PubMed · 8201204
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L B Lane. 1994. The scaphoid shift test.. https://doi.org/10.1016/0363-5023(94)90029-9
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BACKGROUND: Many studies have been published on the development of the human wrist joint, but scant attention has been given to the development of the wrist joint ligaments. Moreover, traditional description of wrist anatomy usually depict only the superficial capsular fibers of the wrist joint. The only ligamentous structure to receive much attention is the articular disc of the wrist joint, which has been described as a fibrocartilaginous structure extending from the medial edge of the lower end of the radius to the ulnar styloid process. METHODS: In the present report, we synthesize our observations in the wrist joint ligaments in 35 serially sectioned human embryonic and fetal hands (16 embryos and 19 fetuses). RESULTS: The interosseous intercarpal ligaments are organized from the mesenchyme, which, until O'Rahilly's stage 23, fills the intercarpal spaces. These ligaments are not individually distinguishable until the 9th week of development. The collateral ligaments begin to form in O'Rahillys's stage 22 and are completely formed by the end of week 10. The palmar radiocarpal and ulnocarpal ligaments (beginning with the palmar radiocarpal ligament) begin to form in O'Rahilly's stage 23 and are fully developed by the end of week 10. At this time, development of the dorsal radiocarpal ligament begins; this process is completed by the end of week 13. The articular disc which is initially formed of a single element, first appears in O'Rahilly's stage 23 and its organization is completed at week 10 of development. CONCLUSIONS: We establish the morphogenetic time-table of the wrist joint ligaments. Our descriptive findings may help explain carpal motion and the origin of wrist injuries.
The general principles of judging wrist injuries are discussed. Carefully made standard views will provide recognizable projections of carpal bones in order to judge abnormal positions. Additional views, conventional tomography and CT scans are, in some instances, necessary to diagnose fractures. For ligamentous damage resulting in carpal instability, fluoroscopy of the wrist and/or an arthrogram should be obtained. Examples of difficult pathology are shown and variations or more or less borderline pathology as coincidental findings are discussed. The main pitfalls are: wrong diagnosis made on inappropriately taken radiographs; misinterpretation of carpal bone relationships; and overestimation of some arthrographically found abnormalities.
In a prospective study of 80 operations in 61 patients for carpal tunnel syndrome, special attention was given to the course of the thenar motor branch and its variations. An anomalous origin of the branch was found in 21%. Multiple motor branches occurred in 12.5%. Seventeen patients had operations on both hands, but anomalies were often found in one side only. Special attention is drawn to an additional anomaly where the motor branch lies superficially to the retinaculum buried in a hypertrophic preligamentous muscle. If this anomaly is not borne in mind, the nerve can easily be injured during splitting of the flexor retinaculum. We found this variation in 9% of our patients, but it is rarely mentioned in the literature and in many large series it is not described at all.