Midcarpal Instability

Higgin, Ryan P.C.; Hargreaves, D. G.

doi:10.1016/j.hcl.2017.06.003

Cited by 13 publications

(2 citation statements)

References 31 publications

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“…The wrist may be considered unique as postoperative splinting is technically easy and does not confer significant functional loss to patients during the splinting period. 6 The procedure is considered more acceptable to patients and families as a result. In a small cohort series of 13 adult patients (average age 28) almost all patients improved significantly at a mean of 42 months' follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…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. 6,7 The volar wrist ligaments are intimately related to the capsule, and despite the procedure title the intention is to shrink the ligaments themselves, as opposed to applying thermal instruments to the capsule which risks perforation and damage to the structures more superficial to it.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%