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Updated: Feb 16, 2026

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Dorsal Wrist Plication for Midcarpal Instability.

Herbert P von Schroeder1

  • 1Division of Orthopaedic Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada; Division of Plastic and Reconstructive Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada.

The Journal of Hand Surgery
|December 16, 2017
PubMed
Summary

Immobilization alone did not resolve chronic wrist pain from midcarpal instability (MCI). Surgical capsular plication showed promise for young females with ligament laxity, but was less effective in men with posttraumatic instability.

Keywords:
Carpal instabilityhypermobilitymidcarpal instabilitysurgical plication

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Musculoskeletal Disorders

Background:

  • Midcarpal instability (MCI) is a significant cause of chronic wrist pain.
  • Treatment options for MCI remain controversial, necessitating further investigation into effective algorithms.

Purpose of the Study:

  • To evaluate the efficacy of a treatment algorithm for midcarpal instability.
  • The algorithm included initial immobilization followed by surgical interventions if necessary.

Main Methods:

  • Prospective enrollment of 23 patients (27 wrists) with symptomatic MCI.
  • Initial treatment involved 6 weeks of immobilization, followed by surgical dorsal capsular plication for recurrence.
  • A 4-corner arthrodesis was performed for cases refractory to surgical plication.

Main Results:

  • Immobilization provided only temporary relief for most patients, with symptoms returning upon mobilization.
  • Surgical capsular plication led to significant improvements in grip strength and patient-rated wrist evaluation scores.
  • Outcomes were most favorable in young female patients with hypermobility and minor trauma, while men with significant posttraumatic injuries showed poorer results.

Conclusions:

  • Immobilization alone is insufficient for managing chronic wrist pain due to MCI.
  • Surgical capsular plication is a viable option for specific patient demographics, particularly young females with ligamentous laxity.
  • Posttraumatic instability in men presents a challenge, with capsular plication demonstrating limited effectiveness in this subgroup.