Diagnóstico y Manejo de la Inestabilidad del Carpo. Revisión de la literatura
Palabras clave:
inestabilidad del carpo, ligamentos, diagnóstico, manejo
Resumen
La inestabilidad del carpo se puede definir como la falta de capacidad de dicha articulación en poder soportar cargas fisiológicas provocando las subluxaciones. De origen multifactorial y habitualmente difícil de diagnosticar. Debido a esto se presenta la clasificación Mayo logrando clasificar a la inestabilidad carpiana en cuatro categorías: disociativa, no disociativa, compleja y adaptativa. Uno de los métodos diagnósticos más eficaces es la radiología utilizando modalidades de imagen avanzadas como la tomografía computarizada y la resonancia magnética sin embargo un manejo adecuado del paciente y de sus resultados dependen directamente de la interpretación precisa del estudio de imagen. Si bien el tratamiento conservador puede ser efectivo en casos leves, las lesiones más graves, especialmente en la inestabilidad carpiana disociativa, requieren intervención quirúrgica para prevenir el deterioro funcional y el desarrollo de complicaciones a largo plazo.
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Andersson, J. (2017). Treatment of scapholunate ligament injury: Current concepts. EFORT open reviews, 2(9), 382-393. doi: https://doi.org/10.1302/2058-5241.2.170016
De Filippo, M., Sudberry, J., Lombardo, E., Corradi, M., Pogliacom, F., Ferrari, F., . . . Zompatori, M. (2006). Pathogenesis and evolution of carpal instability: imaging and topography. Acta bio-medica : Atenei Parmensis, 77(3), 168-180. Obtenido de
https://pubmed.ncbi.nlm.nih.gov/17312988/
Dietrich, T., Toms, A., Cerezal, L., Omoumi, P., Boutin, R., Fritz, J., . . . Pracoń, G. (2021). Interdisciplinary consensus statements on imaging of scapholunate joint instability. European radiology, 31(12), 9446-9458. doi: https://doi.org/10.1007/s00330-021-08073-8
Ferreira Branco, D., Bouvet, C., Hamard, M., Beaulieu, J., Poletti, P., & Boudabbous, S. (2022). Reliability of radio-ulnar and carpal alignment measurements in the wrist between radiographs and 3D imaging. European journal of radiology, 154. doi:
https://doi.org/10.1016/j.ejrad.2022.110417
Gondim Teixeira, P., Rouizi, K., Moustache-Espinola, P., Romain, G., Hossu, G., Athlani, L., & Blum, A. (2022). Imaging assessment of dorsal scaphoid displacement in patients with scapholunate ligament tears: what is the best option for quantitative assessment?. European radiology, 32(5), 3121-3120. doi: https://doi.org/10.1007/s00330-021-08446-z
Grunz, J., Gietzen, C., Grunz, K., Bley, T., & Schmitt, R. (2021). Imaging of Carpal Instabilities. Bildgebende Diagnostik karpaler Instabilitäten. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 193(2), 139-150. doi:
https://doi.org/10.1055/a-1219-8158
Grunz, J., Gietzen, C., Kunz, A., Weng, A., Veyhl-Wichmann, M., Ergün, S., . . . Gassenmaier, T. (2020). Twin Robotic X-Ray System for 3D Cone-Beam CT of the Wrist: An Evaluation of Image Quality and Radiation Dose. American journal of roentgenology, 214(2), 422-427. doi: https://doi.org/10.2214/AJR.19.21911
Harwood, C., & Turner, L. (2016). Conservative management of midcarpal instability. The Journal of hand surgery, 41(1), 102-109. doi: https://doi.org/10.1177/1753193415613050
Hearon, B., Frantz, L., Helsper, E., & Morris, H. (2024). Experience with Diagnosis and Management of Distal Radioulnar Joint Instability. Journal of wrist surgery, 10(5), 392-400. doi: https://doi.org/10.1055/s-0041-1726408
Ibitayo, A., & Beckmann, N. (2021). Imaging evaluation of traumatic carpal instability. Emergency radiology, 28(2), 349-359. doi: https://doi.org/10.1007/s10140-020-01839-5
Kashiyama, T., Miura, T., Sugawara, R., & Uehara, K. (2020). Ultrasonographic Classification of Scapholunate Interosseous Ligament Injury Associated With Distal Radius Fracture. The Journal of hand surgery, 45(12). doi: https://doi.org/10.1016/j.jhsa.2020.05.021
