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Dorsal wrist pain with or without a palpable dorsal wrist ganglion is a common complaint. Watson developed the concept of the dorsal wrist syndrome (DWS) which is an entity encompassing pre-dynamic rotary subluxation of the scaphoid and the overloaded wrist. We reviewed 20 cases of DWS treated surgically. There were nine males (11 wrists) and nine females (nine wrists). Post-operative follow-up ranged from five to 67 months (mean, 37 months). At operation, we observed SLL tears in eight wrists and dorsal ganglia in 12 cases. Following surgery, 12 cases reported being pain free, five had mild pain, two moderate pain and one case reported severe pain. Post-operative extension/flexion was 73/70 average. Post-operative grip strength was 28 kg average. We believe that excision of the posterior interosseous nerve and the dorsal capsule including the ganglion, if present, provides pain relief in DWS.

We report a case of carpal instability complex, which presented apparent volar intercalated segmental instability (VISI) caused by acute injury. Proper diagnosis and treatment by ligament repair and Kirschner wire fixation yielded good clinical results.

Isolated dorsal scapholunate reconstruction may be inadequate to stabilize and restore physiological scapholunate kinematics in the setting of combined dorsal and palmar ligamental incompetence. To address this entity, a combined reconstruction that encompass both dorsal and palmar scapholunate reconstruction was performed in 20 patients followed up to 19.8 (6–84) months. Compared to the contralateral wrist, the results were extension (67 ± 1.6 to 85.7%, p < 0.01), flexion (84.5 ± 3.2 to 81 ± 2.3%, p = 0.38), grip strength (62 ± 1.6 to 88.3 ± 1.9%, p < 0.01), and pain score (rest: 1.55 ± 0.26 to 0.2 ± 0.09, p < 0.01; activity: 3.2 ± 0.09 to 0.4 ± 0.17, p < 0.01). Based on Mayo wrist score, five excellent, 13 good, and two fair results were reported.

Management of scapholunate (SL) instability remains controversial. The modified Brunelli procedure is a soft tissue procedure that recreates the stabilising forces of the SL ligament using a split flexor carpi radialis tendon graft passed from volar to dorsal via a tunnel in the distal pole of the scaphoid. Thirteen consecutive patients with an average age of 35 years underwent the modified Brunelli procedure. Pain improved from a mean visual analog score of eight preoperatively to 1.5. The DASH score improved from a preoperative score of 55.4 to 34.9 as did the grip strength from 40% to 75% respectively. All wrist ranges of motion were decreased post-operatively in particular wrist flexion. SL ligament reconstruction using the modified Brunelli procedure resulted in satisfactory outcomes. Post-operatively patients were relatively pain free, with improved grip strength. The range of motion was reduced postoperatively, however did not restrict return to work or premorbid activities.

Injury to the lunotriquetral ligament can result in midcarpal instability, with resultant alterations in normal wrist kinematics and subsequent arthrosis. We performed a previously undescribed technique of lunotriquetral ligament reconstruction in two patients utilizing a palmaris longus tendon autograft. Average age at presentation was 24 years old with a mean follow up of 10 months. Average range of motion was 62.5° of flexion and 57.5° of extension. Total arc of motion was 83% of the contralateral uninvolved extremity. Average grip strength was 31 kg which was 91% of the contralateral extremity. Average Quick Disability of Arm, Shoulder and Hand score was 12.5 and Modern Activity Subjective Survey of 2007 was 1.5. No complications were noted.

We experienced a rare case of carpal tunnel syndrome and rupture of the flexor digitorum profundus tendon to the index finger with a scapholunate advanced collapse wrist. We speculated that the lunate that had extruded into the carpal tunnel compressed the median nerve and caused wear of the flexor tendon following neglected perilunate subluxation. Carpal tunnel release, opponensplasty by palmaris longus tendon transfer, and a bridge graft by a half-slip of the flexor carpi radialis tendon resulted in recovery of pinch function and improvement in numbness of the hand.

Background: Previous studies have discussed the diagnostic value of four dimensional kinematic CT in cases of carpal instabilities. This analysis compares calculated skin doses of 4D CT and conventional cineradiography of the wrist in cases of suspected SLL rupture.

Methods: Retrospective calculation and interpolation of skin doses and effective doses for ten consecutive 4D CT examinations and 41 cineradiographies for suspected lesions of the scapholunate ligament. Standardised anterior-posterior and lateral cine sequences using a flat-panel digital subtraction imager and of 4D kinematic CT using a dual-source scanner were acquired and acquisition parameters recorded. We tested if the skin dose of 4D CT is different from cineradiography.

Results: Median dose area product (DAP) of cineradiography was 135.34 cGycm² resulting in a calculated median skin dose of 32.6 mSv (confidence interval 26.86–42.90 mSv) and an estimated effective skin dose of 3.26 µSv. CT dose index (CTDI) for 4D examinations was recorded to be 26.79 mGy and the dose-length product (DLP) was 150 mGy × cm. This resulted in an estimated skin dose of 34 mSv, which is covered by the confidence interval of cineradiography, and an effective skin dose of 3.4 µSv.

Conclusions: Skin dose calculations are comparable for 2D cineradiography in two plains and 4D kinematic CT of the wrist. Calculated effective doses are < 0.01 mSv.