ISSN 2380-2995 (Online)
ISSN 2380-2987 (Print)


Ronald W. Lindsey, MD
Zbigniew Gugala, MD, PhD

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Midcarpal Instability: Unlocking the Secrets of the Wrist

David M. Lichtman, MD[1]; William F. Pientka II, MD[2]

[1] Department of Orthopaedic Surgery, University of North Texas Health Science Center; Fort Worth, TX, USA
[2] Department of Orthopaedic Surgery, John Peter Smith Hospital; Fort Worth, TX, USA

Corresponding Author: William F. Pientka II, MD
Department of Orthopaedic Surgery
John Peter Smith Hospital
1500 S Main St.
Fort Worth, TX 76104

DOI: 10.18600/toj.020205


Our attempt to understand the pathology leading to midcarpal instability (MCI) over the previous 40 years has allowed us to not only better describe the pathomechanics of the condition, but also guide treatment decisions, and even propose a theory of carpal kinematics which seems to describe multiple carpal instability patterns. Pathology of the dorsal radiotriquetral ligament (DRT) has been identified as an etiology for MCI, and reefing of this ligament is now the recommended surgical treatment. Furthermore, nonsurgical proprioceptive training allows for the avoidance of surgical intervention for many patients with MCI. We describe our experience with MCI, from our earliest patient encounters, from which we gained insight into the importance of the DRT, to the observation that nonsurgical symptomatic management with functional splinting and proprioceptive training could alleviate many patient complaints and allow for a return to full activity.

Level of Evidence: V; Descriptive review/Expert opinions.

Keywords: Midcarpal instability; Carpal kinematics; Dorsal radiotriquetral ligament; Wrist.