A Method of Defining Palpable Landmarks for the Ligament-Splitting Dorsal Wrist Capsulotomy

Purpose The concept of a ligament-splitting dorsal capsulotomy of the wrist has been defined and has been shown to have practical applications. Due to the abundance of peritendinous tissue, however, the ligaments are often difficult to visualize. This article presents a method of defining incision capsular lines based on reliably palpable landmarks. Methods The palpable landmarks include the sulcus between the scaphoid and trapezoid, the dorsal tubercle of the triquetrum, and the midpoint between Lister’s tubercle and the dorsal rim of the sigmoid notch. These points identify the bisection lines of the dorsal intercarpal and dorsal radiocarpal ligaments. A radial-based capsulotomy can be easily elevated by incising the dorsal wrist joint capsule using these landmarks and then extending the incision along the dorsal rim of the distal radius to the radial styloid process. Results This method of defining capsular incision lines based on palpable landmarks was used on 253 consecutive dorsal wrist arthrotomies with excellent exposure, accurate splitting of the dorsal radiocarpal and intercarpal ligaments, and no complications. Conclusions Using specific, palpable landmarks on the dorsal wrist, an accurate estimation of the locations and courses of the dorsal radiocarpal and intercarpal ligaments can be reliably made. Even when poorly visualized, these ligaments can be split longitudinally in a reliable fashion to create a standard, ligament-sparing dorsal capsulotomy.