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Volar capitohamate ligament

The volar (palmar) capitohamate ligament is a strong fibrous band connecting the capitate and hamate bones on the palmar aspect of the wrist. It is part of the intercarpal ligament complex that stabilizes the distal carpal row and maintains the integrity of the capitohamate joint, a key articulation in carpal stability and motion.

The ligament contributes to load transmission between the central and ulnar carpal columns, preventing abnormal translation between the capitate and hamate bones during wrist flexion and extension. A corresponding dorsal capitohamate ligament reinforces the dorsal aspect of this articulation, together ensuring multidirectional stability.

Synonyms

  • Palmar capitohamate ligament

  • Capitohamate interosseous ligament (palmar and dorsal portions)

  • Capitohamate joint capsule reinforcement

Location and Structure

  • Situated on the palmar surface of the midcarpal joint.

  • Extends from the volar surface of the capitate (distal aspect) to the volar surface of the hamate (proximal aspect).

  • Fibers are short, thick, and obliquely oriented from radial-proximal to ulnar-distal direction.

  • Composed of dense collagenous connective tissue interlaced with fibrocartilaginous fibers at bony insertions.

  • Lies deep to the palmar radiocarpal ligament and superficial to the joint capsule.

Attachments

  • Proximal attachment: Volar aspect of the capitate, near its distal neck.

  • Distal attachment: Volar aspect of the hamate, at the junction of its body and hook.

  • Merges medially with the volar triquetrohamate ligament and laterally with the volar capitotrapezoid ligament, forming part of the volar midcarpal ligament complex.

  • Closely related to the palmar capsule of the capitohamate joint and flexor tendons anteriorly.

Relations

  • Anteriorly: Flexor tendons and deep layer of palmar fascia.

  • Posteriorly: Capitohamate joint capsule and midcarpal joint cavity.

  • Laterally: Volar capitotrapezoid ligament.

  • Medially: Volar triquetrohamate ligament and hook of hamate.

Function

  • Joint stabilization: Maintains alignment between the capitate and hamate, reinforcing the volar aspect of the midcarpal joint.

  • Force transmission: Transfers compressive and torsional loads from the capitate (central carpal axis) to the hamate during wrist motion.

  • Support of carpal arch: Contributes to maintaining the curvature of the distal carpal row and prevents carpal collapse.

  • Dynamic balance: Acts with adjacent volar ligaments to limit excessive hyperextension or translation at the capitohamate articulation.

Clinical Significance

  • Ligament injury: Rarely isolated; usually occurs with midcarpal instability or perilunate dislocations.

  • Degeneration: May result from chronic repetitive loading or early carpal osteoarthritis.

  • Surgical relevance: Important during midcarpal arthroscopy, partial wrist fusion, and capitohamate arthrodesis procedures.

  • Instability: Damage may cause capitohamate subluxation or contribute to carpal instability non-dissociative (CIND) patterns.

  • Imaging role: MRI and CT arthrography are key for direct visualization of ligament integrity and associated midcarpal pathology.

MRI Appearance

  • T1-weighted images:

    • Ligament appears as a thin, low-signal (dark) band connecting capitate and hamate.

    • Adjacent bone marrow: bright signal due to fatty content.

    • Partial tears: focal discontinuity or thickening with intermediate signal.

    • Periligamentous fat is bright, helping delineation.

  • T2-weighted images:

    • Normal ligament: low signal intensity, darker than surrounding soft tissues.

    • Pathology: bright hyperintense areas or irregular thickening indicating edema, strain, or partial tear.

    • Joint fluid: hyperintense, highlighting ligament margins.

  • STIR:

    • Normal: dark, low signal band.

    • Pathologic: bright periligamentous hyperintensity in sprain or inflammation.

  • Proton Density Fat-Saturated (PD FS):

    • Normal: uniformly dark ligament.

    • Tear or inflammation: focal or diffuse bright signal within ligament or surrounding soft tissue.

    • Useful for identifying partial tears and subtle capsular disruptions.

  • T1 Fat-Sat Post-Contrast:

    • Normal ligament: minimal to no enhancement.

    • Inflamed or torn ligament: peripheral or linear enhancement due to synovitis or granulation tissue.

    • Chronic fibrosis: low signal, non-enhancing thickened band.

MRI Arthrography Appearance

  • Contrast fills the midcarpal joint space, outlining the volar and dorsal capitohamate ligaments.

  • Normal: Both ligaments appear as intact low-signal bands separating contrast-filled spaces.

  • Tear: Contrast extends across or beneath the ligament, indicating discontinuity or perforation.

  • Capsular laxity: Excessive joint distension with intact but elongated ligament.

  • Provides high accuracy in differentiating partial vs complete tears.

CT Appearance

Non-Contrast CT:

  • Ligament not directly visible due to low contrast with surrounding soft tissue.

  • Bony landmarks (capitate and hamate articular margins) well defined.

  • Indirect signs: joint space widening, subtle subchondral sclerosis, or small avulsion fragments in trauma.

Post-Contrast CT (standard):

  • Ligament remains faintly visualized as a soft-tissue band.

  • Capsular thickening or pericapsular enhancement may indicate inflammation.

CT Arthrography Appearance

  • Contrast delineates the midcarpal joint cavity, clearly outlining the capitohamate ligaments.

  • Normal: Ligament appears as a fine non-opacified low-density band between contrast-filled compartments.

  • Tear or defect: Contrast extravasates across or beneath the ligament, forming irregular bright clefts.

  • Chronic degeneration: Thickened, irregular, or partially calcified band with adjacent joint irregularity.

  • Best for visualizing intra-articular pathology and capsular-ligamentous continuity in carpal instability.

MRI image

MRI image

Volar capitohamate ligament axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000