Midcarpal Instability Research Articles

Surgical Techniques in Non-Traumatic Midcarpal Instability: Evaluating the Dorsal Capsulodesis and Three-Ligament Tenodesis Technique.

Surgical management of midcarpal instability (MCI), also referred to as carpal instability nondissociative, remains controversial due to limited evidence on different techniques. This study aimed to assess and compare differences in patient-reported pain, hand and wrist function, patient satisfaction, range of motion, and return to work in patients with non-traumatic MCI who underwent surgical treatment either through dorsal wrist capsulodesis or three-ligament tenodesis (3LT). Patients with MCI and persisting complaints after conservative therapy treated with 3LT or dorsal capsulodesis were included. Patients with posttraumatic instability were excluded. Primary endpoints included the Patient Rated Wrist Evaluation (PRWE) and Satisfaction with Treatment Result Questionnaire at 12 months postoperative. All data were retrospectively analyzed. A total of 91 patients treated with dorsal capsulodesis and 21 treated with 3LT between December 2011 and December 2019 were included. At twelve months postoperative, both treatment groups reported significant improvements in pain and function scores. However, at three months postoperative, the dorsal capsulodesis group exhibited significantly better outcomes, followed by a greater return to work (72%) compared to the 3LT group (50%). However, the capsulodesis group demonstrated a decreased range of motion at three months which was restored at 12 months postoperative. No significant difference in satisfaction with treatment was observed. Both 3LT and dorsal capsulodesis demonstrate promising results for addressing non-traumatic MCI. However, considering the quicker recovery and faster return to work associated with dorsal capsulodesis, we recommend favoring capsulodesis over 3LT when both surgical options are deemed suitable for the patient. III.

Excision of the Distal Pole of the Scaphoid and the Midcarpal Joint

Abstract Background Excision of the distal pole of the scaphoid is used to treat arthritis of the scaphotrapezial trapezoid (STT), radioscaphoid joint, and arthritis following scaphoid nonunion. Some patients develop midcarpal instability limiting utilization of this technique. Why some wrists develop postoperative instability while others do not, remains unclear. Questions/Purposes To identify the wrists prone to developing midcarpal joint instability we evaluated the effect of midcarpal joint structure on force transfer through the wrist, we hypothesized that the force transfer will be further altered when a distal pole excision is performed and that midcarpal joint structure will affect force transfer. Patients and Methods We used finite element analysis based on 19 computer tomography wrist scans. Nine type 1 (lunate has a facet with the capitate alone) and 10 type 2 (lunate has facets with both the capitate and hamate) models were prepared. A 200 N force was evenly split and applied to the dorsal crests of the trapezoid and capitate (100 N along each crest) to replicate the performance of a knuckle push-up. Displacement of the trapezoid, trapezium, scaphoid, capitate, and hamate was measured along each axis after the applied load. The simulation model was used to predict motion at the capitate and STT joint with excision of the distal pole. Results Excision of the distal pole of the scaphoid affected the transfer of forces significantly (∼200% all bones in all directions) in all wrists. There are significant differences in force transfer between type 1 and type 2 wrists in the amount of force transferred (type 1 > type 2), in the percent difference from an intact wrist (type 1 > type 2) and in the direction of displacement (type 1 the bones moved in different directions while type 2 wrists moved as one block). Conclusion This study suggests that midcarpal joint structure affects force transfer through the wrist and may predict wrist behavior following excision of the distal pole of the scaphoid. Specifically, type 1 wrists may be more prone to midcarpal joint collapse after excision. Level of evidence: 1.

Arthroscopic suture in the management of palmar midcarpal instability.

Patients with midcarpal instability are difficult to manage. It is a rare condition, and few studies have reported the outcomes of surgical treatment. No prospective or retrospective study has reported the results of arthroscopic palmar capsuloligamentous suturing. Our aim was to report the results of a prospective study of arthroscopic suture of this ligament complex in patients with midcarpal instability. This prospective single-centre study was undertaken between March 2012 and May 2022. The primary outcome was to evaluate the functional outcomes of arthroscopic palmar midcarpal suture. The study included 12 patients, eight male and four female, with a mean age of 27.5 years (19 to 42). They were reviewed at three months, six months, and one year postoperatively. There was a significant improvement in flexion, extension, grip strength, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire score, and pain, in all patients. After telephone contact with all patients in March 2023, at a mean follow-up of 3.85 years (2.2 to 6.25), no patient had a persistent or recurrent clunk. Arthroscopic suture of the midcarpal capsuloligamentous complex represents a minimally invasive, easy, and reproducible technique for the management of patients with midcarpal instbility, with a clear improvement in function outcomes and no complications.

