Abstract
The wrist is disposed to a variety of instability patterns owing to its complex anatomical and biomechanical properties. Various classification schemes have been proposed to describe the different patterns of carpal instability, of which the Mayo classification is the most commonly used. Understanding the concepts and pertinent terminology of this classification scheme is important for the correct interpretation of images and optimal communication with referring physicians. Standard wrist radiographs are the first line of imaging in carpal instability. Additional information may be obtained with the use of stress radiographs and other imaging modalities.
Similar content being viewed by others
References
Linscheid RL, Dobyns JH. Dynamic carpal stability. Keio J Med. 2002;51:140–7.
Wolfe SW, Garcia-Elias M, Kitay A. Carpal instability nondissociative. J Am Acad Orthop Surg. 2012;20:575–85.
Carlsen BT, Shin AY. Wrist instability. Scand J Surg. 2008;97:324–32.
May O. The pisiform bone: sesamoid or carpal bone? Ann Chir Main Memb Super. 1996;15:265–71.
Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972;54:1612–32.
Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am. 2012;37:2175–96.
Loredo RA, Sorge DG, Garcia G. Radiographic evaluation of the wrist: a vanishing art. Semin Roentgenol. 2005;40:248–9.
Shin AY, Battaglia MJ, Bishop AT. Lunotriquetral instability: diagnosis and treatment. J Am Acad Orthop Surg. 2000;8:170–9.
Taleisnik J. The ligaments of the wrist. J Hand Surg. 1976;1A:110–8.
Schmitt R, Froehner S, Coblenz G, Christopoulos G. Carpal instability. Eur Radiol. 2006;16:2161–78.
Theumann NH, Etechami G, Duvoisin B, Wintermark M, Schnyder P, Favarger N, et al. Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations. Radiology. 2006;238:950–7.
Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part II. J Hand Surg Am. 2005;30:24–34.
Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am. 2007;32:297–309.
Ruby LK, Cooney III WP, An KN, Linscheid RL, Chao EY. Relative motion of selected carpal bones: a kinematic analysis of the normal wrist. J Hand Surg Am. 1988;13:1–10.
Kauer JM. The interdependence of carpal articulation chains. Acta Anat (Basel). 1974;88:481–501.
Horii E, Garcia-Elias M, An KN, Bishop AT, Cooney WP, Linscheid RL, et al. A kinematic study of luno-triquetral dissociations. J Hand Surg Am. 1991;16:355–62.
Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology. 1992;184:15–24.
Jedlinski A, Kauer JMG, Jonsson K. X-ray evaluation of the true neutral position of the wrist: the groove for extensor carpi ulnaris as a landmark. J Hand Surg Am. 1995;20:511–2.
Levis CM, Yang Z, Gilula LA. Validation of the extensor carpi ulnaris groove as a predictor for the recognition of standard posteroanterior radiographs of the wrist. J Hand Surg Am. 2002;27(2):252–7.
Schmitt R, Lanz U. Diagnostic imaging of the hand. 1st ed. Stuttgart: Thieme; 2007. p. 4–5.
Yang Z, Mann FA, Gilula LA, Haerr C, Larsen F. Scaphopisocapitate alignment: criterion to establish a neutral lateral view of the wrist. Radiology. 1997;205:865–9.
Gilula LA. Carpal injuries: analytic approach and case exercises. AJR Am J Roentgenol. 1979;133:503–17.
Viegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am. 1990;15A:564–71.
Gilula LA, Weeks PM. Post-traumatic ligamentous instabilities of the wrist. Radiology. 1978;129:641–51.
Sarrafian SK, Melamed JL, Goshgarian GM. Study of wrist motion in flexion and extension. Clin Orthop Relat Res. 1977;126:153–9.
Schmitt R, Lanz U. Diagnostic imaging of the hand. 1st ed. Stuttgart: Thieme; 2007. p. 269–92.
Truong NP, Mann FA, Gilula LA, Kang SW. Wrist instability series: increased yield with clinical-radiologic screening criteria. Radiology. 1994;192:481–4.
Lee SK, Desai H, Silver B, Dhaliwal G, Paksima N. Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model. J Hand Surg Am. 2011;36:1149–57.
Lawand A, Foulkes GD. The “clenched pencil” view: a modified clenched fist scapholunate stress view. J Hand Surg Am. 2003;28:414–20.
Gilula LA, Yin Y. Imaging of the wrist and hand. Philadelphia: Saunders; 1996. p. 373–84.
