Wrist Capsular Ligament Case Study

Ligaments connect bones together and are made up of grossly parallel, fibrous, dense connective tissue.1 Many ligaments are parts of anatomically inseparable structures known as joint capsules, and this is certainly the case with the wrist. Ligaments often have a more vascular overlying layer termed the "epiligament" covering their surface. This layer is often indistinguishable from the actual ligament and merges into the periosteum of the bone around the attachment sites of the ligament.7 Removal of the epiligament exposes the fibrous architecture of the ligament which is further organized hierarchically into groups of parallel fibers known as bundles. These bundles are difficult to separate suggesting that they are interconnected in some …show more content…
In the adult patient with a distal radius fracture, the event that resulted in a fracture may also have created a high level of strain to the wrist capsular ligaments, and may have resulted in sprain injuries to one or more of those ligaments. The six week period of immobilization is consistent with a prolonged low stress/activity level for the capsular ligaments of the wrist which results in decreased cross-sectional area, decreased stiffness and decreased strength of the ligaments.3 Removal of loading leads to degradation of the extra-cellular matrix and disruption of collagen fiber alignment and cross-linking.8 Changes in structural properties reflect both geometric and material property changes. Ligaments adapt to increased or decreased mechanical loading by adjusting their size, their material properties, or both.8 Joint immobilization causes a rapid deteriorization in ligament biochemical and mechanical properties, partially because of atrophy, which causes a net loss of ligament strength and stiffness.1 Immobility causes ligaments to shift from a maintenance state to a catabolic state, where only a few weeks of immobilization causes the ligament matrix to decrease in quantity.1 Studies also indicate that during this period the quality of the matrix also is reduced, further supporting the PST. The resorption of bone causes even …show more content…
Some studies suggest that changes to the capsule are the result of a high rate of joint capsule matrix turnover resulting from trauma and the ensuing immobilization.9 The cause of capsulitis is often unknown but the impact on function can be great and requires post-immobilization