Scapholunate instability is an example of CID and is the most frequent form of carpal instability.5 Scapholunate instability refers to a spectrum of conditions including the following: subtle instability without overt anatomic disruption but with insufficient load-bearing capacity; dynamic instability that occurs only under load; static instability with full dislocation/rotary subluxation of the scaphoid; and scapholunate advanced collapse (SLAC).
Very rarely the pisiform may be dislocated without fracture and displaced radially. The bone sticks out, more or less for different people. Grip strengthening can also be introduced at this time. Diagnostic and therapeutic local anesthetic and corticosteroid injections can be particularly helpful in obtaining the correct diagnosis and in providing pain relief. This is caused by partial or complete disruption of the intrinsic interosseous ligaments. Or if you have a specific question or concern about this or any aspect of your or your family’s health, you can get back in touch via our Ask the Expert service, available around the clock, 365 days a year, whenever and wherever you need us. Examination of the pisiform is performed quite easily by loading the subpisiform joint laterally as with the thumb CMC joint.
Our approach is to observe whether the fracture is nondisplaced. Because of the rarity of acutely diagnosed pisiform fracture, there are no well-defined guidelines for optimal treatment. Ulnar nerve irritation may occur, because the pisiform makes up the ulnar wall of Guyon's canal.4 Conservative treatment involves 3 to 6 weeks of cast immobilization. During the acute phase of fracture healing, instruct the client in AROM exercises of all the uninvolved joints of the injured arm to minimize stiffness and reduce swelling.
Non-displaced or minimally displaced fractures of the hamate are treated with rigid immobilization for 6 weeks.
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