- Estágios de Lichtman
The distal carpal row, as a fixed unit, is connected medially to the triquetrum (link A) and laterally to the scaphoid (link B). These two bones are connected to the lunate by means of two more links (links C
and D). Failure of any one of these four ligamentous links is likely to result in an alteration of motion or load transfer coordination or both
- Classificação de Mayo
- - I: Instabilidade cárpica dissociativa
- - II: Instabilidade cárpica não dissociativa
- - III: Instabilidade cárpica combinada ou complexa (dissociativa e não dissociativa)
- - IV: Carpo adaptativo
- Mayfield Instabilidade perisemilunar
- Estágio I: Fratura de escafóide ou dissociação escafo-semilunar ou ambas
- Estágio II: Falha do capitato semilunar
- Estágio III: Falha do piramidal semilunar
- Estágio IV: Falha ligamentar radiocarpal dorsal que permite luxação semilunar
Mayfield JK, Johnson RP, Kilcoyne RK: Carpal dislocations: pathomechanics and progressive perilunar instability, J Hand Surg [Am] 5:226-241, 1980
- 1. Dinâmico: Não pode ser demonstrado com RX
- 2. Estático
- 2 mm entre o escafóide e semilunar
- intervalo aumenta com posição de punho fechado
- Sinal do duplo anel
- 3. Com artrite degenerativa
- 4. Secundário a outra doença como Kienböck
- Larsen - Instabilidade Carpal
- Classificação Artroscópica Lesão Carpal - Geissler
Attenuation/hemorrhage of interosseous ligament seen from the radiocarpal joint; no incongruency of carpal alignment in the midcarpal space
Attenuation/hemorrhage of interosseous ligament seen from the radiocarpal joint; incongruency/step off seen from midcarpal space; slight gap (less than the width of a probe) between carpals may be present
Incongruency/step off of carpal alignment seen in radiocarpal and midcarpal space; probe may be passed through the gap between carpals
Incongruency/step off of carpal alignment seen in radiocarpal and midcarpal space; gross instability with manipulation noted; 2.7-mm arthroscope may be passed through the gap between carpals
Geissler WB, Freeland AE, Savoie FH, et al: Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius, J Bone Joint Surg Am 78:357-365, 1996
- Luxação Radio-carpal - Dumontier
Type I includes patients with a pure radiocarpal dislocation, without an associated fracture of the distal radius.
Type II involves a radiocarpal dislocation with an avulsion fracture of the radial styloid, which contains the origin of the palmar radioscaphoid and radioscaphoidcapitate ligaments
- Instabilidade Médiocarpal
I, In anterior midcarpal instability, the whole proximal row appears abnormally flexed in the lateral view.
II, Posterior midcarpal instability has normal alignment in standard radiographs, but abnormal midcarpal subluxation when a dorsally directed force (arrow) is applied.
III, In combined radiocarpal and midcarpal instability, both joints are abnormally subluxable in a palmar and dorsal direction, usually the consequence of increased global laxity.
IV, Adaptive dysfunction secondary to an extracarpal problem, usually a malunited distal radius, may produce a similar dysfunction as in midcarpal instabilities
- Colapso EscafoSemilunar - Krakauer
- Krakauer JD, Bishop AT, Cooney WP: Surgical treatment of scapholunate advanced collapse, J Hand Surg 19A:751, 1994. Copyright Mayo Clinic.