Treatment For Intasubstance Tear Of The Extensor Carpi Ulnaris Tendon

Scapholunate instability

Scapholunate instability is the most common carpal instability. It may occur after a traumatic extension injury to the wrist or result from repetitive stress, as in chronic crutch walking [65]. Weakness and pain about the dorsal radial aspect of the wrist are frequent complaints. On clinical examination, a positive scaphoid shift test may be found [66]. This result consists of a click elicited when bringing the wrist from ulnar to radial deviation while the scaphoid tuberosity is stabilized by the examiner's thumb.

The diagnostic work-up of scapholunate instability includes conventional postero-anterior (PA) and lateral radiographs of the wrist. Radiographic signs of scapholunate instability may be seen in advanced stages when the scapholu-nate and radioscaphoid ligaments are fully torn. These include (1) scapholunate interval widening of more than 3 mm on the PA view; (2) cortical ring sign, in which the scaphoid tuberosity is seen in profile; and (3) disruption of the proximal carpal arc with a step-off in the contour of the scapholunate interval. On the lateral view, a scapholunate angle of more than 70° is consistent

Ecu Tenosynovitis
Fig. 11. Partial tear of the extensor carpi ulnaris longus tendon. Axial fat-suppressed T2-weighted image shows intrasubstance longitudinal split of the ECU tendon (arrow) associated with peritendinous edema (asterisk) at the level of the ulnar styloid.

with scapholunate dissociation. Progressive instability will lead to a dorsal intercalated segment instability pattern of the wrist and, ultimately, to degenerative arthritis [65,67]. The instability is considered static if the abnormalities are noted on static radiographs of the wrist. In some cases, the instability will only become apparent on dynamic radiographic evaluation with clenched-fist PA view or cineradiography.

On MRI, direct visualization of a scapholunate ligament tear may be achieved. Complete tears are characterized by a distinct area of discontinuity within the ligament, outlined by fluid-like T2 hyperintensity, or by complete absence of the ligament (Fig. 12). Fluid signal at the attachment sites of the ligament can also be seen. On MR arthrography, complete tears are outlined by contrast material extravasating through a full-thickness defect. Widening of the scapholunate interval is seen when more than two portions of the ligament are involved. It is believed that injury and tearing of the dorsal portion of the scapholunate ligament must be present for instability to occur [68,69]. Ancillary signs include associated tears of the volar extrinsic radiocarpal ligaments, scaphoid or lunate chondromalacia, bone marrow contusions or fractures (see Fig. 12A), ganglion cysts (usually dorsal), and secondary osteoarthritis. Partial tears are characterized by focal thinning or irregularity in a portion of the ligament (Fig. 13). Partial tears more commonly affect the weaker volar ligamentous attachment [18].

MR arthrography appears to have greater sensitivity in the evaluation of partial tears than routine MRI or conventional arthrography [13,70-72]. MR ar-thrographic findings include contrast leak or imbibition into a portion of the

Ulnotriquetral Ligament Split Tear

Fig. 12. Scapholunate ligament tear. (A, B) Coronal fat-suppressed T2-weighted images demonstrate full-thickness disruption of the scapholunate ligament at its scaphoid insertion (arrow), resulting in widening of the scapholunate interval. Associated bone marrow contusions of the lunate, capitate, scaphoid, and radial styloid are present. Also noted are radial avulsion of the triangular fibrocartilage (arrowhead) and partial-thickness rupture of the dorsal intercarpal ligament (asterisk). c, capitate; l, lunate; rs, radial styloid; s, scaphoid.

Fig. 12. Scapholunate ligament tear. (A, B) Coronal fat-suppressed T2-weighted images demonstrate full-thickness disruption of the scapholunate ligament at its scaphoid insertion (arrow), resulting in widening of the scapholunate interval. Associated bone marrow contusions of the lunate, capitate, scaphoid, and radial styloid are present. Also noted are radial avulsion of the triangular fibrocartilage (arrowhead) and partial-thickness rupture of the dorsal intercarpal ligament (asterisk). c, capitate; l, lunate; rs, radial styloid; s, scaphoid.

Partial Tear Scapholunate Ligament
Fig. 13. Scapholunate ligament partial tear. Coronal fat-suppressed T2-weighted image shows a partial tear of the volar portion of the scapholunate ligament outlined by fluid (arrow).

injured scapholunate ligament. Ligamentous stretching and elongation without tear can also be seen on MR images.

