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Updated: Dec 10, 2025

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Imaging of Carpal Instabilities.

Jan-Peter Grunz1, Carsten Herbert Gietzen1, Katharina Grunz1

  • 1Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany.

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Summary

Carpal instability, a wrist dysfunction, requires early diagnosis to prevent osteoarthritis. Imaging techniques like MRI and CT arthrography are crucial for identifying ligament damage and guiding treatment.

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Area of Science:

  • Orthopedics and Sports Medicine
  • Radiology
  • Anatomy

Background:

  • Carpal instability encompasses wrist conditions where the carpus loses its normal motion and load-bearing capacity.
  • It is classified into four types: dissociative, non-dissociative, complex, and adaptive.
  • Dissociative carpal instability, the most prevalent form, is further divided into dorsal or palmar intercalated segment instability based on the affected interosseous ligament.

Purpose of the Study:

  • To review the various types of carpal instability, their underlying pathophysiology, and clinical manifestations.
  • To discuss the diagnostic utility of different imaging modalities.
  • To outline established treatment strategies in relation to current scientific literature.

Main Methods:

  • Literature review of carpal instability entities, pathophysiology, and clinical presentation.
  • Analysis of diagnostic significance of various imaging methods.
  • Evaluation of established treatment options for different instability forms.

Main Results:

  • Traumatic lesions of the scapholunate interosseous ligament are the primary cause of carpal instability.
  • Carpal instability can be dynamic (occurring during motion) or static (occurring at rest).
  • Imaging methods such as stress imaging, fluoroscopy, MRI, and CT/MR arthrography are vital for diagnosis, with MRI and CT/MR arthrography offering direct visualization of ligament damage.

Conclusions:

  • Prompt diagnosis and treatment of carpal instability are critical to prevent the development of carpal osteoarthritis.
  • Distinguishing between dissociative and other forms of carpal instability is essential for appropriate management.
  • Traumatic injuries and calcium pyrophosphate dihydrate (CPPD) arthropathy are common underlying causes of carpal instability.