Demystifying Palmar Midcarpal Instability

Jing, Shan Shan; Smith, Gemma; Deshmukh, S. C.

doi:10.1055/s-0040-1714688

Cited by 5 publications

(4 citation statements)

References 50 publications

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“…The diagnosis of midcarpal instability is essentially clinical. [45][46][47] The role of imaging methods is limited to excluding other pathologies as the origin of symptoms. 48 The four main categories of midcarpal instability are palmar, dorsal, combined, and adaptive.…”

Section: Midcarpal Instabilitymentioning

confidence: 99%

“…Volar midcarpal instability is the most common type and generally related to injury to the ulnar arm of the arcuate ligament (triquetrum-hamate-capitate ligament) and the dorsal radiocarpal ligament. [45][46][47] The sudden changes in carpal alignment that occur in midcarpal instability are a useful diagnostic sign in videofluoroscopy and four-dimensional dynamic CT. In static palmar midcarpal instability, a nondissociative VISI pattern is observed with an increase in the capitolunate angle (> 30 degrees) in the lateral radiographic projection with a normal scapholunate angle (30-60 degrees).…”

Section: Midcarpal Instabilitymentioning

confidence: 99%

“…Soft tissue reconstructions and thermal stabilization with laser or thermal wands show a high failure rate in treating midcarpal instability. [45][46][47]…”

Section: Midcarpal Instabilitymentioning

confidence: 99%

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Postoperative Imaging of Ulnar Wrist Pain

Cerezal

Llopis

Canga

et al. 2021

Semin Musculoskelet Radiol

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Ulnar wrist pain, caused by a broad spectrum of bone and soft tissue injuries, is the most common clinical condition of the wrist. Multiple surgical techniques and their variants in the treatment of these injuries are constantly evolving. Postoperative evaluation of the wrist for many surgeons is limited to serial clinical and radiographic monitoring. However, imaging methods such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and arthrographic techniques (arthrographic CT and arthrographic MRI) play a fundamental role in diagnosing and managing postsurgical complications.The several critical aspects in evaluating the postsurgical wrist imaging spectrum are familiarity with the surgical techniques, knowledge of the original clinical problem, understanding the strength and limitations of the different radiologic modalities, and effective communication between surgeon and radiologist.

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Section: Midcarpal Instabilitymentioning

confidence: 99%

Section: Midcarpal Instabilitymentioning

confidence: 99%

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Postoperative Imaging of Ulnar Wrist Pain

Cerezal

Llopis

Canga

et al. 2021

Semin Musculoskelet Radiol

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“…Most authors advocate a period of nonoperative treatment of 3 to 6 months including activity modification, splints including ulnar boost splints designed to support the supinated carpus, and proprioception and strengthening exercises, with a limited role for steroid injection. 4,5 Should nonoperative measures fail, an array of surgical techniques have been described, including historically partial wrist fusion, or ligament reconstruction and reinforcement via tendon transfer or tenodesis. These have variable reported results in the literature, and a recent vogue has arisen for arthroscopic capsular shrinkage (ACS), as a less invasive and lower morbidity option with quick recovery and good subjective patient-reported and objective outcomes.…”

mentioning

confidence: 99%

Arthroscopic Capsular Shrinkage Is Safe and Effective in the Treatment of Midcarpal Instability in a Pediatric Population: A Single-Center Experience of 51 Cases

2022

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Objective Treatment of palmar midcarpal instability (PMCI) remains controversial and children can develop PMCI from asymptomatic hypermobility. Recently, case series have been published regarding the use of arthroscopic thermal shrinkage of the capsule in adults. Reports of the use of the technique in children and adolescents are rare, and there are no published case series. Methods In a tertiary hand center for children's hand and wrist conditions, 51 patients were treated with arthroscopy for PMCI between 2014 and 2021. Eighteen out of 51 patients carried additional diagnosis of juvenile idiopathic arthritis (JIA) or a congenital arthritis. Data were collected including range of movement, visual analog scale (VAS) at rest and with load, and grip strength. Data were used to determine the safety and efficacy of this treatment in pediatric and adolescent patients. Results Mean follow-up was 11.9 months. The procedure was well tolerated and no complications were recorded. Range of movement was preserved postoperatively. In all groups VAS scores at rest and with load improved. Those who underwent arthroscopic capsular shrinkage (ACS) had significantly greater improvement in VAS with load, compared with those who underwent arthroscopic synovectomy alone (p = 0.04). Comparing those treated with underlying JIA versus those without, there was no difference in postoperative range of movement, but there was significantly greater improvement for the non-JIA group in terms of both VAS at rest (p = 0.02) and VAS with load (p = 0.02). Those with JIA and hypermobility stabilized postoperatively, and those with JIA with signs of early carpal collapse and no hypermobility achieved improved range of movement, in terms of flexion (p = 0.02), extension (p = 0.03), and radial deviation (p = 0.01). Conclusion ACS is a well-tolerated, safe, and effective procedure for PMCI in children and adolescents. It improves pain and instability at rest and with load, and offers benefit over open synovectomy alone. This is the first case series describing the usefulness of the procedure in children and adolescents, and demonstrates effective use of the technique in experienced hands in a specialist center. Level of Evidence This is a Level IV study.

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