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J Wrist Surg 2021; 10(02): 094-101
DOI: 10.1055/s-0040-1714688
Special Review Article

Demystifying Palmar Midcarpal Instability

Shan Shan Jing
1   Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, United Kingdom
,
Gemma Smith
1   Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, United Kingdom
,
Subodh Deshmukh
1   Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, United Kingdom
› Author Affiliations Funding None.
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Abstract

Palmar midcarpal instability is an uncommon condition diagnosed clinically with a painful pathognomonic clunk on terminal ulnar deviation of the wrist. Various causes have been described, but congenital laxity of the carpal ligaments is thought to be a key contributor. Treatment commences with conservative measures. This includes proprioceptive training based on more recent concepts on the sensorimotor function of the wrist. When these measures plateau, surgery is considered. The lack of high-level evidence and consensus on its cause continue to hamper our understanding and knowledge of this condition. The purpose of this review is to examine the current evidence to conceptualize this mysterious, yet infrequent phenomenon, and to provide an algorithm on its management.

Keywords

midcarpal - instability - chronic - hypermobility - arthrodesis - proprioception

Authors' Contributions

S.S.J. acquired, analyzed, and interpreted majority of the data and primary contributor to the manuscript including its concept and design. G.S. reviewed 10 articles and revised the manuscript critically. S.D. is the senior author who provided intellectual support and revised the manuscript critically.


Ethical Approval

The authors declare that no ethical approval was required for this article. Also, no informed consent was required for this article.




Publication History

Received: 17 May 2020

Accepted: 15 June 2020

Article published online:
27 August 2020

© 2020. Thieme. All rights reserved.

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