64 - Classification and Management of Carpal Instability

Abstract

The term carpal instability should only be used to describe symptomatic wrist dysfunctions with loss of the ability to carry physiologic loads without yielding (kinetic instability) or the capability of moving smoothly, without sudden changes of carpal alignment (kinematic dysfunction). Treatment of carpal instability is based on a thorough analysis of different parameters, including age, profession, vocational activities, etiology, chronicity, severity, location, direction of the malalignment, and pattern of instability. Most acute and some chronic instabilities may be successfully treated by solving the underlying injury (ligament disruption or bone fracture). However, when a chronic dysfunction has permanently altered the spatial relationships between the carpal bones, making malalignment irreducible, and particularly when the joint cartilage has undergone a process of degeneration as a consequence of such dysfunction, a salvage procedure (partial fusion, proximal-row carpectomy, or a wrist arthroplasty) may be necessary. In all circumstances, it is important that proper muscle reeducation of the wrist dynamic stabilizers be used to reestablish the proprioceptive neuromuscular reflexes that ensure stability.