Central carpal instability-capitate lunate instability pattern: diagnosis by dynamic displacement

Eleven patients have been diagnosed as having a central carpal instability that has, to our knowledge, not been previously described. The clinical symptom complex is one of pain and clicking in the region of the midcarpus and, at times, frank snapping, usually while lifting heavy objects. Tight grasping, especially in supination, tends to provoke the symptoms. In ten of the patients, the diagnosis of instability was demonstrated by a dynamic traction displacement technique with the aid of fluoroscopy, in one patient the instability pattern was recognized only at the time of surgical exploration of the carpus. One patient has undergone a surgical procedure to reinforce the dorsal ligamentous support at the capitate lunate area. The other ten patients have become asymptomatic as a result of modifying their activities. The capitate lunate instability pattern (CLIP wrist) is a definite and distinct entity, which may be diagnosed with appropriate studies.