https://youtube.com/shorts/QjadaRb1aXM
1. Gross Anatomy Overview
The scapholunate ligament (SLL) consists of dorsal, volar, and intermediate (interosseous) components, supported by surrounding secondary stabilizers.
2. Dorsal Component
- Short, transverse collagen fibers
- Approximately 3 mm thick
- Blends with the joint capsule, scaphotriquetral, and intercarpal ligaments
- Strongest part of the SLL complex
- Primary controller of flexion/extension
- Complete tears are usually symptomatic
3. Volar Component
- Oblique collagen fibers
- Approximately 1 mm thick
- Blends with the extrinsic volar radioscapholunate ligament
- Controls rotational motion
- Plays a major proprioceptive role
4. Intermediate (Interosseous) Component
- Proximal and central; also called central or proximal component
- Fibrocartilaginous
- Sparse neurovascular supply
- Weakest part of the SLL complex
- Extends a few millimeters into the joint, resembling a meniscus-like structure
- Often asymptomatic when torn in isolation
- Classically tears at the scaphoid attachment
5. MRI Appearance: Key Points
5.1 Normal Appearance
- Dorsal and volar components of both SLL and LTL appear bandlike on axial MRI
- Typically show predominantly low signal intensity across all pulse sequences
5.2 Volar SLL Signal Characteristics
- The volar SLL often demonstrates striated, heterogeneous, increased signal, especially on GRE sequences
- This likely reflects associated loose vascular connective tissue
5.3 Critical Pitfall: RLT vs Volar SLL
- The radiolunotriquetral ligament (RLT) lies intimately over the volar SLL
- On axial images, this close relationship can mimic thickening or abnormal signal of the volar SLL
- Radiologists must avoid misinterpreting the RLT as the volar SLL
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