TOPIC:

Hi

I am new to this site and came across it when doing a google search for mid carpal instability.

I have had wrist pain for a couple of years now with no cause factor with both wrists affected (right more than left).

Physiotherapy didn't help and nor did steroid injections (apart from a few weeks relief) and splinting was also little help but very limiting.

Last year after xrays, MRI and an arthroscopy my consultant diagnosed R wrist dequervains tendinitus and arthritis along my carpal bones (especially scaphoid, trapezium and trapezoid).

This resulted in me having a dequervains release and a joint replacement of the STT joint.

Now nearly a year later my wrist movement is approximately half of what it should be and all movement of the wrist towards the end of range is painful, as is lifting any weight and I have very weak grip strength.

This consultant had all but given up on me not knowing why my movement and pain hadn't improved but referred me to another consultant.

I saw this consultant today and he mentioned that I may well have mid carpal instability and is planning another MRI to try to confirm it and plan future treatment.

It has been a great help to read all the information you have posted on here and to hear other people's stories.

It is so limiting to have this almost constant pain in your wrists it has affected me and my life so profoundly in a way I do believe others fully understand.

Thank you for providing me with what I needed just now. Julie<br><br>Post edited by: Scott_1984, at: 2008/01/29 16:46

Hiya Julie

This is an excellent website creadted by Karl Dean & I run 2 forums on Ablehere.Com - RSD/CRPS & Carpal Instability Support & Depression/Mental Health Issues.

I am very glad you've found this website & these forums

I'm a Mid Carpal Instability (MCI) suffer in my left hand/wrist & I Completely understand the Pain/Discomfort, Clunking, Snapping, & Popping/Clicking movements/sensations, & disability it causes.

Another way to see if you have Mid Carpal Instability (Carpal Instability), without having another Wrist Arthroscopy Surgery, is to ask for an detailed VideoFluoroscopy & Stress X-Rays of both your hands/wrists to see if you suffer from Mid Carpal Instability (Carpal Instability).

Most soft tissue injuries/disablities will never show up on plan X-rays & they will only be obvious like in 5 - 10 years time, when the bones/joints have moved totally out of place or normal range.

So in other words soft tissue will never show up on a plan X-rays & its only years later that the hospital might notice there could be a soft tissue injury/disability, as all the bones have moved out of normal range/aliment.

Wrist Instability/Carpal Instability (MCI/PMCI) Chat: www.ablehere.com/component/option,com_jo...iew/id,1974/catid,47

What Is Midcarpal Instability (Wrist Instability/Carpal Instability)?: www.ablehere.com/component/option,com_jo...iew/id,1162/catid,47

Post edited by: Scott_1984, at: 2008/01/27 05:18

Hiya Julie

Your new surgeon might suggest, another Wrist-Arthroscopy for this surgeon to diagnosis the levels of Wrist Instability Patterns, he may also seek for an detailed VideoFluoroscopy, Stress X-rays, & possible an MRI-Scan.

Most MRI-Scans are Pointless in detecting soft tissue damage/Carpal Instability in your hands/wrists.

So the gold standard for detecting & diagnosing Carpal Instability is: Wrist Arthroscopy & Physical Eaxminations/Tests of the hands/wrists, & these Physical Eaxminations/Tests won't be very nice, but I'am sure you may have had some of these carried out before.

One Eaxmination/Test for Wrist Instability Is: Watson's Test: en.wikipedia.org/wiki/Watson%27s_test

This Website Show An Series Of Ways For Detecting & Diagnosing Wrist Instability/Carpal Instability & More Detail Of Carpal Instability: www.maitrise-orthop.com/corpusmaitri/ort...h/dumontier_us.shtml & www.maitrise-orthop.com/corpusmaitri/ort...3_saffar/index.shtml

Sadly there's no cure for Carpal Instability & it's still sadly poorly misunderstood, so the treatments are limited & very Controversial & Experimental.

Most treatments would involve:

1. Physiotherapy/Exercise to the Fingers, Hands, Wrists, & Upper-Limbs, & Grip/Strengthening Exercises for your Hands/Wrists/Fingers & this could go on for weeks/months/years.

2. Wrist Splints for use day & night, Except for Baths/Showers & Washing Up, & twice a day plus Physiotherapy/Exercises. (You'd most probably be advised to wear the wrist splint for 6 - 8 weeks every day/night, Except for Baths/Showers & Washing Up, & twice a day plus Physiotherapy/Exercises) (Or you might have to wear the wrist spint for life or until an successful stabilizing wrist operation)

3. Hot & Cold Therapy, Painkillers, Heat Pads, & Counselling, all theses would be used to try to deal/cope with the Pain/Discomfort in your hands/wrists.

