Carpal Instability: Difference between revisions

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== Definition/Description ==
== Definition/Description &nbsp;<br> ==


Carpal instability Is defined as an injury where there is a loss of normal alignment of the carpal bones and/ or the radioulnair joint. This lose is mostly caused by an traumatic event, the trauma causes ligamentous injuries that lead to misalignments of the joint surfaces, or badly healed fractures with consequent articular incongruence, This loss can also be caused by chronic ligament weakening. <br>The patients suffers from a disturbed grip strength, the wrist may feel weak and stiff .The patients experience a snapping sensation or hear a clicking noise when they move their hand from ulnar to radial. Carpal instability can cause ongoing pain in your wrist and over time, your hand may develop arthritis. <ref name="Trail IA et al.">, Stanly JK, Hayton MJ. Twenty questions on carpal instability. Journal of hand surgery. 3 JUNE 2007; 32: pg 240-255. Level of evidence: 2 A</ref><ref name="Winkel D et al ">Winkel D, Wyffels P, Martens M. Aandoeningen van het kapsel-bandapparaat 1. Orthopedische geneeskunde: onderzoek diagnostiek en behandeling van de extremiteiten, 1e druk, Bohn Stafleu van Loghum, 1995. Pg 129-131 .Level of evidence: 5</ref>
Carpal instability is defined as an injury where there is a loss of normal alignment of the carpal bones and/ or the radioulnar joint. The loss creates a disturbance of the normal balance of the carpal- and radioulnar joints which results in changes to the range of motion. If undiagnosed, carpal instability can lead to progressive limitation of movement, and later to degenerative intercarpal and radiocarpal arthritis, chronic pain and disability.. [6,14] [LoE: 5, 5]


The MAYO Classification is de most widly adabted classification. <ref name="Garcia-Elias M">Garcia-Elias M: The treatment of wrist instability. Journal of Bone and Joint Surgery [Br]. 1997; 79: pg 684-690. Level of evidence: 2A</ref><ref name="Carlsen BT et al ">Carlsen BT, Shin AY. Wrist instability. Scandinavian Journal of Surgery. 2008; 97: 324–332. Lever of evidence: .level of evidence 2A</ref><br>TABLE 1 <br>Carpal Intstabilily - Mayo Classification <br>
<br>A traumatic event is often at the origin of carpal injury: the trauma causes ligamentous injuries that lead to misalignments of the joint surfaces, or badly healed fractures with consequent articular incongruence. Chronic ligament weakening can also lead to carpal instability in certain cases. [1,2,7] [LoE: 2A, 5, 5]


<br>
Carpal instability can be classified in different ways depending on the nature of the instability, its location and its origin. Ligament lesions are frequent in a young population. Resulting from high-energy injuries they principally include perilunate dislocation and scapholunate dissociation (resulting from a fall on an outstretched hand, with wrist in hyperextension and forearm pronated). (see: Scapholunate Dissocation). On the other hand, degenerative lesions are more common in elderly patients. These lesions are related to pathologies such as chondrocalcinosis, rheumatoid arthritis and other rheumatisms. [21] [LoE: 2A]<br>The main problem with carpal ligament lesions and fractures is the high potential for arthritis. [21] [LoE: 2A]<br>
 
{| style="width: 471px; height: 251px" border="1" cellspacing="1" cellpadding="1" width="471"
|-
| type
| name
| Radiographic pattern <br>
|-
| CID <br>
| 1.1 Proximal row CID <br>a. Unstable scaphoid fracture <br>b. Scapholunate dissociation <br>c. Lunotriquetral dissociahon <br>1.2 Distal carpal row CID <br>a. Axial radial disruption <br>b. Axial ulnar disruption <br>c. Combined <br>
|
DISI <br>DISI <br>VISI <br>
 
RT,PT <br>UT,PT <br>
 
|-
| CIND <br>
|
1.2 Radiocarpal CIND <br>a. Palmar ligament rupture <br>b. Dorsalligament rupture <br>c. After "radius malunion," Madehmg's defonnity, scaphoid <br>malunion, luna te malunion (see "Adaptive carpus" below) <br>2.2 Midcarpal CIND
 
a. Ulnar MCI from palmar ligament damage <br>b. Radial MCI from palmar ligament damage <br>c. Combined UMCI and RMCI, palmar ligament damage <br>d. MCI from dorsalligament damage <br>2.3 Combined radiocarpal-midcarpal CIND <br>a. CLIP <br>b. Disruption of radial and centralligaments
 
|
<br>
 
<br>
 
<br>
 
<br>
 
<br>
 
<br>
 
<br>
 
<br>VISI <br>VISi<br>VISI <br>DISi <br>VISI, DISI, alternating <br>UT with or without VISI or DISI <br><br><br>
 
|-
| CIC <br>
|
a. Perilunate with radiocarpal instability
 
b. Perilunate with axial instability <br>c. Radiocarpal with axial instability <br>d. Scapholunate dissociation with UT <br>
 
| DISI and UT <br>AxUIand UT <br>AxRland UT <br>DISI and UT <br>
|-
| Adaptive carpus
| a. Malposition of carpus with distal radius malunion <br>b. Malposition of carpus with scaphoid nonunion <br>c. Malposition of carpus with lunate malunion <br>d. Malposition of carpus with Madelung's deformity
| DISI or DT <br>DISI <br>DISI or VISI <br>UT, DISI,PT
|}


== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==

Revision as of 17:48, 12 June 2016

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Definition/Description  
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Carpal instability is defined as an injury where there is a loss of normal alignment of the carpal bones and/ or the radioulnar joint. The loss creates a disturbance of the normal balance of the carpal- and radioulnar joints which results in changes to the range of motion. If undiagnosed, carpal instability can lead to progressive limitation of movement, and later to degenerative intercarpal and radiocarpal arthritis, chronic pain and disability.. [6,14] [LoE: 5, 5]


A traumatic event is often at the origin of carpal injury: the trauma causes ligamentous injuries that lead to misalignments of the joint surfaces, or badly healed fractures with consequent articular incongruence. Chronic ligament weakening can also lead to carpal instability in certain cases. [1,2,7] [LoE: 2A, 5, 5]

Carpal instability can be classified in different ways depending on the nature of the instability, its location and its origin. Ligament lesions are frequent in a young population. Resulting from high-energy injuries they principally include perilunate dislocation and scapholunate dissociation (resulting from a fall on an outstretched hand, with wrist in hyperextension and forearm pronated). (see: Scapholunate Dissocation). On the other hand, degenerative lesions are more common in elderly patients. These lesions are related to pathologies such as chondrocalcinosis, rheumatoid arthritis and other rheumatisms. [21] [LoE: 2A]
The main problem with carpal ligament lesions and fractures is the high potential for arthritis. [21] [LoE: 2A]

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