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Extrinsic Carpal Ligaments: Normal MR Arthrographic Appearance in Cadavers¹

¹ From the Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161. Received October 19, 2001; revision requested January 11, 2002; revision received March 12; accepted April 2. Supported by the Swiss Radiological Society and the Swiss National Science Foundation. Address correspondence to D.R. (e-mail: dresnick@ucsd.edu).

View larger version (79K): [in a new window]   Figure 1a. (a) Schematic shows the palmar carpal ligaments (frontal view). 1 = radioscaphocapitate (RSC) ligament, 2 = radiolunotriquetral (RLT) (long radiolunate) ligament, 3 = radioscapholunate ligament, 4 = palmar ulnotriquetral ligament, 5 = ulnolunate ligament, 6 = proximal and distal bands of the palmar scaphotriquetral ligament. The thick black line along the distal surface of the ulna represents the palmar radioulnar ligament. (b) Schematic shows the dorsal carpal ligaments (frontal view). 7 = dorsal scaphotriquetral ligament, 8 = dorsal radiotriquetral ligament, 9 = dorsal ulnotriquetral ligament, 10 = radial collateral ligament. Thick black line represents the dorsal radioulnar ligament.

View larger version (78K): [in a new window]   Figure 1b. (a) Schematic shows the palmar carpal ligaments (frontal view). 1 = radioscaphocapitate (RSC) ligament, 2 = radiolunotriquetral (RLT) (long radiolunate) ligament, 3 = radioscapholunate ligament, 4 = palmar ulnotriquetral ligament, 5 = ulnolunate ligament, 6 = proximal and distal bands of the palmar scaphotriquetral ligament. The thick black line along the distal surface of the ulna represents the palmar radioulnar ligament. (b) Schematic shows the dorsal carpal ligaments (frontal view). 7 = dorsal scaphotriquetral ligament, 8 = dorsal radiotriquetral ligament, 9 = dorsal ulnotriquetral ligament, 10 = radial collateral ligament. Thick black line represents the dorsal radioulnar ligament.

View larger version (29K): [in a new window]   Figure 2. Schematic shows the RSC (1), ulnolunate (2), and radial collateral (3) ligaments in the transverse (left) (from distal to proximal = top to bottom), sagittal (middle) (from radial to ulnar = left to right), and coronal (right) planes. C = capitate, H = hamate, L = lunate, P = pisiform, R = radius, S = scaphoid, T = triquetrum, U = ulna.

View larger version (183K): [in a new window]   Figure 3a. Palmar radiocarpal and intercarpal ligaments. (a) Coronal T1-weighted spin-echo (500/12) MR arthrographic image. The RSC ligament arises from the radial aspect of the radial styloid process. It inserts widely on the palmar aspect of the capitate (C). The palmar scaphotriquetral ligament (pST) is composed of a proximal band running directly from the scaphoid (S) to the triquetrum (T) and a distal band forming an arch from the scaphoid to the capitate, hamate (H), and triquetrum. The radioscapholunate (RSL) ligament (arrowhead) arises from the distal palmar aspect of the radius (R) and extends distally to the scapholunate ligament. The RLT (long radiolunate) ligament arises in common with the RSC ligament. The palmar ulnotriquetral ligament arises from the palmar radioulnar ligament. L = lunate. (b) Coronal anatomic comparison specimen of the wrist. The RSC ligament arises from the radial aspect of the radial styloid process. It inserts widely on the palmar aspect of the capitate. The RLT ligament arises in common with the RSC ligament (arrowheads). The ulnolunate (UL) and palmar ulnotriquetral (UT) ligaments arise from the palmar radioulnar ligament (arrows). P = pisiform, R = radius, S = scaphoid.

View larger version (195K): [in a new window]   Figure 3b. Palmar radiocarpal and intercarpal ligaments. (a) Coronal T1-weighted spin-echo (500/12) MR arthrographic image. The RSC ligament arises from the radial aspect of the radial styloid process. It inserts widely on the palmar aspect of the capitate (C). The palmar scaphotriquetral ligament (pST) is composed of a proximal band running directly from the scaphoid (S) to the triquetrum (T) and a distal band forming an arch from the scaphoid to the capitate, hamate (H), and triquetrum. The radioscapholunate (RSL) ligament (arrowhead) arises from the distal palmar aspect of the radius (R) and extends distally to the scapholunate ligament. The RLT (long radiolunate) ligament arises in common with the RSC ligament. The palmar ulnotriquetral ligament arises from the palmar radioulnar ligament. L = lunate. (b) Coronal anatomic comparison specimen of the wrist. The RSC ligament arises from the radial aspect of the radial styloid process. It inserts widely on the palmar aspect of the capitate. The RLT ligament arises in common with the RSC ligament (arrowheads). The ulnolunate (UL) and palmar ulnotriquetral (UT) ligaments arise from the palmar radioulnar ligament (arrows). P = pisiform, R = radius, S = scaphoid.

