M.MANGHANI1, A. PRAKASH1, KO KONG1
Tan Tock Seng Hospital1
Ultrasound examination of the wrist is commonly conducted in patients with inflammatory arthritis to assess for synovitis. Wrist ligaments, especially the extrinsic ones arising from the radius and ulna, insert onto the carpal bones and are extremely important for wrist stability. The purpose of our study is to describe a systematic reproducible ultrasound technique to assess six functionally important ligaments and describe the status of these ligaments in patients with rheumatoid arthritis.
Using a high frequency probe, we evaluated the following ligaments in normal controls and rheumatoid arthritis patients. Our study describes the clinical anatomy and ultrasound scanning technique for the volar radioscaphocapitate, radiolunotriquetral, and short radiolunate ligaments, as well as the dorsal scapholunate, radiotriquetral and intercarpal ligaments. Imaging findings of these ligaments in normal controls and rheumatoid arthritis patients are described and compared.
Normal fibrillar pattern and thickness of the volar and dorsal ligaments was seen in the control group. In patients with rheumatoid arthritis these ligaments showed mixed echogenicity, thinning, loss of fibrillar pattern, presence of calcification and partial or complete ruptures, as depicted in the pictorial essay.
The study demonstrated that ultrasound is an excellent tool for the evaluation of superficial ligaments when standardized imaging protocol is implemented. Our results show that extrinsic wrist ligaments are thinner and less visible on ultrasound in patients affected by rheumatoid arthritis, contributing to overall wrist instability.