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New Concepts in Carpal Instability

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Wrist and Elbow Arthroscopy with Selected Open Procedures

Abstract

Our understanding of carpal stability and kinematics continues to evolve through research and clinical experience. Conventional thinking relies on the belief that the interosseous ligaments of the proximal carpal row maintain stability primarily whilst other intercarpal and extrinsic structures act as secondary stabilisers.

However, cadaveric sectioning studies have suggested that changes in carpal alignment secondary to proximal row instability manifest only after concomitant injury or late attenuation of supporting intrinsic and extrinsic ligaments, in particular those inserting onto the lunate. The structures formerly known as secondary stabilisers are more appropriately termed ‘critical stabilisers’ of the carpus.

This chapter discusses new concepts in carpal stability as briefly outlined above exploring in particular the dorsal intrinsic and extrinsic critical stabilisers, that is, dorsal radiocarpal and dorsal intercarpal ligaments and their broad insertions onto the dorsal lunate (bare area). In doing so we offer an algorithm-based approach to investigation, treatment and how best to approach the dorsal carpus without worsening instability iatrogenically.

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Authors and Affiliations

  1. Brisbane Hand and Upper Limb Research Institute, Brisbane, QLD, Australia

    Senthooran Raja, Daniel Williams, Gregory Couzens & Mark Ross

  2. Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia

    Senthooran Raja, Daniel Williams, Gregory Couzens & Mark Ross

  3. Hand and Upper Extremity Service, Department of Orthopedic Surgery, The Hospital for Special Surgery, New York, NY, USA

    Scott W. Wolfe

  4. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia

    Gregory Couzens

  5. The University of Queensland, St. Lucia, QLD, Australia

    Mark Ross

Authors
  1. Senthooran Raja
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  2. Daniel Williams
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  3. Scott W. Wolfe
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  4. Gregory Couzens
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  5. Mark Ross
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Corresponding author

Correspondence to Mark Ross .

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Editors and Affiliations

  1. Division of Hand and Upper Extremity Surgery Section of Arthroscopic Surgery and Sports Medicine, Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA

    William B. Geissler

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Raja, S., Williams, D., Wolfe, S.W., Couzens, G., Ross, M. (2022). New Concepts in Carpal Instability. In: Geissler, W.B. (eds) Wrist and Elbow Arthroscopy with Selected Open Procedures. Springer, Cham. https://doi.org/10.1007/978-3-030-78881-0_14

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  • DOI: https://doi.org/10.1007/978-3-030-78881-0_14

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78880-3

  • Online ISBN: 978-3-030-78881-0

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