Dr. Mark E. Pruzansky
Dr. Jason S. Pruzansky
975 Park Avenue New York, NY 10028

Carpal Instability

What is Carpal Instability?

Carpal instability is a condition in which an injury – such as a Fall On an Outstretched Hand (aka: FOOSH) which may occur in football, basketball, hockey or skiing – has distorted the alignment of the wrist bones, whether through a:

Another condition known as Ulnar Carpal Instability occurs when the normal mechanics of the wrist are disrupted due to misalignment of the three bones on the pinky side of the wrist. Falling on an outstretched hand with a twisting motion causes this injury to the many ligaments on the medial side of the wrist.

The nature, location, and origin of instability determines how the carpal instability is classified. Younger patients frequently experience ligament tears while older patients typically have degenerative ligament tears related to calcium crystal deposits, rheumatoid arthritis, and other chronic pain conditions.

There is a high potential for arthritis with carpal ligament tears and fractures.

Symptoms of Carpal Instability

Symptoms of carpal instability commonly include:

  • Weakness of the wrist
  • Tenderness
  • Clicking, snapping, or clunking noise (with certain movements)
  • Sensation of the wrist “giving way”

Symptoms of carpal instability can sometimes occur with or without pain.

Common Causes of Carpal Instability

There are several different causes that can lead to carpal instability including:

  • Acute traumatic events
  • Chronic repetitive stress
  • Microcrystal deposits

Acute traumatic events are one of the most common causes of carpal instability can include:

There are a range of injuries resulting from a fall on an outstretched hand, the severity of which are determined by the force, rate, point of impact, and the position of the wrist when the injury occurs.

Wrist sprains are also very common and can result in carpal instability. They are typically due to a blow or impact that can result in tears or ruptures of one or more of the carpal ligaments.

Diagnosing Carpal Instability

Speaking with you to carefully understand what your pain feels like, where it is felt, and what exacerbates it, is essential. A thorough physical exam is also required to accurately make the diagnosis of the underlying cause of the carpal instability.
Stress test are often used to identify which carpal ligaments are affected by the injury. These type of tests are used to reproduce the pain or instability by stressing the ligaments.

However, an injured wrist is often swollen and very tender which makes it difficult to accurately diagnose the exact ligament injury.

Medical imaging, such as an x-ray or MRI, and arthroscopy are often helpful when diagnosing carpal instability.

Every carpal instability injury has different consequences making it imperative to correctly identify which ligaments are injured which determines the appropriate course of treatment.

If left undiagnosed carpal instability can lead to:

  • Limited movement
  • Degenerative arthritis
  • Chronic pain
  • Disability

Treatment Options for Carpal Instability

Early treatments include occupational and physical therapy, immobilizing the wrist or ligament repair; older and more severely disabling instances of the condition require arthroscopically assisted reconstructive surgery.

The carpal region is very complex making it difficult to treat wrist injuries so, selecting the best treatment relies on the expertise and experience of your hand specialist. Carpal instability can have several different causes.

When carpal instability does not respond to conservative treatments, surgical treatments are the best option. Physical therapy is used to regain movement and flexibility post-surgery.


Carpal instability can present in many ways and be caused by many things. Call Dr.Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis.