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Instructional Course Lecture   |    
Carpal Instability*†
Richard H. Gelberman, M.D.‡; William P. CooneyIII, M.D.§; Robert M. Szabo, M.D, M.P.H.#
View Disclosures and Other Information
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
†Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2001 in Instructional Course Lectures, Volume 50. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
‡Department of Orthopaedic Surgery, Barnes-Jewish Hospital at Washington University, One Barnes Plaza, Suite 11300, St. Louis, Missouri 63110. E-mail address: gelbermanr@msnotes.wustl.edu.
§Department of Orthopaedic Surgery, Mayo Graduate School of Medicine, 1085 Orchard Acres Lane S.W., Rochester, Minnesota 55902. E-mail address: cooney.william@mayo.edu.
#Division of Plastic Surgery, Department of Surgery, University of California, Davis, School of Medicine, 4860 Y Street, Sacramento, California 95817. E-mail address: rmszabo@ucdavis.edu.

J Bone Joint Surg Am, 2000 Apr 01;82(4):578-578
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Extract

The intracapsular ligaments of the wrist are divided into intrinsic and extrinsic components1-9. The two most important intrinsic (interosseous) ligaments, the scapholunate and lunotriquetral ligaments, are divided into dorsal, proximal, and palmar regions (Fig. 1)1,10. The thickest and strongest region of the scapholunate ligament is located dorsally10, and that of the lunotriquetral ligament is located palmarly10.There are three strong palmar extrinsic radiocarpal ligaments: the radioscaphocapitate, long radiolunate, and short radiolunate ligaments2. The radioscaphocapitate ligament, which extends from the radial styloid process through a groove in the waist of the scaphoid to the palmar aspect of the capitate, acts as a fulcrum around which the scaphoid rotates (Fig. 2). The long radiolunate ligament, which lies parallel to the radioscaphocapitate ligament, extends from the palmar rim of the distal part of the radius to the radial margin of the palmar horn of the lunate. The long radiolunate ligament and the palmar region of the lunotriquetral interosseous ligament, thought to be in continuity in earlier studies, were previously labeled the radiotriquetral ligament7. Located between the radioscaphocapitate and long radiolunate ligaments, at the level of the midcarpal joint, is an area of capsular weakness known as the space of Poirier. The short radiolunate ligament, which is contiguous with palmar fibers of the triangular fibrocartilage complex, originates from the palmar margin of the distal part of the radius and inserts into the proximal part of the palmar surface of the lunate. The radioscapholunate ligament (the ligament of Testut), previously thought to be an important stabilizer of the scaphoid, is now considered to be a neurovascular pedicle derived from the anterior interosseous and radial arteries and from the anterior interosseous nerve3. The ulnolunate and ulnotriquetral ligaments arise from the volar edge of the triangular fibrocartilage and insert into the lunate and the triquetrum, respectively. The dorsal radiocarpal ligament originates from the dorsal margin of the distal part of the radius and extends ulnarly and distally to attach to the lunate, the lunotriquetral interosseous ligament, and the dorsal tubercle of the triquetrum (Fig. 3)11. The dorsal intercarpal ligament originates from the triquetrum and extends radially to insert into the lunate, the dorsal groove of the scaphoid, and the trapezium11.
Figures in this Article
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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