[Instability of the wrist joint--diagnosis and therapy]

Wrist-joint instability can be caused by injuries to ligaments or bones, it can be intermittent or permanent. Clinical symptoms and pain sensations are non-characteristic. The X-ray findings are the clue to the diagnosis. In this article recommendations are given for exact X-ray positions of the hand and their evaluation. The classification of instability is corresponding to the X-ray findings. Further investigations like radiographs under stress, dynamic investigations or the arthrography of the wrist-joint can be helpful to find out the exact pathologic changes. They are variable and are ranging from dysharmonic movement to a complete destruction of the carpal bones. Treatment is according to the pathologic changes and their causes. Fresh ligamentous injuries (e.g. additional injuries to a Colles' fracture or a perilunate luxation) should not be discarded lightly. Most cases we saw presented very late, the patients showed already osteoarthritic changes of the carpal bones with destruction of the cartilage. The late results of ligamentous reconstructions have not fulfilled their expectations, the current trend is towards a partial arthrodesis of the carpal joints in order to reconstruct the joint stability under preservation of partial mobility. This method of treatment has certain disadvantages: Pathologic wrist-joint movements, impingement syndromes and undue stress reactions within the neighbouring joints. Recommendations for the different indications are given.