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KEY FACTS
Imaging
Pathology
TERMINOLOGY
Abbreviations
- Carpal instability dissociative (CID)
- Carpal instability nondissociative (CIND)
- Capitolunate instability pattern (CLIP)
- Dorsiflexion instability, dorsal intercalated segmental instability (DISI)
- Lunotriquetral ligament (LTL)
- Perilunate instability (PLI)
- Midcarpal instability (MCI)
- Palmar midcarpal instability (PMCI)
- Scapholunate advanced collapse (SLAC)
- Scapholunate ligament (SLL)
- Scaphoid nonunion advanced collapse (SNAC)
- Volar flexion instability, 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 (particular focus on alignment between lunate & 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
- Ramamurthy NK et al: Imaging in carpal instability. J Hand Surg Eur Vol. 41(1):22-34, 2016
- White NJ et al: Injuries of the scapholunate interosseous ligament: An Update. J Am Acad Orthop Surg. 23(11):691-703, 2015
- 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
- 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
- Patterson RM et al: Prediction of ligament length and carpal diastasis during wrist flexion-extension and after simulated scapholunate instability. J Hand Surg Am. 2013 Mar;38(3):509-18. doi: 10.1016/j. jhsa. PubMed Central PMCID: PMC3583201, 2012
- 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
- 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
- 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
- Bencardino JT et al: Sports-related injuries of the wrist: an approach to MRI interpretation. Clin Sports Med. 25(3):409-32, vi, 2006
- 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
- 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
- Cerezal L et al: Wrist MR arthrography: how, why, when. Radiol Clin North Am. 43(4):709-31, viii, 2005
- Viegas SF et al: Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg Am. 20(2):312-8, 1995
- Mann FA et al: Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 184(1):15-24, 1992
- Johnson RP et al: Chronic capitolunate instability. J Bone Joint Surg Am. 68(8):1164-76, 1986
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References
Tables
Tables
KEY FACTS
Imaging
Pathology
TERMINOLOGY
Abbreviations
- Carpal instability dissociative (CID)
- Carpal instability nondissociative (CIND)
- Capitolunate instability pattern (CLIP)
- Dorsiflexion instability, dorsal intercalated segmental instability (DISI)
- Lunotriquetral ligament (LTL)
- Perilunate instability (PLI)
- Midcarpal instability (MCI)
- Palmar midcarpal instability (PMCI)
- Scapholunate advanced collapse (SLAC)
- Scapholunate ligament (SLL)
- Scaphoid nonunion advanced collapse (SNAC)
- Volar flexion instability, 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 (particular focus on alignment between lunate & 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
- Ramamurthy NK et al: Imaging in carpal instability. J Hand Surg Eur Vol. 41(1):22-34, 2016
- White NJ et al: Injuries of the scapholunate interosseous ligament: An Update. J Am Acad Orthop Surg. 23(11):691-703, 2015
- 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
- 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
- Patterson RM et al: Prediction of ligament length and carpal diastasis during wrist flexion-extension and after simulated scapholunate instability. J Hand Surg Am. 2013 Mar;38(3):509-18. doi: 10.1016/j. jhsa. PubMed Central PMCID: PMC3583201, 2012
- 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
- 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
- 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
- Bencardino JT et al: Sports-related injuries of the wrist: an approach to MRI interpretation. Clin Sports Med. 25(3):409-32, vi, 2006
- 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
- 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
- Cerezal L et al: Wrist MR arthrography: how, why, when. Radiol Clin North Am. 43(4):709-31, viii, 2005
- Viegas SF et al: Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg Am. 20(2):312-8, 1995
- Mann FA et al: Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 184(1):15-24, 1992
- Johnson RP et al: Chronic capitolunate instability. J Bone Joint Surg Am. 68(8):1164-76, 1986
