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Kinematics and Pathophysiology of Carpal Instability

  • Alan E. FreelandEmail author
  • William B. Geissler
Chapter

Abstract

The intricacies of normal and abnormal wrist kinesiology continue to be revealed as we transition from specific static sagittal and frontal (coronal) two-dimensional evaluations to dynamic “out of plane” (global) 3-diimensional analyses and from unloaded to loaded investigations. Image, study-design, and nomenclature standardizations will help to minimize, or even eliminate, misinterpretation and misunderstandings of carpal positions. We have learned that many of the daily activities of human wrist function are performed in the functional (mechanical) dart thrower’s coupled wrist pathway rather than in the anatomic sagittal and frontal planes. Forearm, wrist, hand, and articular contact position at the moment of impact; point of impact; columns; rows; individual carpal bones; amount, direction, and rate of the applied and resistance forces; individual bone and articular cartilage morphology and containment; and viscoelastic ligament properties and relative strengths, especially in the PCR, interact to provide various multiplanar global wrist motions and play a role in injury susceptibility. Each of these parameters allows some measure of integral static and continuous dynamic quantification for biometric analysis, comparisons, communication, and management of carpal bone and ligament injuries as we unravel the comprehensive three-dimensional geometrics of normal and abnormal carpal motion with and without loading. Our composite of information continues to accumulate.

Arthroscopy has been, and will continue to be, instrumental by directly identifying specific ligament injuries and carpal instabilities and their extent. This has been especially true of the scapholunate interosseous ligament, the primary stabilizer, and most frequently injured ligament of the wrist joint, and in assessing the extent of progressive radial- and ulnar-sided perilunar instability. The degree of articular cartilage damage, chondromalacia, or arthrosis, if present, can also be evaluated. This chapter includes video.

Keywords

Wrist Flexion Ulnar Deviation Carpal Instability Ulnar Styloid Fracture Midcarpal Joint 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 9.1

Arthroscopic management of carpal instability (MP4 85,233 kb)

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© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and RehabilitationUniversity of Mississippi Medical CenterBrandonUSA

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