Cooney WP, Linscheid RL, Dobyns JH. The wrist: diagnosis and operative treatment. St. Louis: Mosby; 1998. p. 490–500.
Resnick D, Niwayama G. Carpal instability in rheumatoid arthritis and calcium pyrophosphate deposition disease. Ann Rheum Dis. 1977;36:311–8.
Schmitt R, Heinze A, Fellner F, Obletter N, Strühn R, Bautz W. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol. 1997;25:92–103.
Drewniany JJ, Palmer AK, Flatt AE. The scaphotrapezial ligament complex: an anatomic and biomechanical study. J Hand Surg Am. 1985;10:492–8.
Watson HK, Ashmead IV D, Makhlouf MV. Examination of the scaphoid. J Hand Surg Am. 1988;13:657–60.
Nathan R, Blatt G. Rotary subluxation of the scaphoid. Revisited. Hand Clin. 2000;16:417–31.
Taleisnik J. Classification of carpal instability. Bull Hosp Jt Dis Orthop Inst. 1984;44:511–31.
Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am. 2002;27:991–1002.
Ruby LK, An KN, Linscheid RL, Cooney 3rd WP, Chao EY. The effect of scapholunate ligament section on scapholunate motion. J Hand Surg Am. 1987;12:767–71.
Linn MR, Mann FA, Gilula LA. Imaging the symptomatic wrist. Orthop Clin North Am. 1990;21:515–43.
Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am. 1980;5:226–41.
Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9A:358–65.
Watson H, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res. 1986;202:57–67.
Weiss KE, Rodner CM. Osteoarthritis of the wrist. J Hand Surg Am. 2007;32:725–46.
Stahelin A, Pfeiffer K, Sennwald G, Segmuller G. Determining carpal collapse: an improved method. J Bone Joint Surg Am. 1989;71:1400–5.
Viegas SF, Patterson RM, Peterson PD, Pogue DJ, Jenkins DK, Sweo TD, et al. Ulnar-sided perilunate instability: an anatomic and biomechanic study. J Hand Surg Am. 1990;15:268–78.
Reagan DS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg Am. 1984;9:502–14.
Garcia-Elias M, Dobyns JH, Cooney III WP, Linscheid RL. Traumatic axial dislocations of the carpus. J Hand Surg Am. 1989;14:446–57.
Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res. 1987;214:136–47.
Weiss AC, Berger RA. Hand surgery. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 534–47.
Garcia-Elias M, An KN, Cooney WP, Linscheid RL, Chao EY. Transverse stability of the carpus. J Orthop Res. 1989;7:738–43.
Shin AY, Glowacki KA, Bishop AT. Dynamic axial carpal instability: a case report. J Hand Surg Am. 1999;24:781–5.
Reinsmith LE, Garcia-Elias M, Gilula LA. Traumatic axial dislocation injuries of the wrist. Radiology. 2013;267:680–9.
Lichtman DM, Wroten ES. Understanding midcarpal instability. J Hand Surg Am. 2006;31:491–8.
Sawardeker PJ, Kindt KE, Baratz ME. Fracture-dislocations of the carpus: perilunate injury. Orthop Clin North Am. 2013;44:93–106.
Johnson RP. The acutely injured wrist and its residuals. Clin Orthop Relat Res. 1980;149:33–44.
Bain GI, McLean JM, Turner PC, Sood A, Pourgiezis N. Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept. J Hand Surg Am. 2008;33:1770–6.
Herzberg G, Comtet JJ, Linscheid RL, Amadio PC, Cooney WP, Stalder J. Perilunate dislocations and fracture-dislocations: a multicenter study. J Hand Surg Am. 1993;18:768–79.
Taleisnik J. Current concepts review. Carpal instability. J Bone Joint Surg Am. 1988;70:1262–8.
Dumontier C, Meyer ZU, Reckendorf G, Sautel A, Lenoble E, Saffar P, et al. Radiocarpal dislocations: classification and proposal for treatment: a review of twenty-seven cases. J Bone Joint Surg Am. 2001;83A:212–8.
Moneim MS, Bolger JT, Omer GE. Radiocarpal dislocation—classification and rationale for management. Clin Orthop. 1985;192:199–209.
Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology. 2001;219:11–28.
Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986;206:202–10.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors indicate that they have no conflicts of interest.
Financial disclosures
None.
Rights and permissions
About this article
Cite this article
Kani, K.K., Mulcahy, H. & Chew, F.S. Understanding carpal instability: a radiographic perspective. Skeletal Radiol 45, 1031–1043 (2016). https://doi.org/10.1007/s00256-016-2390-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-016-2390-y