The topic of wrist or carpal instability has been a source of confusion and miscommunication for decades. The terminology can often be difficult to understand and one surgeon's concept of instability may be completely different from another's. This is by no means a comprehensive review of carpal instability, which has often been the focus of numerous multi-volume textbooks. The purpose of this paper is to detail the basics of carpal instability, the anatomy, pathomechanics, terminology and basic principles of treatment.
BergerRA: The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin1997;13(1):63–82.
2.
ViegasSFPattersonRMPetersonPDPogueDJJenkinsDKSweoTDHokansonJA: Ulnar-sided perilunate instability: An anatomic and biomechanic study. J Hand Surg (Am)1990;15(2):268–278.
3.
ViegasSFYamaguchiSBoydNLPattersonRM: The dorsal ligaments of the wrist: Anatomy, mechanical properties, and function. J Hand Surg (Am)1999;24(3):456–468.
4.
BergerRA: The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res2001;383:32–40.
5.
ShortWHWernerFWGreenJKMasaokaS: Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg (Am)2002;27(6):991–1002.
6.
ShortWHWernerFWGreenJKMasaokaS: Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg (Am)2005;30(1):24–34.
7.
ShortWHWernerFWGreenJKSuttonLGBrutusJP: Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part III. J Hand Surg (Am)2007;32(3):297–309.
8.
MitsuyasuHPattersonRMShahMABufordWLIwamotoYViegasSF: The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg (Am)2004;29(2):279–288.
9.
GilulaL.A.WeeksP. M.: Post-traumatic ligamentous instabilities of the wrist. Radiology1978;129(3):641–51.
10.
LinscheidRLDobynsJHBeaboutJWBryanRS: Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am1972;54(8):1612–1632.
11.
Garcia-EliasMAnKNAmadioPCCooneyWPLinscheidRL: Reliability of carpal angle determinations. J Hand Surg (Am)1989;14(6):1017–1021.
12.
BergerRACrowninshieldRDFlattAE: The three-dimensional rotational behaviors of the carpal bones. Clin Orthop Relat Res1982;167:303–310.
13.
PattersonRMNicodemusCLViegasSFElderKWRosenblattJ: Normal wrist kinematics and the analysis of the effect of various dynamic external fixators for treatment of distal radius fractures. Hand Clin1997;13(1):129–141.
14.
SeradgeHSterbankPTSeradgeEOwensW: Segmental motion of the proximal carpal row: Their global effect on the wrist motion. J Hand Surg (Am)1990;15(2):236–239.
15.
WolfeSWCriscoJJKatzLD: A non-invasive method for studying in vivo carpal kinematics. J Hand Surg (Br)1997;22(2):147–152.
LichtmanDMSchneiderJRSwaffordARMacKGR: Ulnar midcarpal instability-clinical and laboratory analysis. J Hand Surg (Am)1981;6(5):515–523.
18.
CraigenMAStanleyJK: Wrist kinematics. Row. column or both? J Hand Surg (Br)1995;20(2):165–170.
19.
GilfordWWBoltonRHLambrinudiC: The mechanism of the wrist joint with special reference to fractures of the scaphoid. Guy Hosp Rep1943;92:52–59.
20.
LandsmeerJM: Studies in the anatomy of articulation. I. The equilibrium of the “intercalated” bone. Acta Morphol Neerl Scand1961;3:287–303.
21.
FiskGR: Carpal instability and the fractured scaphoid. Ann R Coll Surg Engl1970;46(2):63–76.
22.
KauerJM:The interdependence of carpal articulation chains. Acta Anat (Basel)1974;88(4):481–501.
23.
DobynsJHLinscheidRL: A short history of the wrist joint. Hand Clin1997;13(1):1–12.
24.
NavarroA: Luxaciones del carpo. An de Fac de Med Montevideo. Orthop Trans1921;6:113–141.
25.
DestotE: Traumatismes du poignet et rayons x. Masson, Paris, 1923.
26.
DestotE: The classic: injuries of the wrist: a radiological study.New York, NY: Paul B. Hoeber; 1926. Clin Orthop Relat Res, 2006;445:8–14.
27.
MayfieldJKJohnsonRPKilcoyneRK: Carpal dislocations: Pathomechanics and progressive perilunar instability. J Hand Surg (Am)1980;5(3):226–241.
28.
Garcia-EliasM: Understanding wrist mechanics: A Long and Winding Road in ASSH Annual Meeting. 2008. Chicago.
29.
LichtmanDMMartinRA: Introduction to the carpal instabilities. The wrist and its disorders, LichtmanD.M.1988, WB Saunders: Philadelphia, pp. 245–250.
30.
TaleisnikJ (Ed): The wrist. Churchill Livingstone, New York, 1985.
31.
GilulaLAMannJHDobynsJHYinY: Wrist terminology as defined by the wrist investigators' workshop. J Bone Joint Surg2002;84:1–66.
32.
DobynsJHCooneyWP: Classification of carpal instability. The wrist: Diagnosis and operative treatment, CooneyW. P.LinscheidR. L.DobynsJ.H.Vol. 1. 1998, St. Louis: Mosby pp. 490–500.
33.
ReaganDSLinscheidRLDobynsJH: Lunotriquetral sprains. J Hand Surg (Am)1984;9(4):502–514.
34.
ShinAYBattagliaMJBishopAT: Lunotriquetral instability: Diagnosis and treatment. J Am Acad Orthop Surg2000;8(3):170–179.
35.
Garcia-EliasMDobynsJHCooneyWP3rdLinscheidRL: Traumatic axial dislocations of the carpus. J Hand Surg (Am)1989;14(3):446–457.
36.
SchweizerAKammerE: Transhamate periscaphoid axial radial fracture dislocation of the carpus. J Hand Surg (Am)2008;33(2):210–212.
37.
FinsterbushAPogrundH: The hypermobility syndrome. Musculoskeletal complaints in 100 consecutive cases of generalized joint hypermobility. Clin Orthop Relat Res1982;168:124–127.
38.
WrightTWDobynsJH: Carpal instability nondissociative. The wrist: Diagnosis and operative treatment, CooneyW. P.LinscheidR.L.DobynsJH. Vol. 1. 1998, St. Louis: Mosby, pp. 550–568.
39.
ViegasSFPattersonRMWardK: Extrinsic wrist ligaments in the pathomechanics of ulnar translation instability. J Hand Surg (Am)1995;20(2):312–318.
40.
WiesnerLRumelhartCPhamEComtetJJ: Experimentally induced ulno-carpal instability. A study on 13 cadaver wrists. J Hand Surg (Br)1996;21(1):24–29.
41.
MouchetABelotJ: Poignet a'ressaut: Subluxation mediocarpienne en avant. Bulletin et Memoires de la Soceite nationale de Chirurgie1934;60:1243–1244.
42.
LichtmanDMWrotenES:Understanding midcarpal instability. J Hand Surg (Am)2006;31(3):491–498.
43.
KirkJAAnsellBMBywatersEG: The hypermobility syndrome. Musculoskeletal complaints associated with generalized joint hypermobility. Ann Rheum Dis1967;26(5):419–425.
44.
HerzbergGComtetJJLinscheidRLAmadioPCCooneyWPStalderJ: Perilunate dislocations and fracture-dislocations: A multicenter study. J Hand Surg (Am)1993;18(5):768–779.
45.
CooneyWP3rdDobynsJHLinscheidRL: Complications of Colles' fractures. J Bone Joint Surg Am1980;62(4):613–619.
46.
TaleisnikJWatsonHK: Midcarpal instability caused by malunited fractures of the distal radius. J Hand Surg (Am)1984;9(3):350–357.