View larger version (30K): [in a new window]   Figure 4. Schematic shows the RLT (or long radiolunate) (1), scaphotriquetral (2), and palmar ulnotriquetral (3) ligaments in the transverse (left) (from distal to proximal = top to bottom), sagittal (middle) (from radial to ulnar = left to right), and coronal (right) planes. C = capitate, H = hamate, L = lunate, P = pisiform, R = radius, S = scaphoid, T = triquetrum, U = ulna. The palmar ulnotriquetral ligament attaches proximally to the palmar radioulnar ligament and not directly onto the ulna.

View larger version (96K): [in a new window]   Figure 5a. (a) Sagittal T1-weighted fat-saturated spin-echo (500/12) MR arthrographic image of the wrist and (b) anatomic correlation. The RSC ligament courses through the groove of the palmar aspect of the waist of the scaphoid (S) and attaches to the palmar aspect of its distal pole (arrows). The RLT ligament arises from the palmar edge of the distal radius (R) (arrowheads). Tp = trapezium, Tr = trapezoid.

View larger version (134K): [in a new window]   Figure 5b. (a) Sagittal T1-weighted fat-saturated spin-echo (500/12) MR arthrographic image of the wrist and (b) anatomic correlation. The RSC ligament courses through the groove of the palmar aspect of the waist of the scaphoid (S) and attaches to the palmar aspect of its distal pole (arrows). The RLT ligament arises from the palmar edge of the distal radius (R) (arrowheads). Tp = trapezium, Tr = trapezoid.

View larger version (146K): [in a new window]   Figure 6. Transverse T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The RLT ligament arises from the palmar aspect of the distal radius (R) and radial styloid process (arrowheads), extends to the palmar aspect of the lunate (L, short arrows), and extends ulnarly to the radial side of the pisotriquetral joint on the palmar aspect of the triquetrum (T, long arrows). The dorsal radiotriquetral (dRT) ligament arises from the dorsal aspect of the distal radius and extends over the scaphoid (S) and the lunate to insert on the dorsal aspect of the triquetrum. P = pisiform.

View larger version (145K): [in a new window]   Figure 7a. (a) Sagittal T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The palmar ulnotriquetral ligament (pUT) arises from the palmar radioulnar ligament (pRUL, open arrow) and extends perpendicularly to the palmar radioulnar ligament to the proximal and palmar aspect of the triquetrum (T, arrowheads). The dorsal ulnotriquetral (dUT) ligament arises from the dorsal radioulnar ligament (dRUL, curved arrow) and extends to the dorsal aspect of the triquetrum to a common insertion with the dorsal radiotriquetral ligament (straight arrows). The triangular fibrocartilage is the dark structure extending between the palmar radioulnar ligament and the dorsal radioulnar ligament. U = ulna. (b) Sagittal anatomic correlation. The palmar ulnotriquetral ligament (pUT) arises from and extends perpendicularly to the palmar radioulnar ligament (open arrows) to the proximal and palmar aspect of the triquetrum (T, arrowheads). The dorsal ulnotriquetral ligament (dUT) arises from the dorsal radioulnar ligament (straight solid arrows) and extends to the dorsal aspect of the triquetrum to a common insertion with the dorsal radiotriquetral ligament (curved arrow). TFC = triangular fibrocartilage, U = ulna.

View larger version (154K): [in a new window]   Figure 7b. (a) Sagittal T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The palmar ulnotriquetral ligament (pUT) arises from the palmar radioulnar ligament (pRUL, open arrow) and extends perpendicularly to the palmar radioulnar ligament to the proximal and palmar aspect of the triquetrum (T, arrowheads). The dorsal ulnotriquetral (dUT) ligament arises from the dorsal radioulnar ligament (dRUL, curved arrow) and extends to the dorsal aspect of the triquetrum to a common insertion with the dorsal radiotriquetral ligament (straight arrows). The triangular fibrocartilage is the dark structure extending between the palmar radioulnar ligament and the dorsal radioulnar ligament. U = ulna. (b) Sagittal anatomic correlation. The palmar ulnotriquetral ligament (pUT) arises from and extends perpendicularly to the palmar radioulnar ligament (open arrows) to the proximal and palmar aspect of the triquetrum (T, arrowheads). The dorsal ulnotriquetral ligament (dUT) arises from the dorsal radioulnar ligament (straight solid arrows) and extends to the dorsal aspect of the triquetrum to a common insertion with the dorsal radiotriquetral ligament (curved arrow). TFC = triangular fibrocartilage, U = ulna.

