Dynamic Evaluation of Dorsal Scapholunate Ligament

The scapholunate ligament (SL) is one of the most clinically signicant ligaments of the wrist and unfortunately, its injuries often are not diagnosed or treated during the acute phase of injury, when direct repair of the ligament would be possible. It has three components – volar, dorsal, and interosseous. The dorsal and volar represent true ligaments, whereas the interosseous component is fibrocartilage.  All of the surgeons needs to know as much information as possible about the ligament anatomy and its relationships with other carpal structures, especially under dynamic conditions. In an interesting paper, Wrist MRI and Carpal Instability: What the Surgeon Needs to Know, and the Case for Dynamic Imaging the author closes the abstract with these words: “Providing specifics about the clinical questions that arise with various carpal instabilities serves to highlight the challenges facing current imaging technology, and provides a framework that supports the argument for the development of dynamic MRI as one-and perhaps the only-truly satisfactory solution to this problem“. I agree with him, definitely. In my daily practice I always perform both dynamic Mri and ultrasound examination; I find very attractive the study of carpal stability with dynamic Mri and ultrasound imaging. First knowing the normal appearance of carpal behaviour, then carpal instability.


Normal appearance of dorsal scapholunate ligament: Coronal Ge stir, 3D and X-bone T1w Mri scans (0.3 Tesla).


Axial and Sagittal T2w Mri scans (0.3 Tesla). Perfect allignement of the central osseus carpal chain is evident on sagittal scan.

Dynamic Mri of dorsal scapholunate ligament: radial and ulnar deviation.

See the video below and enjoy your practice!





How Much is Enough?

Taking inspiration from an interesting paper – Advances in Musculoskeletal MRI – Technical Considerations – I was asking myself: how many Tesla are needed to make a correct diagnosis of knee pathology? Recent MRI technology developments have brought new powerful systems; some radiology departments start using 3 Tesla Mri imaging systems for knee exams. But what is the real added value on musculoskeletal imaging? Not considering special techniques like spectroscopy or molecular imaging, what can I see more than a dedicated system does not reveal? I often wondered if my report would change by scanning the same patient with a 3 Tesla Mri. Three days ago a man came to my department bringing a previous 3 Tesla Mri exam: what a nice chance to reveal if there was any difference! Take a look at the comparison between 0.3, 1.5 and 3 Tesla images of the same patient; history of patellar fracture, femoro-patellar chondropathy and posterior horn medial meniscus tear. High field Mri for knee evaluation: is it always needed?