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Fig S1: Transverse T1-weighted GRE high-field MR image obtained 1 cm distal to the carpometacarpal joint. Medial is to the left and dorsal is to the top. The margins of the suspensory ligament are poorly defined. A small proportion of the dorsomedial aspect of the suspensory ligament has similar low signal intensity to the palmar cortex of the third metacarpal bone. This should not be misinterpreted as periosteal irregularity. The fibres originating from the third carpal bone can be identified in the palmar axial aspect of the suspensory ligament as an area of lower signal intensity than the rest of the ligament (white arrow). There is an axial indentation in the palmar cortex of the third metacarpal bone (black arrow).

Fig S2: (a) Transverse T1-weighted GRE high-field MR image of the same limb as shown in Figure 1b, c and in Supporting Figures S2b–d, obtained 2 cm distal to the carpometacarpal joint, at the level indicated in Figure 1b. Medial is to the left and dorsal is to the top. The medial aspect of the palmar cortex (m) of the third metacarpal bone is thicker than the lateral aspect (l) and there is mild endosteal irregularity (black arrows). Note the fibres of the suspensory ligament originating from the fourth metacarpal bone (white arrow). These fibres have higher signal intensity than the rest of the collagenous tissue of the suspensory ligament. In the medial lobe the central area has a mixture of intermediate and high signal intensity, whilst in the lateral lobe it consists of mainly high signal intensity tissue. (b) Transverse T1-weighted GRE low-field MR image of the same limb as shown in Figures 1b,c and in Supporting Figures S2a,c,d, obtained 2 cm distal to the carpometacarpal joint, at the level indicated in Figure 1b. Medial is to the left and dorsal is to the top. The endosteal surface of the palmar cortex of the third metacarpal bone appears smooth (black arrows) (compare with Figs 1c,d). The collagenous tissue of the suspensory ligament has intermediate signal intensity, which is higher than in the corresponding high-field MR image (Fig 1c). The lateral palmar aspect of the lateral lobe has slightly higher signal intensity than the collagenous tissue of the rest of the suspensory ligament and appears to have an irregular margin (arrowheads). (c) Transverse T2*-weighted GRE low-field MR image of the same limb as shown in Figure 1b,c and in Supporting Figure S2a,b,d, obtained 2 cm distal to the carpometacarpal joint, at the level indicated in Figure 1b. Medial is to the left and dorsal is to the top. The endosteal surface of the palmar cortex of the third metacarpal bone appears smooth (black arrows) (compare with Fig 1c and Supporting Fig S2a). Note the high signal intensity between the lateral lobe of the suspensory ligament and the fibres originating from the fourth metacarpal bone (white arrow), which corresponds to synovial fluid in the palmar pouch of the carpometacarpal joint. The regions of muscle and adipose tissue are less well-defined than in high-field images. (d) Transverse T2-weighted FSE low-field MR image of the same limb as shown in Figure 1b, c and in Supporting Figure S2a-c, obtained 2 cm distal to the carpometacarpal joint, at the level indicated in Figure 1b. Medial is to the left and dorsal is to the top. The endosteal surface of the palmar cortex of the third metacarpal bone appears smooth (black arrows) (compare with Fig 1c and Supporting Fig S2a). Note the high signal intensity between the lateral lobe of the suspensory ligament and the fibres originating from the fourth metacarpal bone (white arrow), which corresponds to synovial fluid in the palmar pouch of the carpometacarpal joint. The signal intensity of the collagenous tissue is lower than in low-field GRE images. The abaxial and palmar margins of the suspensory ligament and the regions of muscle and adipose tissue are much better defined than in low-field GRE images, but it is not possible to differentiate between the palmar cortex of the third metacarpal bone and the suspensory ligament.

Fig S3: Transverse T1-weighted GRE high-field MR image obtained 5 cm distal to the carpometacarpal joint. Medial is to the left and dorsal are to the top. The muscle and adipose tissue in the suspensory ligament are more diffusely distributed within the collagenous tissue than in more proximal locations and has mixed intermediate and high signal intensity. The medial and lateral palmar metacarpal neurovascular structures (arrows) are adjacent to the abaxial aspects of the suspensory ligament and can confound interpretation of the margins.

Fig S4: Transverse T1-weighted GRE high-field MR image obtained 7 cm distal to the carpometacarpal joint. Medial is to the left and dorsal is to the top. The medial and lateral lobes of the suspensory ligament are fused. The muscle and adipose tissue have intermediate signal intensity and are more diffusely distributed compared with more proximal locations and extend to the periphery of the ligament.

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EVJ_365_sm_Supp-item-2d.tif1361KSupporting info item
EVJ_365_sm_Supp-item-3.tif4700KSupporting info item
EVJ_365_sm_Supp-item-4.tif4160KSupporting info item

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