Midcarpal instability

Area of Science:

• Orthopedics
• Hand Surgery
• Biomechanics

Background:

• Midcarpal instability (MCI) is a wrist condition affecting the proximal and distal carpal rows.
• It is considered relatively rare and often does not require surgical intervention.
• Palmar MCI is the most common subtype, characterized by a painful, clunking wrist.

Purpose of the Study:

• To review the diagnosis and classification of midcarpal instability.
• To discuss current and proposed staging methods for palmar midcarpal instability.
• To outline existing treatment options for midcarpal instability.

Main Methods:

• Clinical diagnosis using provocative tests for midcarpal instability.
• Review of imaging and arthroscopic findings in excluding other pathologies.
• Description of a proposed functional staging scheme for palmar midcarpal instability.

Main Results:

• Diagnosis of palmar MCI is primarily clinical, with provocative tests being key.
• Standard imaging and arthroscopy are useful for excluding other conditions but not for definitive MCI diagnosis.
• A functional staging system is proposed due to the functional nature of the instability.

Conclusions:

• Midcarpal instability, particularly the palmar type, presents with specific clinical signs.
• Accurate classification and staging are evolving, with a functional approach proposed.
• Treatment options exist but are based on limited evidence due to the condition's rarity.