4. Just carry on with the above treatments & hope you can live with the consent Pain/Discomfort & Wrist Disability.

5. Look into the Controversial & Experimental Wrist Operations for stabilizing/fusing the hands/wrists, in the hope of increasing grip/strength in your hands/wrists & the hope to get rid of the Pain/Discomfort. (Sadly all Wrist Operations for Mid Carpal Instability, aren't cures & there's no guarantee to improve Pain/Discomfort in the hands/wrists & all operations will involve some decrease of mobility in your hands/wrists I.E. Bending/Flexing, but would hopefully improve strength/grip)<br><br>Post edited by: Scott_1984, at: 2008/01/27 17:30

wristinstability.multiply.com/journal/item/9

The first description of a “snapping wrist,” diagnosed as anterior midcarpal subluxation, was recorded in 1934, although “dorsal luxation of the capitate” had been presented in a congress in Paris in 1919.

However, it was Lichtman’s paper in 1981 that brought this particular condition to the attention of our profession.<br><br>Post edited by: Scott_1984, at: 2009/02/08 10:41

wristinstability.multiply.com/journal/item/14

Abstract: \"This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist.

Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated.

Instability occurs either if the carpus is unable to sustain physiologic loads (\"dyskinetics\") or suffers from abnormal motion of its bones during movement (\"dyskinematics\").

In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns.

It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being \"occult\" for the radiologic assessment.

This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages.

Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability.

To prevent individual and socio-economic implications, the handsurgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.\"<br><br>Post edited by: Scott_1984, at: 2009/02/08 10:40

A Slide Show Of Information, Surgeries, Therapiesa, & More, On Carpal Instability: www.slideshare.net/hoc/carpal-instability

Hiya Julie

Here's an list of Wrist Operations for Mid Carpal Instability:

1. Wrist Ligament Tightening Operation, with or without the use of K-wires, followed by 3 months in an hard cast & then a wrist splint & Physiotherapy/Exercises & grip/strengthening Exercises. (Standard Wrist Operation For Mid Carpal Instability, & will/might limit mobility/bending slightly if successful & may get rid of the Clunk/Snap if successful)

www.donaldsammut.com/wrist_lig_injury.htm

www.evans-hand.com/wrist_lig_injury.htm

2. Limited Wrist Fusion (Controversial & has been around since at least: 1981 & has no chances of successfully getting rid of Chronic Pain/Discomfort, but has an high success of getting rid of the Clunk/Snap I.E. The Carpal Instability, but your wrist would become very stiffer & you'd have limited flexing/bending & mobility in your hands/wrists)

3. Full Wrist Fusion (Controversial & has been around since at least: 1981 & has no chances of successfully getting rid of Chronic Pain/Discomfort, but has an high success of getting rid of the Clunk/Snap I.E. The Carpal Instability, but you wouldn't be able to bend/flex or move you hand left to right, you'd only be able to bend your fingers/make a fist & then your whole arm would bend from the elbow, but these improvements would mean you could lift 1 - 2 Kilograms or more for more than 10 minutes & without the aid of an wrist splint)

4. Arthroscopic thermal capsulorrhaphy for palmar midcarpal instability/Thermal Capsulorrhaphy for Midcarpal Instability (New, Controversial & Experimental, Only been carried out by 4 Uk Hand Surgeons on 20 - 40 patients, in the Uk that I am aware of since: April 2001 - late: 2007, it's been fairly successful, but it may need to be re-done every few years & the long term results/studies are still to be published)

However, further study is necessary to determine the safety and long-term efficacy of this procedure given the recognized complications of thermal capsular shrinkage in the shoulder (recurrent instability, capsular ablation, nerve damage, and chondrolysis): www.assh.org/AM/Template.cfm?Section=Jou...&ContentID=11869 & groups.msn.com/PalmarMidcarpalInstabilit...=4675656732359796979

Contains Pictures Of An Operated Hand/Wrist Limited/Full Wrist Fusions: www.pncl.co.uk/~belcher/information/Wrist%20fusion.pdf & www.emedicine.com/orthoped/topic367.htm

Information/Websites On Limited/Full Wrist Fusions: www.nnuh.nhs.uk/docs%5Cleaflets%5C558.pdf

www.handuniversity.com/topics.asp?Topic_ID=32

www.allaboutarthritis.com/AllAboutArthri...ist_Joint_Fusion.htm

www.eorthopod.com/public/patient_educati...55/wrist_fusion.html

www.netdoctor.co.uk/ate/musclesjoints/202746.html

Post edited by: Scott_1984, at: 2008/01/27 17:16

Hi Again Julie

Some surgeons might say that your suffering from Hypermobility/Hypermobility Syndrome, as you've said you suffer from Pain/Discmofort in both your hands/wrists, more your right hand/wrist, than your left hand/wrist.