Palmar midcarpal instability a narrative review of the literature: Have we reached a consensus on a treatment?

Palmar midcarpal instability (PMCI) is a wrist condition that requires treatment through non-surgical rehabilitation programs or surgical stabilization. This condition's natural history is poorly understood, and the optimal treatment approach remains unknown. Non-surgical treatments are initially implemented, followed by surgical stabilization if necessary. Arthrodesis and soft tissue stabilization are the two main surgical options for PMCI, with no established gold standard for treatment.A systematic review of 12 articles comparing arthrodesis and soft tissue stabilization was conducted to identify the optimal treatment approach for PMCI. Arthrodesis techniques, such as lunotriquetral arthrodesis, showed high functional outcomes but also high reintervention rates due to nonunion. Soft tissue stabilization techniques showed superior functional outcomes with less mobility loss and lower reintervention rates compared to arthrodesis. However, more studies are required to determine the optimal soft tissue technique.Based on this review we created a treatment algorithm for PMCI starting with non-surgical treatment first, followed by surgical stabilization if needed. Soft tissue stabilization techniques are preferred over arthrodesis due to better functional outcomes and lower reintervention rates. However, each patient's treatment approach should be individualized and evaluated independently to determine the best course of action.PMCI is a rare wrist condition, and further research is needed to better understand its natural history and establish a gold standard for treatment. The lack of literature comparing the two surgical options underscores the need for further research to determine the optimal treatment approach. Nonetheless, the current evidence suggests that soft tissue stabilization is a promising alternative to arthrodesis, providing superior functional outcomes and lower reintervention rates.

Outcomes of an exercise program in patients with dorsal or volar midcarpal laxity: a cohort study of 213 patients

Purpose Describing the outcomes of an exercise program on wrist and hand function for patients with midcarpal instability (MCI). Materials and methods This study has a prospective cohort design. Two hundred and thirteen patients with MCI were included. The intervention was a 3-month exercise program consisting of hand therapy and home exercises. The primary outcome was perceived wrist and hand function evaluated with the Patient-Rated Wrist/Hand Evaluation (PRWHE) three months after treatment onset. Secondary outcomes were conversion to surgery, pain, and satisfaction with treatment results. Results PRWHE total scores improved from 51 ± 19 (mean ± SD) to 33 ± 24 at 3 months (95% CI: 36–30, p < 0.001). All visual analog scales for pain demonstrated clinically relevant improvements at 6 weeks and 3 months (p < 0.001). At 3 months, 81% of the participants would undergo the treatment again. After a median follow-up of 2.8 years, 46 patients (22%) converted to surgery. Conclusions We found clinically relevant improvements in hand and wrist function and pain. Most participants would undergo treatment again and 78% of the participants did not convert to surgery. Hence, non-invasive treatment should be the primary treatment choice for patients with MCI.

Midcarpal Instability.

Midcarpal instability (MCI) of the wrist represents multiple distinct clinical entities that all have in common abnormal force transmission across the midcarpal joint. This can be asymptomatic but can also result in painful wrist motion, a characteristic catch-up clunk, and symptoms of instability. The carpus is stabilized by numerous extrinsic and intrinsic ligaments. Dynamic joint reactive forces between the proximal and distal carpal rows help create reciprocal motion, which results in smooth, physiologic wrist mechanics. Diagnosis of MCI requires a thorough history, physical examination, and adequate imaging. MCI can be managed nonsurgically with activity modification, physical therapy, specialized orthotics, medications, and corticosteroid injections. A variety of surgical treatment options exists to treat symptomatic MCI. These include arthroscopic thermal capsulorrhaphy, ligament repair or reconstruction, radial osteotomies, and limited radiocarpal or intercarpal fusions. Capsulorrhaphy or ligament repair is favored for mild to moderate cases; osteotomies can be used for the correction of bony deformities contributing to instability, whereas partial wrist arthrodesis is indicated for severe or recurrent instability and fixed deformities.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

The Lateral-W Construct: An Anatomical Variant of the Dorsal Wrist Ligaments.