View larger version (132K): [in a new window]   Figure 8. Sagittal T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The palmar ulnolunate ligament (UL) arises from the palmar radioulnar ligament (pRUL) and extends to the palmar aspect of the lunate (L) in common with the RLT ligament (black arrowheads). The dorsal ulnotriquetral ligament (dUT) arises from the dorsal radioulnar ligament (dRUL) and extends to the dorsal aspect of the triquetrum (T) to a common insertion with the dorsal radiotriquetral ligament (white arrowheads). Arrows = insertion of the RLT ligament. H = hamate, U = ulna.

View larger version (30K): [in a new window]   Figure 9. Schematic shows the dorsal radiotriquetral (1), dorsal scaphotriquetral (2), and dorsal ulnotriquetral (3) ligaments in the transverse (left) (from distal to proximal = top to bottom), sagittal (middle) (from radial to ulnar = left to right), and coronal (right) planes. C = capitate, H = hamate, L = lunate, P = pisiform, R = radius, S = scaphoid, T = triquetrum, U = ulna. The dorsal ulnotriquetral ligament attaches proximally to the dorsal radioulnar ligament and not directly onto the ulna.

View larger version (141K): [in a new window]   Figure 10a. (a) Transverse T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The RLT ligament arises from the palmar aspect of the distal radius (R) and radial styloid process (white arrowheads), extends to the palmar aspect of the lunate (L, arrow), and runs distally to the radial side of the pisotriquetral joint on the palmar aspect of the triquetrum (T, black arrowheads). The dorsal radiotriquetral (dRT) ligament arises from the dorsal aspect of the distal radius and extends over the scaphoid (S) and the lunate to insert on the dorsal aspect of the triquetrum. (b) Transverse anatomic comparison specimen. The RLT ligament arises from the palmar aspect of the distal radius (R) and radial styloid process (white arrowheads), extends to the palmar aspect of the lunate (L) and runs distally to the radial side of the pisotriquetral joint on the palmar aspect of the triquetrum (T, black arrowheads). The dorsal radiotriquetral (dRT) ligament arises from the dorsal aspect of the distal radius (black arrows) and extends over the scaphoid (S) and the lunate to insert on the dorsal aspect of the triquetrum (white arrows). LT = lunotriquetral ligament, SL = scapholunate ligament.

View larger version (146K): [in a new window]   Figure 10b. (a) Transverse T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The RLT ligament arises from the palmar aspect of the distal radius (R) and radial styloid process (white arrowheads), extends to the palmar aspect of the lunate (L, arrow), and runs distally to the radial side of the pisotriquetral joint on the palmar aspect of the triquetrum (T, black arrowheads). The dorsal radiotriquetral (dRT) ligament arises from the dorsal aspect of the distal radius and extends over the scaphoid (S) and the lunate to insert on the dorsal aspect of the triquetrum. (b) Transverse anatomic comparison specimen. The RLT ligament arises from the palmar aspect of the distal radius (R) and radial styloid process (white arrowheads), extends to the palmar aspect of the lunate (L) and runs distally to the radial side of the pisotriquetral joint on the palmar aspect of the triquetrum (T, black arrowheads). The dorsal radiotriquetral (dRT) ligament arises from the dorsal aspect of the distal radius (black arrows) and extends over the scaphoid (S) and the lunate to insert on the dorsal aspect of the triquetrum (white arrows). LT = lunotriquetral ligament, SL = scapholunate ligament.

View larger version (138K): [in a new window]   Figure 11. Coronal T1-weighted fat-saturated spin-echo (500/12) MR arthrographic image of the wrist. The radial collateral ligament arises from the tip of the radial styloid process (arrows) and extends distally to the lateral aspect of the scaphoid (S) waist (arrowheads). L = lunate, R = radius.

