Abstract
Background
Midcarpal instability (MCI) is a relatively uncommon yet disabling condition that
manifests with wrist pain, weakness, and diminished grip strength. Diagnosis is primarily
clinical, supported by dynamic imaging modalities such as video fluoroscopy and 4D
CT. Initial management typically involves non-operative measures including patient
education, activity modification, pain control, dynamic splinting, hand therapy, and
proprioceptive training. Surgical intervention is considered in cases refractory to
conservative treatment.
Objectives
To describe our novel “Hammock Technique” as a surgical method for the management
of midcarpal instability (MCI). We outlines the detailed surgical steps of the procedure,
defines its indications, and presents the standardized postoperative rehabilitation
protocol. Furthermore, we highlight potential complications and discuss the technique’s
role within the current spectrum of treatment options for MCI.
Materials and Methods
The Hammock Technique was developed to address ligament dysfunction and hyperlaxity
in both the dorsal and palmar regions of the wrist, as well as around the scaphoid.
This technique employs the palmaris longus tendon, incorporated with the wrist capsule,
to achieve a “triple effect”: (1) reinforcement of the dorsal ligaments, (2) hammock-like
support for the proximal capitate and (3) stabilization of the scaphoid through fixation
of its distal pole. It is particularly indicated for mild to moderate cases of midcarpal
instability and can be effectively applied to both palmar and dorsal subtypes.
Results
Application of the Hammock Technique demonstrated improved midcarpal stability, restoration
of functional wrist motion, and enhanced grip strength in patients with mild to moderate
MCI. Early outcomes suggest reproducibility and safety, with a low complication rate.
Conclusion
The Hammock Technique represents a simple, biologically sound, and effective surgical
option for the treatment of mild to moderate MCI. It can be applied to both palmar
and dorsal subtypes, offering satisfactory stability and functional outcomes while
preserving native wrist kinematics.
Keywords midcarpal instability - intrinsic - extrinsic - proprioception - videofluoroscopy
- hammock technique - palmaris longus
