Midcarpal Instability: The Role of Wrist Arthroscopy.

The evidence behind management options for midcarpal instability (MCI) is scarce, relying solely on case series. Established treatments cause significant loss of wrist motion. As understanding of the condition has progressed, surgeons have been trying soft tissue techniques. The treatment option should be chosen for the appropriate type and grade of MCI. The Hargreaves grading system for palmar MCI aids treatment decision-making. A possible role for arthroscopy in treatment of MCI has been developed using arthroscopic thermal capsular shrinkage, appropriate for cases with dynamic instabilities. Static deformities require a soft tissue reconstruction or a partial wrist fusion.

Arthroscopic thermal capsular shrinkage for palmar midcarpal instability.

Background Arthroscopic capsular shrinkage has been previously used to stabilize major joints. This is the first series of its use in the wrist for palmar midcarpal instability (PMCI). Materials and Methods This is a medium-term retrospective review of 13 patients (15 wrists) at an average follow-up of 48 months postoperative. All patients were assessed with a functional questionnaire for instability and a Disabilities of the Arm, Shoulder, and Hand (DASH) score, as well as clinical examination. Description of Technique Arthroscopic capsular shrinkage was performed to the palmar and dorsal capsules of the radiocarpal and midcarpal joints using a bipolar thermal probe. All wrists were immobilized for 6 weeks post operation. Results 100% follow-up was achieved . All cases had an improvement in the frequency and severity of instability symptoms. The average DASH score was significantly reduced. There were no complications. The average loss of movement following the procedure was 15%. Conclusions The medium-term results show that wrist instability due to PMCI can be improved significantly by thermal capsular shrinkage with only a minimal amount of secondary stiffness.

Tabletop relocation test: a new clinical test for posterolateral rotatory instability of the elbow.

We describe a new clinical test for the assessment of posterolateral rotatory instability. This has been assessed in 8 patients who have been diagnosed with posterolateral rotatory instability. Of these, 6 have undergone surgical reconstruction of the lateral ulnar collateral ligament, and the clinical test has subsequently been negative with resolution of their symptoms.

Table top relocation test--New clinical test for posterolateral rotatory instability of the elbow.

We describe a new clinical test for assessment of posterolateral rotatory instability. This has been assessed in 8 patients who have been diagnosed with posterolateral rotatory instability. Six of these have undergone surgical reconstruction of the lateral ulnar collateral ligament, and the clinical test has subsequently been negative with resolution of their symptoms.