Wrist instability and arthritis

The wrist is a complex joint with multiple articulations allowing a multi-planar range of movement. This review will focus on the role of the radiocarpal and midcarpal joint in wrist function and subsequent consequences of pathological instability. Instability of the wrist is most commonly seen in the proximal carpal row, which is inherently more mobile and therefore has a higher propensity for injury to its stabilizing ligaments. This then alters the biomechanics of the wrist and leads to uneven loading through articular surfaces. If left untreated this progresses to predictable patterns of arthritis. Treatment options for instability are dependent on the chronicity of the instability and whether the affected ligaments are reparable or require a reconstruction. Any established arthritic changes make addressing the ligament issue alone futile and management should focus instead on the pain generating degenerative joints. Management algorithms have been formulated to aid decision making for surgical treatment of both wrist instability and arthritis.