Malahias, M., Roumeliotis, L., Nikolaou, V., Chronopoulos, E., Sourlas, I., & Babis, G. (2021). Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial. Cartilage, 12(1), 51-61. doi: https://doi.org/10.1177/1947603518805230
Okoro, C., Skalski, M., Patel, D., White, E., & Matcuk, G. (2023). Imaging Diagnosis and Management of Carpal Trauma and Instability-An Illustrated Guide. Life, 13(7), 1426. doi: https://doi.org/10.3390/life13071426
Puig de la Bellacasa, I., Salva-Coll, G., Esplugas, M., Quintas, S., Lluch, A., & Garcia-Elias, M. (2022). Bilateral Ulnar Deviation Supination Stress Test to Assess Dynamic Scapholunate Instability. The Journal of hand surgery, 47(7), 639-644. doi: https://doi.org/10.1016/j.jhsa.2022.02.021
Rachunek, K., Springer, F., Barczak, M., Kolbenschlag, J., Daigeler, A., & Medved, F. (2022). An algorithmic diagnostic approach to scapholunate ligament injuries based on comparison of X-ray examinations and arthroscopy in 414 patients. ournal of plastic, reconstructive & aesthetic surgery, 75(9), 3293-3303. doi: https://doi.org/10.1016/j.bjps.2022.04.083
Redeker, J., & Vogt, P. (2011). Karpale Instabilität. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 82(1), 85-94. doi: https://doi.org/10.1007/s00104-009-1867-9
Schmitt, R., Hesse, N., Goehtz, F., Prommersberger, K., de Jonge, M., & Grunz, J. (2021). Carpal Instability: I. Pathoanatomy. Seminars in musculoskeletal radiology, 25(2), 191-202. doi: https://doi.org/10.1055/s-0041-1728711
Tan, D., & Lim, J. (2019). Treatment of Carpal Instability and Distal Radioulnar Joint Instability. Clinics in plastic surgery, 46(3), 451-468. doi:https://doi.org/10.1016/j.cps.2019.03.006
Urbanschitz, L., Pastor, T., Fritz, B., Schweizer, A., & Reissner, L. (2021). Posttraumatic Carpal Instability Nondissociative. Journal of wrist surgery, 10(4), 290-295. doi: https://doi.org/10.1055/s-0041-1723794
Van de Grift, T., & Ritt, M. (2016). Management of lunotriquetral instability: a review of the literature. The Journal of hand surgery, 41(1), 72-85. doi: https://doi.org/10.1177/1753193415595167
Wang, J., Wu, W., Chang, K., Chen, L., Nakashima, Y., & Özçakar, L. (2021). Sonoanatomy and Stepwise/Systematic Ultrasound Examination of the Extrinsic/Intrinsic Wrist Ligaments. Diagnostics, 11(10), 1834. doi: https://doi.org/10.3390/diagnostics11101834
Witters, M., Legre, R., & Jalous, C. (2023). Esguinces y luxaciones del carpo. EMC - Aparato Locomotor, 56(4), 1-20. doi: https://doi.org/10.1016/S1286-935X(23)48514-0
Aman, J., Elangovan, N., Yeh, I., & Konczak, J. (2017). The effectiveness of proprioceptive training for improving motor function: a systematic review. Frontiers in human neuroscience(8), 1075. doi: https://doi.org/10.3389/fnhum.2014.01075
Andersson, J. (2017). Treatment of scapholunate ligament injury: Current concepts. EFORT open reviews, 2(9), 382-393. doi: https://doi.org/10.1302/2058-5241.2.170016
De Filippo, M., Sudberry, J., Lombardo, E., Corradi, M., Pogliacom, F., Ferrari, F., . . . Zompatori, M. (2006). Pathogenesis and evolution of carpal instability: imaging and topography. Acta bio-medica : Atenei Parmensis, 77(3), 168-180. Obtenido de
https://pubmed.ncbi.nlm.nih.gov/17312988/
Dietrich, T., Toms, A., Cerezal, L., Omoumi, P., Boutin, R., Fritz, J., . . . Pracoń, G. (2021). Interdisciplinary consensus statements on imaging of scapholunate joint instability. European radiology, 31(12), 9446-9458. doi: https://doi.org/10.1007/s00330-021-08073-8
Ferreira Branco, D., Bouvet, C., Hamard, M., Beaulieu, J., Poletti, P., & Boudabbous, S. (2022). Reliability of radio-ulnar and carpal alignment measurements in the wrist between radiographs and 3D imaging. European journal of radiology, 154. doi:
https://doi.org/10.1016/j.ejrad.2022.110417
