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Related Experiment Video

Updated: Jun 13, 2026

Metacarpal Small Incision for Carpal Tunnel Syndrome
04:08

Metacarpal Small Incision for Carpal Tunnel Syndrome

Published on: April 5, 2024

Midcarpal instability: a radiological perspective.

Andoni Paul Toms1, Adrian Chojnowski, John G Cahir

  • 1Department of Radiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, UK. andoni.toms@nnuh.nhs.uk

Skeletal Radiology
|May 15, 2010
PubMed
Summary

Midcarpal instability (MCI) involves abnormal wrist joint motion due to ligament injuries. Diagnosis and management remain challenging due to complex classifications and imaging limitations.

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Last Updated: Jun 13, 2026

Metacarpal Small Incision for Carpal Tunnel Syndrome
04:08

Metacarpal Small Incision for Carpal Tunnel Syndrome

Published on: April 5, 2024

Area of Science:

  • Orthopedics
  • Sports Medicine
  • Radiology

Background:

  • Midcarpal instability (MCI) is abnormal carpal motion at the wrist's midcarpal joint, a type of non-dissociative carpal instability (CIND).
  • It stems from complex extrinsic ligament injuries, leading to varied subtypes like palmar midcarpal instability (PMCI), dorsal, or ulnar MCI.
  • Existing theories, terminology, and classifications for MCI are often competing and overlapping, complicating diagnosis.

Purpose of the Study:

  • To review the complex nature of midcarpal instability (MCI).
  • To discuss the diagnostic challenges and current imaging modalities for MCI.
  • To explore treatment options for unstable carpal articulations.

Main Methods:

  • Review of existing literature on midcarpal instability (MCI) and its subtypes.
  • Discussion of conventional radiography, stress radiography, videofluoroscopy, dynamic ultrasound (US), MR arthrography, and CT arthrography.
  • Analysis of treatment strategies including limited carpal arthrodesis, capsulorrhaphy, and ligament reconstruction.

Main Results:

  • Conventional radiographs often show only non-specific volar intercalated segment instability (VISI) patterns.
  • Stress radiography and videofluoroscopy are traditional tools for assessing carpal instability and kinematics.
  • Dynamic US can reveal midcarpal dyskinesia, while MR/CT arthrography can identify ligament tears, though intact but redundant ligaments are difficult to visualize.

Conclusions:

  • Midcarpal instability (MCI) presents diagnostic challenges due to complex injury patterns and classification systems.
  • While various imaging techniques exist, their precise roles in diagnosing, categorizing, and managing MCI require further determination.
  • Treatment options range from surgical fusion to ligament repair, depending on the specific instability and injury.