View larger version (156K): [in a new window]   Figure 12a. (a) Coronal T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The dorsal radiotriquetral ligament (dRT) arises from the dorsal aspect of the radius (R, arrowheads). The dorsal scaphotriquetral ligament (dST) arises from the dorsal aspect of the scaphoid (arrows) and extends perpendicularly to the long axis of the forearm to the dorsal aspect of the triquetrum (T) distal to the dorsal radiotriquetral ligament (arrowheads). C = capitate, H = hamate, Tr = trapezoid, dRUL = dorsal radioulnar ligament. (b) Transverse T1-weighted spin-echo (500/12) MR arthrographic images of the wrist. The dorsal scaphotriquetral ligament (dST) arises from the dorsal aspect of the scaphoid (S, arrows on left) and extends perpendicularly to the long axis of the forearm to the dorsal aspect of the triquetrum (T, arrows on right) distal to the dorsal radiotriquetral ligament. The proximal band of the palmar scaphotriquetral (pST) ligament extends from the palmar aspect of the scaphoid (arrowheads on left) directly to the triquetrum on the radial side of the pisotriquetral joint (arrowheads on right). C = capitate.

View larger version (149K): [in a new window]   Figure 12b. (a) Coronal T1-weighted spin-echo (500/12) MR arthrographic image of the wrist. The dorsal radiotriquetral ligament (dRT) arises from the dorsal aspect of the radius (R, arrowheads). The dorsal scaphotriquetral ligament (dST) arises from the dorsal aspect of the scaphoid (arrows) and extends perpendicularly to the long axis of the forearm to the dorsal aspect of the triquetrum (T) distal to the dorsal radiotriquetral ligament (arrowheads). C = capitate, H = hamate, Tr = trapezoid, dRUL = dorsal radioulnar ligament. (b) Transverse T1-weighted spin-echo (500/12) MR arthrographic images of the wrist. The dorsal scaphotriquetral ligament (dST) arises from the dorsal aspect of the scaphoid (S, arrows on left) and extends perpendicularly to the long axis of the forearm to the dorsal aspect of the triquetrum (T, arrows on right) distal to the dorsal radiotriquetral ligament. The proximal band of the palmar scaphotriquetral (pST) ligament extends from the palmar aspect of the scaphoid (arrowheads on left) directly to the triquetrum on the radial side of the pisotriquetral joint (arrowheads on right). C = capitate.

View larger version (83K): [in a new window]   Figure 13a. (a) Sagittal T1-weighted fat-saturated spin-echo (500/12) MR arthrographic image. The RLT ligament arises from the palmar edge (curved arrow) of the distal radius (R) and attaches widely on the palmar aspect of the lunate (L). The RSC ligament inserts in the center of the palmar aspect of the capitate (C). The dorsal radiotriquetral (dRT) ligament arises from the dorsal edge of the distal radius (straight arrows). The dorsal scaphotriquetral (dST) ligament has a thin insertion to the dorsal aspect of the lunate (arrowhead). (b) Sagittal anatomic comparison specimen. The RLT ligament arises from the palmar edge (curved arrow) of the distal radius (R) and attaches widely on the palmar aspect of the lunate (L). The RSC ligament inserts in the center (straight black arrows) of the palmar aspect of the capitate (C). The dorsal radiotriquetral (dRT) ligament arises from the dorsal edge of the distal radius (straight white arrows). The dorsal scaphotriquetral (dST) ligament has a thin insertion to the dorsal aspect of the lunate (arrowhead).

View larger version (154K): [in a new window]   Figure 13b. (a) Sagittal T1-weighted fat-saturated spin-echo (500/12) MR arthrographic image. The RLT ligament arises from the palmar edge (curved arrow) of the distal radius (R) and attaches widely on the palmar aspect of the lunate (L). The RSC ligament inserts in the center of the palmar aspect of the capitate (C). The dorsal radiotriquetral (dRT) ligament arises from the dorsal edge of the distal radius (straight arrows). The dorsal scaphotriquetral (dST) ligament has a thin insertion to the dorsal aspect of the lunate (arrowhead). (b) Sagittal anatomic comparison specimen. The RLT ligament arises from the palmar edge (curved arrow) of the distal radius (R) and attaches widely on the palmar aspect of the lunate (L). The RSC ligament inserts in the center (straight black arrows) of the palmar aspect of the capitate (C). The dorsal radiotriquetral (dRT) ligament arises from the dorsal edge of the distal radius (straight white arrows). The dorsal scaphotriquetral (dST) ligament has a thin insertion to the dorsal aspect of the lunate (arrowhead).