Background The dorsal intercarpal ligament (DIC) is an elegant dorsal stabilizer of the proximal carpal row, including the scaphoid's proximal pole and scapholunate joint. Along with the dorsal radiocarpal (DRC) ligament, it acts as a dorsal radioscaphoid stabilizer, with dynamism due to its ability to modify its length up to threefold by changing the angles between its V-shaped bundle morphology. The DIC ligament consistently originates from the dorsal tubercle of the triquetrum on the ulnar side. It spans transversely, attaching to the dorsal groove of the scaphoid (97-100%), lunate (75-90%), and proximal rim of the trapezium (12.5-50%), and overlapping the lunotriquetral interosseous ligament and the scapholunate interosseous ligament. Together with the DRC, Viegas et al (Viegas SF, Yamaguchi S, Boyd NL, Patterson RM. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg Am 1999;24(3):456-468) proposed that this ligament complex should be called the "lateral-V construct." Anatomical Variant The authors present a unique type C variant of the DIC ligament, showing a distinct thick bundle directed at the dorsal aspect of the second metacarpal base that thus creates a "lateral-W construct." This dorsal triquetro-metacarpal 2 (dTqMC2) ligament acts as restraint to the body of the capitate and will provide enhanced stability of the dorsal midcarpal joint by limiting dorsal translation of the capitate in relation to the lunate. Clinical Relevance Our finding may contribute to the increasing knowledge of the dorsal ligament complex and its role in dorsal midcarpal instability, as well as surgical repair techniques.

Arthroscopic Capsular Shrinkage Is Safe and Effective in the Treatment of Midcarpal Instability in a Pediatric Population: A Single-Center Experience of 51 Cases.

Objective Treatment of palmar midcarpal instability (PMCI) remains controversial and children can develop PMCI from asymptomatic hypermobility. Recently, case series have been published regarding the use of arthroscopic thermal shrinkage of the capsule in adults. Reports of the use of the technique in children and adolescents are rare, and there are no published case series. Methods In a tertiary hand center for children's hand and wrist conditions, 51 patients were treated with arthroscopy for PMCI between 2014 and 2021. Eighteen out of 51 patients carried additional diagnosis of juvenile idiopathic arthritis (JIA) or a congenital arthritis. Data were collected including range of movement, visual analog scale (VAS) at rest and with load, and grip strength. Data were used to determine the safety and efficacy of this treatment in pediatric and adolescent patients. Results Mean follow-up was 11.9 months. The procedure was well tolerated and no complications were recorded. Range of movement was preserved postoperatively. In all groups VAS scores at rest and with load improved. Those who underwent arthroscopic capsular shrinkage (ACS) had significantly greater improvement in VAS with load, compared with those who underwent arthroscopic synovectomy alone ( p = 0.04). Comparing those treated with underlying JIA versus those without, there was no difference in postoperative range of movement, but there was significantly greater improvement for the non-JIA group in terms of both VAS at rest ( p = 0.02) and VAS with load ( p = 0.02). Those with JIA and hypermobility stabilized postoperatively, and those with JIA with signs of early carpal collapse and no hypermobility achieved improved range of movement, in terms of flexion ( p = 0.02), extension ( p = 0.03), and radial deviation ( p = 0.01). Conclusion ACS is a well-tolerated, safe, and effective procedure for PMCI in children and adolescents. It improves pain and instability at rest and with load, and offers benefit over open synovectomy alone. This is the first case series describing the usefulness of the procedure in children and adolescents, and demonstrates effective use of the technique in experienced hands in a specialist center. Level of Evidence This is a Level IV study.

Arthroscopic Midcarpal Tendon Interposition: A New Technique for Capitolunate Constraints

Conflicts of the capitolunate, causing midcarpal pain from friction can be isolated (e.g., avascular necrosis of the proximal pole of the capitate [AVNC], palmar midcarpal instability [PMCI]) or form part of a framework of more complex osteoarthritis phenomena (e.g., scaphoid pseudarthrosis [SNAC], and lesions of the scapholunate capsuloligamentous complex [SLAC]). We group in the term “conflict” all of the causes (with intact cartilage or not) causing midcarpal pain by friction. Treatment by capitolunar arthrodesis can be effective, but inevitably stiffening. In other more specific cases (i.e., AVNC), replacement of the proximal pole of the capitate with a synthetic implant or a tendon has shown variable results. In this work, we propose a management of these conflicts with a conservative arthroscopic technique, including capitolunate tendon interposition. We describe arthroscopic midcarpal tendon interposition (AMTI) for capitolunate conflicts. This technique prevents stiffness due to arthrodesis, but good experience in wrist arthroscopy is required to perform this operation.

