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Ulnar midcarpal instability-clinical and laboratory analysis

D M Lichtman, J R Schneider, A R Swafford

    The Journal of Hand Surgery
    |September 1, 1981
    PubMed
    Summary

    Ulnar midcarpal instability presents as a painful wrist click. Surgical stabilization of the triquetrohamate joint effectively resolved instability in patients with this condition.

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    Area of Science:

    • Orthopedics
    • Hand Surgery
    • Biomechanics

    Background:

    • Ulnar midcarpal instability is characterized by specific clinical signs and symptoms.
    • Patients often report a painful wrist click exacerbated by ulnar deviation, axial compression, and pronation.
    • Standard X-rays are typically normal, necessitating advanced imaging for diagnosis.

    Purpose of the Study:

    • To describe the clinical presentation and pathomechanics of ulnar midcarpal instability.
    • To evaluate the efficacy of conservative and surgical interventions for this condition.
    • To highlight the importance of recognizing midcarpal instability and differentiating it from other carpal dissociations.

    Main Methods:

    • Clinical observation of patients with characteristic wrist symptoms.
    • Diagnostic imaging including routine X-rays and cinefluoroscopy.
    • Laboratory studies to elucidate the pathomechanics of instability.
    • Surgical intervention focusing on the triquetrohamate joint for stabilization.

    Main Results:

    • Cinefluoroscopy revealed proximal and distal carpal row dissociation with a dorsiflexion collapse deformity.
    • Conservative therapy was successful in six patients.
    • Surgical stabilization of the triquetrohamate joint provided relief in four patients.
    • Pathomechanics involve dorsal subluxation of the capitate and hamate on the lunate and triquetrum.

    Conclusions:

    • Ulnar midcarpal instability may be underdiagnosed and often confused with more common carpal instabilities.
    • Triquetrohamate joint stabilization is an effective surgical option for managing midcarpal instability.
    • Understanding the pathomechanics is crucial for accurate diagnosis and treatment.

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