Carpal Instability
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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 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.
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. [1][2]
The MAYO Classification is de most widly adabted classification. [3][4]
TABLE 1
Carpal Intstabilily - Mayo Classification
| type | name | Radiographic pattern |
| CID |
1.1 Proximal row CID a. Unstable scaphoid fracture b. Scapholunate dissociation c. Lunotriquetral dissociahon 1.2 Distal carpal row CID a. Axial radial disruption b. Axial ulnar disruption c. Combined |
DISI RT,PT |
| CIND |
1.2 Radiocarpal CIND a. Ulnar MCI from palmar ligament damage |
|
| CIC |
a. Perilunate with radiocarpal instability b. Perilunate with axial instability |
DISI and UT AxUIand UT AxRland UT DISI and UT |
| Adaptive carpus | a. Malposition of carpus with distal radius malunion b. Malposition of carpus with scaphoid nonunion c. Malposition of carpus with lunate malunion d. Malposition of carpus with Madelung's deformity |
DISI or DT DISI DISI or VISI UT, DISI,PT |
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- ↑ , 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
- ↑ 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
- ↑ Garcia-Elias M: The treatment of wrist instability. Journal of Bone and Joint Surgery [Br]. 1997; 79: pg 684-690. Level of evidence: 2A
- ↑ Carlsen BT, Shin AY. Wrist instability. Scandinavian Journal of Surgery. 2008; 97: 324–332. Lever of evidence: .level of evidence 2A
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