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Semin Musculoskelet Radiol 2021; 25(02): 191-202
DOI: 10.1055/s-0041-1728711
Review Article

Carpal Instability: I. Pathoanatomy

Rainer Schmitt 
1   Department of Radiology, University Hospital LMU, Munich, Germany
2   Department of Radiology, University Hospital, Würzburg, Germany
,
Nina Hesse
1   Department of Radiology, University Hospital LMU, Munich, Germany
,
Florian Goehtz
3   Department of Hand Surgery, Rhön-Klinikum Campus, Bad Neustadt, Germany
,
Karl-Josef Prommersberger
3   Department of Hand Surgery, Rhön-Klinikum Campus, Bad Neustadt, Germany
,
Milko de Jonge
4   Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Jan-Peter Grunz
2   Department of Radiology, University Hospital, Würzburg, Germany
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Abstract

The pathoanatomy of carpal instability is multifactorial and usually complex. A thorough medical history and clinical examination are essential, as well as profound knowledge of the specific instability patterns. The stability of the wrist is ensured by the carpal joint surfaces, by intact intra-articular (particularly the scapholunate interosseous ligament) and intracapsular ligaments, and by crossing extensor and flexor tendons, the latter making the proximal carpal row an “intercalated segment.” An important classification feature is the distinction between dissociative and nondissociative forms of carpal instability. Among others, scapholunate dissociation, lunotriquetral dissociation, midcarpal instability, and ulnar translocation are the most common entities. Early forms of instability are considered dynamic. In the natural course, static instability of the wrist and osteoarthritis will develop. This review focuses on the pathoanatomical fundamentals of the various forms of carpal instability.

Keywords

carpal alignment - dissociative - instability - ligaments - nondissociative


Publication History

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

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