Relation Between the Phase-Lag Index and Lagged Coherence for Assessing Interactions in EEG and MEG Data

Descriptive Epidemiological Study.Ligament tears between carpal bones are easily missed on initial presentation, but can have potentially debilitating effects on the patient if they progress to an instability. They are usually the result of a fall onto an outstretched hand with the wrist in hyperextension. Current incidence of carpal instability after these falls is unknown.Using established clinical and radiological measures, we sought to establish the cumulative incidence of carpal instability in people who have fallen onto an outstretched hand in the second year after injury. We also sought to describe its relationship with functional impairment.We used emergency department records of an inner-urban tertiary hospital to contact all patients who presented with wrist pain following fall onto outstretched hand who were between one and two years after injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson’s) test, Ballottement, and mid-carpal shift test. Wrist-related pain and disability was measured using the Patient-Rated Wrist and Hand Evaluation.Of the 279 potentially eligible cases, only 146 were contactable, and fifty (28 male, 22 female; mean age of 48 years) attended for assessment. We found a cumulative incidence of 44% of carpal instability within the second year after injury. Of these, 12 (24%) cases had scapho-lunate instability, 12 (24%) had luno-triquetral instability and 7 (14%) had mid-carpal instability. There were no significant correlations between clinically confirmed carpal instability and pain, function, or work participation.This study found a higher than anticipated cumulative incidence of carpal instability in the second year after injury, which may reflect volunteer bias. Patients should be advised to monitor symptoms in the year after injury and seek a review if symptoms of pain, clicking or clunking arise.II

Comprehension of Midcarpal Instability

The midcarpal instability is the state with instability between the proximal and distal carpal rows, without dissociation between carpal bones. It can be divided into the intrinsic one that is caused by ligament hyperlaxity, and extrinsic one that is caused secondarily by the malunion of distal radius. The pathophysiology of the intrinsic one is still unknown, and the treatment is also controversial. On the other hand, the extrinsic one can be treated by corrective osteotomy of the radial malunion. This review investigated the comprehension, definition, classification, symptoms, diagnosis, and treatment of the midcarpal instability.

Carpal Instability: I. Pathoanatomy.

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.

Posttraumatic Carpal Instability Nondissociative.

Background Posttraumatic midcarpal instability nondissociative (CIND) is an exceptional rare condition, therefore the outcome after different treatment options remains unknown. Questions The purpose of this study was to investigate the different treatment options for posttraumatic CIND. We also describe the different radiological and magnetic resonance imaging (MRI) findings in this patient cohort. Patients and Methods We present outcomes of 10 patients who developed CIND following acute wrist trauma between 2007 and 2018, 3 with dorsal intercalated segment instability pattern (CIND-DISI) and 7 with volar intercalated segment instability (CIND-VISI) radiographically. Results Three patients with CIND-VISI had satisfactory outcomes with conservative treatment. Two patients with irreducible CIND-DISI and one with CIND-VISI underwent proximal row carpectomy (PRC), two with reducible CIND-VISI had radiolunate fusion, and two with secondary osteoarthritis had total wrist fusion. All patients with CIND-DISI needed surgery, whereas only four of the seven patients with CIND-VISI needed surgery. On MRI, all three patients with CIND-DISI had rupture of the radiolunate ligament. Conclusions The data collected in this study may provide the first step toward better understanding of the pathology for this exceptionally rare finding. In CIND-VISI, we have not seen any ligament injury in four patients. Therefore, conservative therapy is more likely to be the first step. In CIND-DISI, we recommend an operative procedure: if detected early, with ligament suture, otherwise by radiolunate fusion, PRC, or total wrist fusion. Level of Evidence This is a Level IV study.

Long-Term Results of Arthroscopic Capsular Shrinkage for Palmar Midcarpal Instability of the Wrist.

