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Updated: Aug 1, 2025

Metacarpal Small Incision for Carpal Tunnel Syndrome
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Midcarpal Instability.

Remy V Rabinovich1, Omar F Rahman, Matthew H Nasra

  • 1New York Hand & Wrist Center of Lenox Hill, New York, NY (Rabinovich, Polatsch, and Beldner), Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, CA (Rahman), Department of Orthopaedic Surgery, Lenox Hill Hospital - Northwell Health, New York, NY (Nasra).

The Journal of the American Academy of Orthopaedic Surgeons
|April 27, 2023
PubMed
Summary
This summary is machine-generated.

Midcarpal instability (MCI) involves abnormal wrist joint force transmission, causing pain and instability. Treatment ranges from conservative methods to surgical interventions like ligament repair or fusions.

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Biomechanics

Background:

  • Midcarpal instability (MCI) encompasses diverse conditions characterized by abnormal force transmission across the midcarpal joint.
  • This can lead to painful wrist motion, a distinct "catch-up clunk" sensation, and overall instability.
  • Normal wrist mechanics rely on extrinsic and intrinsic ligaments, along with dynamic joint forces for smooth, reciprocal motion.

Purpose of the Study:

  • To review the clinical entities, diagnosis, and management of midcarpal instability.
  • To outline current non-surgical and surgical treatment options for symptomatic MCI.

Main Methods:

  • A comprehensive review of the literature on midcarpal instability.
  • Discussion of diagnostic criteria including history, physical examination, and imaging.
  • Analysis of various conservative and surgical management strategies.

Main Results:

  • Diagnosis requires a detailed clinical assessment and appropriate imaging.
  • Non-surgical management includes activity modification, physical therapy, orthotics, medications, and injections.
  • Surgical options vary based on severity, including arthroscopic capsulorrhaphy, ligament repair/reconstruction, radial osteotomies, and partial wrist fusions.

Conclusions:

  • Mild to moderate MCI often benefits from capsulorrhaphy or ligament repair.
  • Osteotomies address bony deformities contributing to instability.
  • Severe or recurrent cases, or those with fixed deformities, may require partial wrist arthrodesis.