The non-dissociative clunking wrist: a personal view

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Hand and Wrist Surgery

Background:

• Wrist clunking often stems from combined radiocarpal and midcarpal ligament insufficiency and poor neuromuscular coordination.
• Symptomatic wrists may initially benefit from conservative management including splinting, isometric exercises, and activity modification.

Purpose of the Study:

• To review treatment strategies for symptomatic wrist clunking.
• To evaluate the efficacy and outcomes of different surgical interventions for multilevel wrist instability.

Main Methods:

• Review of existing literature on wrist instability and surgical treatments.
• Analysis of outcomes for ligament reconstruction, partial carpal arthrodesis, midcarpal fusion, and radiolunate fusion.

Main Results:

• Soft tissue procedures may fail in cases of multilevel instability.
• Midcarpal fusion effectively eliminates clunking but impairs the dart-throwing motion.
• Radiolunate fusion addresses clunking with less morbidity and preserves key wrist movements.

Conclusions:

• Radiolunate fusion is a viable surgical option for symptomatic wrist clunking due to multilevel instability.
• This procedure effectively alleviates pain and maintains functional wrist motion, specifically the dart-throwing motion.