphoid on the distal radius exhibited 2 possible types of changes: either shifting from the mid-portion to the dorsal ridge of the articular surface of the radius or remaining at the center of the articular surface. Combined wrist hyperextension with radial deviation caused the scaphoid to contact the radius over the radial styloid. The contact of the radius on the scaphoid shifted from proximal lateral to proximal dorsal scaphoid, and that on the lunate shifted dorsally. CLINICAL RELEVANCE This study provided in vivo mechanical findings to improve our understanding of the mechanism of hyperextension injuries of carpus.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong Univeristy, Nantong, Jiangsu, China.
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