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Carpal Instability
Carol L. Andrews, MD
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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

                                1. Ramamurthy NK et al: Imaging in carpal instability. J Hand Surg Eur Vol. 41(1):22-34, 2016
                                2. White NJ et al: Injuries of the scapholunate interosseous ligament: An Update. J Am Acad Orthop Surg. 23(11):691-703, 2015
                                3. 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
                                4. 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
                                5. 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
                                6. 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
                                7. 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
                                8. 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
                                9. Bencardino JT et al: Sports-related injuries of the wrist: an approach to MRI interpretation. Clin Sports Med. 25(3):409-32, vi, 2006
                                10. 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
                                11. 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
                                12. Cerezal L et al: Wrist MR arthrography: how, why, when. Radiol Clin North Am. 43(4):709-31, viii, 2005
                                13. Viegas SF et al: Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg Am. 20(2):312-8, 1995
                                14. Mann FA et al: Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 184(1):15-24, 1992
                                15. 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

                                    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

                                                              1. Ramamurthy NK et al: Imaging in carpal instability. J Hand Surg Eur Vol. 41(1):22-34, 2016
                                                              2. White NJ et al: Injuries of the scapholunate interosseous ligament: An Update. J Am Acad Orthop Surg. 23(11):691-703, 2015
                                                              3. 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
                                                              4. 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
                                                              5. 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
                                                              6. 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
                                                              7. 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
                                                              8. 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
                                                              9. Bencardino JT et al: Sports-related injuries of the wrist: an approach to MRI interpretation. Clin Sports Med. 25(3):409-32, vi, 2006
                                                              10. 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
                                                              11. 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
                                                              12. Cerezal L et al: Wrist MR arthrography: how, why, when. Radiol Clin North Am. 43(4):709-31, viii, 2005
                                                              13. Viegas SF et al: Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg Am. 20(2):312-8, 1995
                                                              14. Mann FA et al: Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 184(1):15-24, 1992
                                                              15. Johnson RP et al: Chronic capitolunate instability. J Bone Joint Surg Am. 68(8):1164-76, 1986