Instability of the Wrist: Kinematics and Functional Anatomy

Carpal kinematics, normal and abnormal, centre on the role of the proximal carpal row, an intercalated segment within the wrist joint. When stability to this segment is impaired by injury or disease, symptoms of weakness, instability or pain may be present, especially with compressive loading of the wrist associated with forearm and hand axial rotation. Treatment of carpal instability is difficult, but can be improved by a systematic approach to the critical factors of acuity, severity, direction, location, aetiology, and pattern. Hand therapists can play an important role in the treatment of carpal instability, and an understanding of the mechanics of carpal instability should help therapists better manage their patients with this difficult problem.