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Carpal Instability
Kambiz Motamedi, MD, FACR; Carol L. Andrews, MD; Kirkland W. Davis, MD, FACR
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KEY FACTS

  • Imaging

    • Pathology

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Carpal instability dissociative (CID)
          • Carpal instability nondissociative (CIND)
          • Capitolunate instability pattern (CLIP)
          • Dorsal intercalated segmental instability (DISI)
          • Lunotriquetral ligament (LTL)
          • Midcarpal instability (MCI)
          • Palmar midcarpal instability (PMCI)
          • Perilunate instability (PLI)
          • Scaphoid nonunion advanced collapse (SNAC)
          • Scapholunate advanced collapse (SLAC)
          • Scapholunate ligament (SLL)
          • Volar intercalated segmental instability (VISI)
        • Definitions

          • Instability: inability to withstand normal loading
          • Static instability: visible on images at rest/neutral
          • Dynamic instability: requires motion (fluoroscopy) or force (clenched fist, deviation) to be detected
          • Translocation: shift of entire carpus from normal position relative to radius
          • Dissociation: abnormal motion between bones within same carpal row, often in association with interruption of corresponding interosseous ligament
          • Intercalated segment instability: instability between carpal rows; in particular, alignment between lunate and capitate

        IMAGING

        • General Features

          • Radiographic Findings

            • Fluoroscopic Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  Selected References

                                  1. Grunz JP et al: Imaging of carpal instabilities. Rofo. 193(2):139-50, 2021
                                  2. Kani KK et al: Understanding carpal instability: a radiographic perspective. Skeletal Radiol. 45(8):1031-43, 2016
                                  3. Ramamurthy NK et al: Imaging in carpal instability. J Hand Surg Eur Vol. 41(1):22-34, 2016
                                  4. White NJ et al: Injuries of the scapholunate interosseous ligament: an update. J Am Acad Orthop Surg. 23(11):691-703, 2015
                                  5. Chennagiri RJ et al: Assessment of scapholunate instability and review of evidence for management in the absence of arthritis. J Hand Surg Eur Vol. 38(7):727-38, 2013
                                  6. Patterson RM et al: Prediction of ligament length and carpal diastasis during wrist flexion-extension and after simulated scapholunate instability. J Hand Surg Am. 38(3):509-18, 2013
                                  7. Bunker DL et al: Radiographic signs of static carpal instability with distal end radius fractures: is current treatment adequate? Hand Surg. 17(3):325-30, 2012
                                  8. Gheno R et al: Differences between radial and ulnar deviation of the wrist in the study of the intrinsic intercarpal ligaments: magnetic resonance imaging and gross anatomic inspection in cadavers. Skeletal Radiol. 39(8):799-805, 2009
                                  9. Magee T: Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol. 192(1):80-5, 2009
                                  10. Chang W et al: Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study. Skeletal Radiol. 36(7):641-5, 2007
                                  11. Bencardino JT et al: Sports-related injuries of the wrist: an approach to MRI interpretation. Clin Sports Med. 25(3):409-32, vi, 2006
                                  12. Kaufmann RA et al: Kinematics of the midcarpal and radiocarpal joint in flexion and extension: an in vitro study. J Hand Surg [Am]. 31(7):1142-8, 2006
                                  13. Theumann NH et al: Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations. Radiology. 238(3):950-7, 2006
                                  14. Cerezal L et al: Wrist MR arthrography: how, why, when. Radiol Clin North Am. 43(4):709-31, viii, 2005
                                  15. Viegas SF et al: Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg Am. 20(2):312-8, 1995
                                  16. Mann FA et al: Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 184(1):15-24, 1992
                                  17. Johnson RP et al: Chronic capitolunate instability. J Bone Joint Surg Am. 68(8):1164-76, 1986
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Imaging

                                    • Pathology

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Abbreviations

                                          • Carpal instability dissociative (CID)
                                          • Carpal instability nondissociative (CIND)
                                          • Capitolunate instability pattern (CLIP)
                                          • Dorsal intercalated segmental instability (DISI)
                                          • Lunotriquetral ligament (LTL)
                                          • Midcarpal instability (MCI)
                                          • Palmar midcarpal instability (PMCI)
                                          • Perilunate instability (PLI)
                                          • Scaphoid nonunion advanced collapse (SNAC)
                                          • Scapholunate advanced collapse (SLAC)
                                          • Scapholunate ligament (SLL)
                                          • Volar intercalated segmental instability (VISI)
                                        • Definitions

                                          • Instability: inability to withstand normal loading
                                          • Static instability: visible on images at rest/neutral
                                          • Dynamic instability: requires motion (fluoroscopy) or force (clenched fist, deviation) to be detected
                                          • Translocation: shift of entire carpus from normal position relative to radius
                                          • Dissociation: abnormal motion between bones within same carpal row, often in association with interruption of corresponding interosseous ligament
                                          • Intercalated segment instability: instability between carpal rows; in particular, alignment between lunate and capitate

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • Fluoroscopic Findings

                                              • MR Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Staging, Grading, & Classification

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  Selected References

                                                                  1. Grunz JP et al: Imaging of carpal instabilities. Rofo. 193(2):139-50, 2021
                                                                  2. Kani KK et al: Understanding carpal instability: a radiographic perspective. Skeletal Radiol. 45(8):1031-43, 2016
                                                                  3. Ramamurthy NK et al: Imaging in carpal instability. J Hand Surg Eur Vol. 41(1):22-34, 2016
                                                                  4. White NJ et al: Injuries of the scapholunate interosseous ligament: an update. J Am Acad Orthop Surg. 23(11):691-703, 2015
                                                                  5. Chennagiri RJ et al: Assessment of scapholunate instability and review of evidence for management in the absence of arthritis. J Hand Surg Eur Vol. 38(7):727-38, 2013
                                                                  6. Patterson RM et al: Prediction of ligament length and carpal diastasis during wrist flexion-extension and after simulated scapholunate instability. J Hand Surg Am. 38(3):509-18, 2013
                                                                  7. Bunker DL et al: Radiographic signs of static carpal instability with distal end radius fractures: is current treatment adequate? Hand Surg. 17(3):325-30, 2012
                                                                  8. Gheno R et al: Differences between radial and ulnar deviation of the wrist in the study of the intrinsic intercarpal ligaments: magnetic resonance imaging and gross anatomic inspection in cadavers. Skeletal Radiol. 39(8):799-805, 2009
                                                                  9. Magee T: Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roentgenol. 192(1):80-5, 2009
                                                                  10. Chang W et al: Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study. Skeletal Radiol. 36(7):641-5, 2007
                                                                  11. Bencardino JT et al: Sports-related injuries of the wrist: an approach to MRI interpretation. Clin Sports Med. 25(3):409-32, vi, 2006
                                                                  12. Kaufmann RA et al: Kinematics of the midcarpal and radiocarpal joint in flexion and extension: an in vitro study. J Hand Surg [Am]. 31(7):1142-8, 2006
                                                                  13. Theumann NH et al: Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations. Radiology. 238(3):950-7, 2006
                                                                  14. Cerezal L et al: Wrist MR arthrography: how, why, when. Radiol Clin North Am. 43(4):709-31, viii, 2005
                                                                  15. Viegas SF et al: Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg Am. 20(2):312-8, 1995
                                                                  16. Mann FA et al: Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 184(1):15-24, 1992
                                                                  17. Johnson RP et al: Chronic capitolunate instability. J Bone Joint Surg Am. 68(8):1164-76, 1986