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Carpal Instability

Scapholunate Dissociation


Presentation

  • CONCLUSIONS: Patients with STT arthritis may present with carpal instability that is not related to radiographic scapholunate instability.[ncbi.nlm.nih.gov]
Hunting
  • Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine Thomas R Hunt III, MD is a member of the following medical societies: American Orthopaedic Association , American Orthopaedic Society[emedicine.medscape.com]
Aspiration
  • Aspiration: intra-articular blood or fat droplets may represent an intra-articular fracture or ligament tear Diminished grip strength X-Rays Views: Standard PA Supinated AP Scaphoid view: AP with wrist supinated 30 degrees and in ulnar deviation Lateral[orthopaedicsone.com]
Wrist Pain
  • Abstract The efficacy of a diagnostic protocol involving videotape fluoroscopy of carpal motion and radiocarpal arthrography was evaluated in patients with wrist pain unexplained by physical examination and conventional radiographs.[ncbi.nlm.nih.gov]
  • Stabilization of the axial instability by capitohamate arthrodesis relieved the chronic wrist pain.[mayoclinic.pure.elsevier.com]
Joint Limitation
  • limited fusion Capsuloligamentodesis tenodesis Complications Prognosis References[orthofracs.com]
Decrease in Height
  • In this condition, there also is decreased carpal height as determined by the fixed ratio between the length of the third metacarpal and the length of a line drawn from the base of the third metacarpal to the distal pant of the radius on the posteroantenion[slideshare.net]

Treatment

  • This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment.[ncbi.nlm.nih.gov]

Prognosis

  • […] of reduction by radiolunate arthrodesis more reliable Dynamic VISI & DISI trial of nonoperative management with AEPOP/ NSAIDS/ local injection of steroids Stabilisation of midcarpal joint limited fusion Capsuloligamentodesis tenodesis Complications Prognosis[orthofracs.com]
  • This pattern of ulnar translocation, in reality, represents a severe form of scapholunate dissociation and carries a worse prognosis. 19 Figure 19: T1-weighted coronal image demonstrates ulnar translocation of only the lunate (L) and triquetrum (T) bones[radsource.us]
  • Rehabilitation is often prolonged, and the prognosis depends mainly on the severity of soft-tissue damage PowerPoint Presentation: Treatment Options for Wrist Ligament Injuries and Instability Acute wrist ligament injuries : closed or arthroscopically[authorstream.com]

Etiology

  • The evaluation of this new type of carpal instability with radiographs, tomography, arthrography, and magnetic resonance imaging failed to demonstrate its etiology.[ncbi.nlm.nih.gov]

Epidemiology

  • […] of carpal bones is lost Aetiology DISI due to disruption of scapho-lunate articulation VISI secondary to disruption of lunate & triquetral Ulnar translocation rarely results from injury but is commonly seen in wrists affected by rheumatoid arthritis Epidemiology[orthofracs.com]
  • Although nearly 30% of all injuries are wrist injuries, there is a lack of epidemiological data available on carpal instability. [7] [LoE:5].[physio-pedia.com]
  • Epidemiology Carpal instability is an injury of young and middle aged populations. The exact incidence of carpal instability is unknown, as the diagnosis is not often apparent.[orthopaedicsone.com]
  • Sprain of carpal joint of unspecified wrist, initial encounter A- initial encounter D- subsequent encounter S- sequela Scapholunate Instability ICD-9 842.01 Sprains and strains wrist and hand; wrist; carpal (joint) Scapholunate Instability Etiology / Epidemiology[eorif.com]
Sex distribution
Age distribution

Pathophysiology

  • The two main reasons for this are that MCI is a mixed bag of conditions, and that their pathophysiology is not well understood. The management of MCI remains controversial. Table 42-1 provides a summary of MCI.[clinicalgate.com]
  • Pathophysiology Patients with ulnar negative variance are at increased risk of SLIL injury [ 42 ].[musculoskeletalkey.com]
  • The book begins with a basic science section on pathophysiology of the hand, wrist and forearm. The rest of the two-volume book then follows a progressive organization from the most common problems to the least common problems of the hand.[books.google.ro]
  • Anatomical and pathophysiological approach to diagnosis and treatment. Churchill Livingstone, New York Google Scholar 11. Taleisnik J (1985) The wrist. Churchill Livingstone, New York Google Scholar 12.[link.springer.com]

Prevention

  • Research is still needed to further investigate the optimal treatments of all carpal injuries in athletes along with designing new means to prevent these injuries.[ncbi.nlm.nih.gov]
  • “And the best way to prevent both of those is to try to obtain more anatomic reductions.”[healio.com]
  • With complete SLIL tears, cast immobilization does not reduce or prevent scapholunate diastasis. [45] Significant force occurs at the scapholunate interval on wrist loading.[emedicine.medscape.com]

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