Carpal Ligament Instability

Source: http://emedicine.medscape.com/article/1241610-overview

The human wrist joint is a complex arrangement of small bones and ligaments that form a mobile yet stable link from the powerful forearm to the hand. The normally functioning carpus can position the hand precisely relative to the forearm and provides remarkably stable transmission of forces. Motion and stability of the carpus provide the critical foundation for maximum hand function from precise fine motor control to power grip activities.
When the normal mechanics of the wrist are disrupted, the instability of the carpal bones results in weakness, stiffness, chronic pain, and often arthritis if not treated appropriately. Although the early clinical and radiographic findings may be subtle, an understanding of wrist kinematics and instability patterns can facilitate early diagnosis and management. Unfortunately, selecting the optimal treatment remains a difficult judgment in most cases.
Linscheid et al described traumatic carpal instability in 1972.^[1] Since the early reports, anatomic and biomechanical studies have provided a foundation for understanding carpal motion, stresses, and pathologic instability. Building on these studies, various models have been suggested to explain the remarkable strength and mobility of this complex joint and the predictable patterns of failure.
This article presents the current understanding of pathologic carpal instability, the common classification patterns, and early treatment options that may avoid protracted dysfunction. Appropriate hand therapy is essential to maximize recovery but requires an appreciation of the limitations of carpal instability dysfunction and the goals of various treatment options.
Images of the carpal ligament and instability are included below.
(Click image to enlarge.) Dorsal carpal ligaments. Copyright Mayo Clinic, used with permission of Mayo Foundation. (Click image to enlarge.) Volar carpal ligaments. Copyright Mayo Clinic, used with permission of the Mayo Foundation. Mayfield perilunate instability pattern. Copyright Mayo Clinic, used with permission of the Mayo Foundation.

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