Carpal Instability - Wrist Ligament Injury 

Introduction
Carpal instability occurs when the small bones in the wrist move out of position and compromise joint functioning.  This may result when the ligaments that hold the bones together are torn or when the bones are fractured or affected by arthritis.  Carpal instability causes ongoing pain and the loss of wrist functioning.  Symptoms may improve with nonsurgical and surgical methods.

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Anatomy
Your wrist complex contains several small carpal bones.  The bones are aligned in two rows.  A complex set of ligaments connect the bones.  Your carpal bones and the two bones in your forearm form several joints in your wrist.  The joints allow movement and position and change the shape of your hand.  Your wrist joints function to position your hand and fingers for precise movements, such as handwriting, and for gripping, such as holding onto a steering wheel.

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Causes
Carpal instability occurs when the carpal bones move out of position.  Chronic ligament weakening, as with arthritis, or ligament injury, such as from a fall, can cause malalignment of the carpal bones.  Carpal bone fractures and deterioration contribute to carpal instability.  When the carpal bones are not aligned accurately, the joints are unstable and may not function properly.

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Symptoms
Carpal instability can cause ongoing pain in your wrist.  You may experience a snapping or hear a clicking noise when you move your hand from side to side.  Your hand and wrist may feel weak and stiff.  You may be unable to use them for activities.  Over time, your hand may develop arthritis.

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Diagnosis
Your doctor can diagnose carpal instability by reviewing your medical history and performing an examination.  If you experienced a wrist injury, you should tell your doctor about how it occurred. 

Your doctor will feel the ligaments and bones in your hand to pinpoint the source of pain.  Your doctor will maneuver the carpal bones to diagnose specific areas of instability. 
Your hand will be X-rayed to determine the position and condition of the carpal bones.  You may receive other imaging tests, such as computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, arthrograms and ultrasound.
Your doctor will classify the instability pattern of your carpal bones.  There are several types of carpal instability patterns, including dissociative carpal instability, nondissociative carpal instability, ulnar translocation, and dorsal subluxation.  Dissociative carpal instability results in instability between the carpal bones that are within a row.  Nondissociative carpal instability is instability that occurs between the two rows of carpal bones.  Ulnar translocation describes a shift in the carpal bones to the little finger side of the hand.  Ulnar translocation can result from rheumatoid arthritis.  Dorsal subluxation describes an upward shift in the carpal bones that can occur after a wrist fracture.
 
Carpal instability is further classified as static or dynamic.  Static instability is apparent on an X-ray when the hand is motionless.  If a doctor can move the carpal bones during maneuvering tests, it is termed a dynamic carpal instability.

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Surgery
There are several types of surgery for carpal instability.  The type of surgery you receive depends on your condition.  Surgery is used to repair and reconstruct ligaments.  Ligaments can be reconstructed with transferred tendons.  Joints may be fused together and bones may be reshaped to provide support and relieve pain.
 
Arthroscopic surgery is commonly used to treat carpal instability.  An arthroscope is a very small surgical instrument.  It contains a lens and lighting system that allows a surgeon to view inside a joint.  The surgeon only needs to make small incisions and the joint does not have to be opened up fully.  A miniature camera attached to an arthroscope allows a surgeon to view and record the magnified images on a video screen.  Thin surgical instruments are inserted for surgery.  An arthroscope may be used to reconstruct, trim, and repair torn ligaments.

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Treatment
Treatment is specific to the type of carpal instability that you experience.  Treatment depends on many factors, including the condition of the ligaments and bones, and the location of the instability.  Treatment of carpal instability can be a complex process.  Some types of carpal instability are treated with splinting, but most types of carpal instability require surgery.  Your doctor will discuss your condition and the most appropriate treatment options with you.
 
Surgery to repair carpal instability is followed by a period of immobilization with a splint or cast.  You will participate in therapy following immobilization after surgical or non-surgical treatment.  Initially, your hand will feel stiff and possibly swollen.  A therapist will move your joints to help reduce swelling and ease discomfort.  This is assisted by the use of various modalities, such as heat, ultrasound and Fluidotherapy.  When you have achieved full range of motion, you will begin strengthening exercises.  Your therapist will also teach you how to improve your hand coordination and prevent future injuries.

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Recovery
Recovery is an individualized process.  The length of your recovery time and your outcome may depend on the type of injury you sustained and the type of treatment that you received.  Your doctor will let you know what to expect.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.