Carpal Instability

The wrist is a complex system involving bones, ligaments, muscles and nerve endings which are working coordinately in an effort to adapt to our needs. A traumatic damage to any of these may cause a symptomatic condition, which may prevent the carpus from fulfilling our necessities. However, not all traumatic events cause carpal instability. A low trauma may cause a mild ligament injury, which could be initially compensated by secondary stabilizers. On the contrary, a more severe trauma may generate dreadful lesions that may be closer to collapse. Accordingly, carpal dysfunction defines this condition in a better way, as it implies any degree of traumatic injury. The carpus is constantly moving and receiving loads. This is the reason why in the face of an undetected or untreated injury, this situation may progress with time leading to situations with worse prognosis. Scapholunate (SL) is the most common type of carpal dysfunction, followed by lunotriquetral (LT) and palmar proximal row dysfunction. Nevertheless, there are many others to be considered. Because of the wide variety of lesions and the inherent complexity of this disorder, managing carpal dysfunction is still a challenge. Understanding wrist anatomy, biomechanics and physiopathology together with a thorough clinical assessment is fundamental in the diagnosis and treatment of this affliction. Besides, and not less important, there are patient related features which need to be taken into account when dealing with carpal dysfunction, such as age, personal medical history and functional requirements. The aim of this chapter is to help the reader to try to understand this condition and provide a guide to recognize and manage the most common types of carpal dysfunction.