Lunotriquetral instability

Disruption of the lunotriquetral ligament can be seen as a result of perilunate instability or ulnocarpal abutment. Concurrent static or dynamic patterns of midcarpal instability or volar intercalated segmental instability may also be found. The instability develops secondary to volar tilt of the lunate, along with the scaphoid, secondary to disruption of the lunate attachment to the triquetrum. MR detection of lunotriquetral ligament tears is more difficult, given the smaller size of this structure; therefore, lower sensitivity, specificity, and accuracy have been found as compared with arthroscopy and surgery [13,73].

Triangular fibrocartilage complex

Tears of the TFCC manifest clinically with ulnar-sided wrist pain and tenderness. On physical examination, an audible click or pain may be elicited with rotation of the forearm. Palmer and Werner [15] divided TFCC tears into traumatic and degenerative types. Traumatic tears include central perforation, ul-nar avulsion with or without distal ulnar fracture, distal avulsion, and radial avulsion with or without sigmoid notch fracture [15]. Central perforations typically occur 2 to 3 mm medial to the radial insertion site of the TFCC. Unstable ulnar avulsions may be associated with fractures of the ulnar styloid (Fig. 14). Distal avulsion of the TFCC at the insertion into the lunate or triquetrum is indicative of a tear of the ulnolunate or ulnotriquetral ligament or both. Radial avulsion of the TFCC occurs at the distal aspect of the sigmoid notch and may be associated with a radial fracture (Fig. 15). Degenerative tears of the TFCC are part of the spectrum of ulnocarpal abutment syndrome.

On MRI, partial tears of the TFCC can be depicted as fluid-signal intensity on T2-weighted images extending only to one articular surface, more frequently to the proximal articulating surface with the DRUf [13]. Full-thickness

Triquetrum Avulsion Fracture Treatment

Fig. 14. Ulnar avulsion of the triangular fibrocartilage. (A) Axial fat-suppressed T2-weighted image demonstrates complete avulsion of the volar radioulnar ligament (arrowhead) outlined by fluid (asterisk) in this patient with distal radial fracture. (B) Sagittal Tl-weighted image shows dorsal subluxation of the distal ulna. R, radius; tfc, triangular fibrocartilage; U, ulna.

defects can be outlined either by joint fluid or intra-articular contrast material. No specific MR signs help to differentiate traumatic from degenerative tears. The age of the patient, location of the tear, and presence of associated lesions such as bruises or fractures may help in this regard. The location of the injury should always be reported. Tears located in the periphery have better blood supply and may be treated with primary repair. By contrast, central lesions are avascular and are treated with debridement.

Fig. 15. Radial avulsion of the triangular fibrocartilage. Coronal gradient echo T2*-weighted image shows complete avulsion of the triangular fibrocartilage (asterisk) from its attachment to the radius at the distal aspect of the sigmoid notch (arrow). Fluid outlines loss of cartilage along the articulating surfaces of the lunate and distal radius (white arrowheads) in keeping with secondary osteoarthritis and probable abutment. Scapholunate ligament indicated by black arrowhead.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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Responses

  • Jonathan
    What is t2 hyperintensity of the arm tendon?
    6 years ago
  • roope
    What is intrasubstance tear of the extensor carpi ulnaris tendon?
    6 years ago
  • tanja kluge
    How to read scapholunate tear mri?
    6 years ago
  • Elisa
    What is partial tear extensor carpi ulnaris?
    5 years ago
  • ANNI
    How to treat partial ulnaris carpi tendon tear?
    5 years ago
  • alix
    What is an intrasubstance tear of the common extensor tendon?
    5 years ago
  • bethan
    How to fix a split tear of the extensor carpi ulnaris?
    4 years ago
  • andrew
    What is an intrasubstance fracture?
    4 years ago
  • Hilda
    What is partial thickness tear of the extensor carpi ulnaris tendon?
    3 years ago
  • richard
    What is a subtle intrasubstance partial tear of the ECU?
    3 years ago
  • Henrik
    How to treat a split of the extensorcarpi ulnaris?
    3 years ago
  • jessica
    WHAT treatment is USED FOR tear of the extensor carpi ulnaris tendon.?
    3 years ago
  • Patricia
    How to treat a partial tear of the extensor tendon?
    2 years ago
  • Mikko
    Can one fix a lunate abutment?
    1 year ago
  • olavi
    How to treat a torn extensor carpi ulnaris tendon?
    1 year ago

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