Wrist MRI and carpal instability: what the surgeon needs to know, and the case for dynamic imaging

The common clinical problem of carpal instability is often difficult to diagnose with the precision necessary to confidently direct appropriate treatment. The role of magnetic resonance imaging (MRI) in the evaluation of carpal instabilities is evolving but remains problematic. Finding solutions to these problems is contingent upon both the imaging specialist and clinician appreciating the full scope and clinical implications of the mechanical and kinematic complexity inherent in the anatomic design of the carpus. Providing specifics about the clinical questions that arise with various carpal instabilities serves to highlight the challenges facing current imaging technology, and provides a framework that supports the argument for the development of dynamic MRI as one--and perhaps the only--truly satisfactory solution to this problem.