Carpal Instability and Carpal Injuries

SUMMARYCarpal instability or collapse deformities of the carpus are a poorly recognised radiological entity. The spectrum of these lesions includes painful non‐united scaphoid fractures, rotatory subluxations of the scaphoid, post‐arthritic degenerative changes and acute “wrist sprains”. The collapse patterns can be subdivided into two types:—Dorsiflexion carpal instabilityPalmarflexion carpal instability.In the acute form, the radiological appearances may be non‐specific if normal carpal relationships are maintained in standard wrist projections. The use of six standard projections is advocated in diagnosis with accurate lateral radiographs and with the hand in a true neutral position. Serial examinations may be required to make the diagnosis, possibly augmented with lateral views using carpal compression or motion studies of the wrist. Patients with acute and chronic “wrist sprains” and “carpal tunnel” syndrome should be energetically investigated with the purpose of diagnosing collapse deformities and instituting the appropriate orthopaedic treatment.