Background Midcarpal instability is a term for a collection of poorly understood conditions where the proximal row of the carpus is unstable. The most common type of midcarpal instability is palmar midcarpal instability (PMCI). Treatment for PMCI includes nonoperative proprioceptive retraining of the wrist, splints, and strengthening. If this fails, various authors have suggested several different fusions, tenodesis procedures, or capsular shrinkage. There are no long-term case series in the literature. Objective The aim of this study is to assess the long-term results of arthroscopic capsular shrinkage when used for PMCI of the wrist. Methods A prospective cohort study of patients who underwent arthroscopic capsular shrinkage for PMCI was performed. Ethical board approval was given for this study. All patients were followed up and reviewed independently from the operating surgeon. Assessment included a structured questionnaire, disabilities of the arm, shoulder and hand (DASH) questionnaire, and clinical examination using a goniometer. PMCI was assessed objectively with the anterior drawer test and radiological imaging was only performed if clinically relevant to the residual symptoms. Results Thirteen patients (15 wrists) underwent arthroscopic capsular shrinkage for PMCI. Twelve patients (14 wrists) were available for clinical review with a follow-up rate of 92.3%. The mean time from index procedure to final review was 12 years (range: 10-14years). The symptoms of instability had completely resolved in nine wrists (7 patients). Only 2 of the 14 wrists had symptoms that were reproduced with a positive anterior drawer test. All other wrists were stable on objective assessment. The mean DASH score had improved from pre op of 34 to post op of 12.1 and at 12-year follow-up this had deteriorated minimally to 15.3. Assessment of the range of motion showed an average increase in range of flexion/extension by 22 degrees. Patient satisfaction was excellent. The patients rated that nine wrists were much better than presurgery, three as better, one unchanged, and one worse. Discussion/Conclusion There are no studies looking at the long-term natural history of treatments for PMCI. The lead author proposes a grading system for symptomatic PMCI that has been retrospectively applied to this cohort. It is a grading system from 1 to 4 and is based on a treatment algorithm. This is the first long-term study from any joint, where the results of capsular shrinkage have been maintained over time. In this series, we have not seen any deleterious effect from possible mechanoreceptor injury. We suspect that functioning mechanoreceptors are more relevant in the unstable joint, than the structurally stable joint. The authors propose that thermal capsular shrinkage is an effective and durable option for use in mild-to-moderate forms of PMCI.

Biomechanical Effects of Radioscapholunate Fusion With Distal Scaphoidectomy and Triquetrum Excision on Dart-Throwing and Wrist Circumduction Motions

Distal scaphoid and triquetrum excisions can improve the range of wrist motion after radioscapholunate (RSL) fusion, but little is known about the kinematics of dart-throwing and global circumduction motions. We hypothesized that these excisions could increase the range of motion without causing midcarpal instability. Seven fresh-frozen cadaver upper extremities were mounted on a testing apparatus after isolation and preloading of the tendons of the flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis, and extensor carpi ulnaris. Sequential loadings of the flexor carpi ulnaris and extensor carpi radialis simulated active dart-throwing motion. Passive circumferential loading produced the wrist circumduction motion. We measured the range of wrist motions with an electromagnetic tracking system in 4 experiments: intact, simulated RSL fusion, RSL fusion with distal scaphoid excision, and RSL fusion with distal scaphoid and total triquetrum excisions. To evaluate midcarpal stability, we conducted passive mobility testing of the distal carpal row in the radial, volar, ulnar, and dorsal directions. Radioscapholunate fusion decreased the dart-throwing motion to a mean of 46% of the baseline value; distal scaphoid and triquetrum excisions increased the mean arc to 50% and 62%, respectively. Radioscapholunate fusion diminished the wrist circumduction to a mean of 43% of the baseline value, which increased to a mean of 58% and 74% after distal scaphoid and triquetrum excision, respectively. A significant increase in radial deviation was noted after distal scaphoid excision, and subsequent triquetrum excision significantly increased motion in the ulnar-palmar direction. Regarding midcarpal stability, dorsal translation significantly increased after distal scaphoid and triquetrum excisions. Distal scaphoid and triquetrum excision after RSL fusion improved both dart-throwing and circumduction motions, but dorsal midcarpal instability occurred. Subsequent carpal excisions may improve short-term outcome by increasing motions in a RSL-fused wrist; however, a potential risk of midcarpal instability should be considered.