This might not be the case for yourself, but it does happen.

Information On Hypermobility/Hypermobility Syndrome: www.ablehere.com/component/option,com_jo...iew/id,1222/catid,47

Also some Uk/World Consultant Orthopeadic & Trauma Hand & Upper-Limb Surgeons & Doctors/Consultants, choose to either ignore this disability & it's causes & effects, or say it's in your head.

Either because they no little about it or only look for signs in the X-rays & won't carry out any Physical Eaxminations/Tests on your hands/wrists, to see/reveal the early signs of Carpal Instability/Wrist Instability.

Quotes From - MUSCULOSKELETAL - Carpal Instability: wristinstability.multiply.com/journal/item/14

Instability occurs either if the carpus is unable to sustain physiologic loads (\"dyskinetics\") or suffers from abnormal motion of its bones during movement (\"dyskinematics\").

& It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being \"occult\" for the radiologic assessment.

& Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability.

To prevent individual and socio-economic implications, the handsurgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.\"

& Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated.

More Information Carpal Instability/Wrist Instability, Can Be Found At: www.ablehere.com/component/option,com_jo...iew/id,1162/catid,47 & wristinstability.multiply.com/notes/item/6 & msngroup.aimoo.com/PalmarMidcarpalInstabilityPMCIRSD

Post edited by: Scott_1984, at: 2009/02/08 10:39

Hi Again Julie

I can't wait for you to come back online & log into: Ablehere.Com - www.Abelehere.Com :)

I also can't wait to learn more about what your new surgeon will diagnosis you with & hers/his advice on treatments, & so on.

If you'd like to see more stories from fellow Mid Carpal Instability Suffers, Please Visit: Wrist Instability/Carpal Instability (MCI/PMCI) Chat: www.ablehere.com/component/option,com_jo...iew/id,1974/catid,47 & read Michelle's (yarnsbaby1) story, when she joined my msn support group last year & said she will be joining Ablehere.Com real soon :)

Her direct stories/replies can be found at: wristinstability.multiply.com/notes/item/6 & msngroup.aimoo.com/PalmarMidcarpalInstabilityPMCIRSD

Post edited by: Scott_1984, at: 2009/02/08 10:37

Hiya Again Julie

This is for yourself & other Ablehere.Com Members/Users & Visitors/Guests.

Mid Carpal Instability can/has gone by many names & there are many different types/forms of Wrist Instability Patterns, so I've added a list of these Wrist Instability Patterns or the names Mid Carpal Instability may also be called.

Mid Carpal Instability (MCI)/Palmar Midcarpal Instability (PMCI) also known as:

Ulnar Midcarpal Instability,
CLIP-Wrist,
Wrist Instability,
Capitolunate Instability Patterns,
Capito Lunate Instability Pattern,
Ulnocarpal Instability,
Midcarpal Instability,
Mid Carpal Instability (MCI),
Palmar Midcarpal Instability (PMCI),
Carpal Instability,
Inter-Carpal Instability,
Scaphoid Instability,
Capitolunate Scaphoid Instability,
Wrist Sprains,
Wrist Pain,

Wrist Instability/Wrist Operations Stories: Websites: wristinstability.multiply.com/notes/item/6 & msngroup.aimoo.com/PalmarMidcarpalInstabilityPMCIRSD

timmerduder.com/lornaarm.htm (Full wrist Fusion

timmerduder.com/kellyarm.htm (Limited Wrist Fusion & Wrist Operation)

timmerduder.com/shortarm.htm (Ulnar Shortening & Wrist Operation)

timmerduder.com/stepharm.htm (Ulnar Shortening & Wrist Operation)

timmerduder.com/anaarm.htm (Ulnar Shortening & Wrist Operation)<br><br>Post edited by: Scott_1984, at: 2009/02/08 10:36

I've had another possible MCI/PMCI Suffer contact Me, At: wristinstability.multiply.com/journal/it...y_Pain_-_Jack_L_Rook - There Multiply.Com Site is: auntkracker.multiply.com

I also found this online too, American Occupational Therapy Association - Inc - Mid Carpal Instability Advice Forum: otconnections.aota.org/forums/p/2471/33952.aspx

Post edited by: Scott_1984, at: 2009/07/25 22:32