Carpal Instability

Symptoms of Carpal Instability

Symptoms include:

• Pain in the wrist when gripping or performing weight-bearing activities.
• Swelling or tenderness around the wrist area.
• Feeling of weakness or instability in the wrist.
• Clicking, popping, or clunking sensations when moving the wrist.
• Reduced range of motion.
  In advanced or untreated cases, this can lead to stiffness, arthritis, and loss of function over time.

What Causes Carpal Instability?

Trauma or a fall on an outstretched arm can cause wrist ligament damage, resulting in carpal instability. Ligaments are the tissues that connect bones to other bones. They consist of several fibers, and one or all of them can be affected.

When a complete ligament injury happens, it means that all the fibers have been torn. Additionally, carpal instability might be the result of a wrist bone fracture or degenerative arthritis.

Diagnosis of Carpal Instability

Diagnosis begins with a detailed medical history and physical examination.

Imaging studies may include:

• X-rays (both normal and stress or clenched fist views)
• MRI to check the condition of the ligaments
• CT to give you a precise view of the carpal alignment and fractures
• Targeted clinical tests help identify which ligament is most likely involved.

When imaging studies are inconclusive, diagnostic wrist arthroscopy is still the most accurate method to assess subtle ligament injuries.

Treatment of Carpal Instability

Conservative treatment options may include:

• Medication to reduce inflammation or relieve pain.
• Changing activities and avoiding motions that cause pain.
• Use a wrist splint or cast for immobilization.
• The hand physiotherapy through exercises aimed at improving the sensing of hands, strengthening, and stabilization.
• Corticosteroid injections in certain cases.

When conservative treatment fails or the case is of a serious, unstable situation, surgical treatment is the main method of consideration. The surgery will be based on the location, type, and severity of the ligament damage, and might be:

• To fix or rebuild the damaged ligament
• The insertion of K-wires or pins in the carpal bones for temporary stabilization
• Removal of the damaged tissue through the arthroscopic or open method
• Partial wrist fusion or salvage procedures in arthritis cases

A cast for a few weeks supports your wrist. Your physical therapist will teach you specific exercises to help you recover sooner. You should regularly follow up with your surgeon. You may return to normal activities after a few months with your surgeon’s approval.