Demystifying Palmar Midcarpal Instability

Palmar midcarpal instability is an uncommon condition diagnosed clinically with a painful pathognomonic clunk on terminal ulnar deviation of the wrist. Various causes have been described, but congenital laxity of the carpal ligaments is thought to be a key contributor. Treatment commences with conservative measures. This includes proprioceptive training based on more recent concepts on the sensorimotor function of the wrist. When these measures plateau, surgery is considered. The lack of high-level evidence and consensus on its cause continue to hamper our understanding and knowledge of this condition. The purpose of this review is to examine the current evidence to conceptualize this mysterious, yet infrequent phenomenon, and to provide an algorithm on its management.

Palmar Capsuloligamentous Plication in Dorsal Capitolunate Instability: Technique and Preliminary Results.

Midcarpal instability (MCI) is a form of the carpal instability nondissociative pattern and can be differentiated into dorsal, palmar, or extrinsic MCI. Dorsal MCI can frequently be observed in adolescent or adult patients due to trauma or hyperlaxity of the palmar intrinsic carpal ligaments. Clinical stress tests and cinematography are capable to depict the ligamentous instability centered around the capitolunate area. We describe a novel technique which aims to address palmar ligamentous hyperlaxity by plication of the radioscaphocapitate, radiolunotriquetral, and arcuate ligaments, thus closing the so-called space of Poirier. This palmar technique has been used in several cases in isolated form or in conjunction with other concomitant procedures. After the floor of the carpal tunnel and thus the palmar ligaments are exposed and the weak spot meticulously verified, 2 or rarely 3 deep FibreWire pulley sutures are used for capsuloligamentous plication. Among 11 patients, 4 cases (5 operated wrists) with isolated capitolunate capsuloligamentous plication were followed at an average of 2.6 years after surgery. The results were excellent with a mean postoperative Disabilities of the Arm, Shoulder and Hand Score of 9.7 (range, 6.9 to 15.0), mean numerical rating scale of 0 at rest and 1 (range, 0 to 2) during stress. All cases stated that they were very satisfied with the result and all would definitely elect to choose the surgery again. Palmar capsuloligamentous plication has been shown to be a quick, relatively easy and reliable procedure to reduce dorsal MCI in our patient cohort.

Dynamic Tendon Transfer for the Treatment of Palmar Midcarpal Instability: A Case Report

Dynamic Tendon Transfer for the Treatment of Palmar Midcarpal Instability: A Case Report

Scaphoïdectomie distale pour arthrose STT, résultats à court terme — la valeur du DISI mise en question

Isolated symptomatic scaphotrapezio-trapezoid arthritis forms an important differential diagnosis in basal thumb pain. Due to the relatively high complication ratio of the conventional STT-arthrodesis and the weakness of thumb strength reported after trapezial excision, emphasis in research has swung towards distal scaphoid resection with or without interposition. In 2009, Decramer and Le Viet described a proper reproducible technique, using Flexor Carpi Radialis tendon as a spacer. Currently, discussion regarding outcomes and complications of this type of interposition procedure needs the most attention. Dorsal Intercalated Segment Instability deformity described after STT-excision doesn’t always seem to correlate with the patients functional ability after surgery and we could ask ourselves whether DISI really matters. All patients with isolated symptomatic STT arthritis that have undergone the above-mentioned technique, between 2012 and 2018, were included. Clinical, radiographical and patient-based written outcome measures were obtained during postoperative visits. We used the operative technique as described in a poster presentation at the FESSH in Poznan in 2009 by Decramer and Le Viet (Institut de la Main, Paris). It involves a distal scaphoid resection, followed by the harvesting of half of the split FCR, which is then accordion like, seated into the freed-up space. The clinical evaluation comprises of range of motion as well as strength measurements. Different relevant carpal angles and the scaphoid length are measured on front and lateral radiographs and compared to the contralateral wrist. Written scores entailed a qDASH, a PRWE score, a VAS pain and a VAS daily functionality of the hand. Twenty-one cases have been evaluated. One patient had wound infection. Three patients suffered from persistent wrist extension deficit, for which 1 patient had revision surgery. Six patients developed CTS complaints. A mild DISI deformity was seen in the majority of the patients. No evolution to gross midcarpal instability was observed. Our results are comparable to earlier studies and report a global satisfactory outcome. Although a mild DISI deformity was seen in the majority of the cases, there was no correlation with the functional scores. This should be interpreted with caution given the relatively short follow-up period. Given the encouraging results of this type of intervention, this operative technique is considered successful in the short term. This study set-up could be used to develop a prospective protocol in order to offer a higher level of evidence with larger series and a longer follow-up period.