Gondim Teixeira, P., Rouizi, K., Moustache-Espinola, P., Romain, G., Hossu, G., Athlani, L., & Blum, A. (2022). Imaging assessment of dorsal scaphoid displacement in patients with scapholunate ligament tears: what is the best option for quantitative assessment?. European radiology, 32(5), 3121-3120. doi: https://doi.org/10.1007/s00330-021-08446-z
Grunz, J., Gietzen, C., Grunz, K., Bley, T., & Schmitt, R. (2021). Imaging of Carpal Instabilities. Bildgebende Diagnostik karpaler Instabilitäten. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 193(2), 139-150. doi:
https://doi.org/10.1055/a-1219-8158
Grunz, J., Gietzen, C., Kunz, A., Weng, A., Veyhl-Wichmann, M., Ergün, S., . . . Gassenmaier, T. (2020). Twin Robotic X-Ray System for 3D Cone-Beam CT of the Wrist: An Evaluation of Image Quality and Radiation Dose. American journal of roentgenology, 214(2), 422-427. doi: https://doi.org/10.2214/AJR.19.21911
Harwood, C., & Turner, L. (2016). Conservative management of midcarpal instability. The Journal of hand surgery, 41(1), 102-109. doi: https://doi.org/10.1177/1753193415613050
Hearon, B., Frantz, L., Helsper, E., & Morris, H. (2024). Experience with Diagnosis and Management of Distal Radioulnar Joint Instability. Journal of wrist surgery, 10(5), 392-400. doi: https://doi.org/10.1055/s-0041-1726408
Ibitayo, A., & Beckmann, N. (2021). Imaging evaluation of traumatic carpal instability. Emergency radiology, 28(2), 349-359. doi: https://doi.org/10.1007/s10140-020-01839-5
Kashiyama, T., Miura, T., Sugawara, R., & Uehara, K. (2020). Ultrasonographic Classification of Scapholunate Interosseous Ligament Injury Associated With Distal Radius Fracture. The Journal of hand surgery, 45(12). doi: https://doi.org/10.1016/j.jhsa.2020.05.021
Malahias, M., Roumeliotis, L., Nikolaou, V., Chronopoulos, E., Sourlas, I., & Babis, G. (2021). Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial. Cartilage, 12(1), 51-61. doi: https://doi.org/10.1177/1947603518805230
Okoro, C., Skalski, M., Patel, D., White, E., & Matcuk, G. (2023). Imaging Diagnosis and Management of Carpal Trauma and Instability-An Illustrated Guide. Life, 13(7), 1426. doi: https://doi.org/10.3390/life13071426
Puig de la Bellacasa, I., Salva-Coll, G., Esplugas, M., Quintas, S., Lluch, A., & Garcia-Elias, M. (2022). Bilateral Ulnar Deviation Supination Stress Test to Assess Dynamic Scapholunate Instability. The Journal of hand surgery, 47(7), 639-644. doi: https://doi.org/10.1016/j.jhsa.2022.02.021
Rachunek, K., Springer, F., Barczak, M., Kolbenschlag, J., Daigeler, A., & Medved, F. (2022). An algorithmic diagnostic approach to scapholunate ligament injuries based on comparison of X-ray examinations and arthroscopy in 414 patients. ournal of plastic, reconstructive & aesthetic surgery, 75(9), 3293-3303. doi: https://doi.org/10.1016/j.bjps.2022.04.083
Redeker, J., & Vogt, P. (2011). Karpale Instabilität. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 82(1), 85-94. doi: https://doi.org/10.1007/s00104-009-1867-9
Schmitt, R., Hesse, N., Goehtz, F., Prommersberger, K., de Jonge, M., & Grunz, J. (2021). Carpal Instability: I. Pathoanatomy. Seminars in musculoskeletal radiology, 25(2), 191-202. doi: https://doi.org/10.1055/s-0041-1728711
Tan, D., & Lim, J. (2019). Treatment of Carpal Instability and Distal Radioulnar Joint Instability. Clinics in plastic surgery, 46(3), 451-468. doi:https://doi.org/10.1016/j.cps.2019.03.006
Urbanschitz, L., Pastor, T., Fritz, B., Schweizer, A., & Reissner, L. (2021). Posttraumatic Carpal Instability Nondissociative. Journal of wrist surgery, 10(4), 290-295. doi: https://doi.org/10.1055/s-0041-1723794
Van de Grift, T., & Ritt, M. (2016). Management of lunotriquetral instability: a review of the literature. The Journal of hand surgery, 41(1), 72-85. doi: https://doi.org/10.1177/1753193415595167
Wang, J., Wu, W., Chang, K., Chen, L., Nakashima, Y., & Özçakar, L. (2021). Sonoanatomy and Stepwise/Systematic Ultrasound Examination of the Extrinsic/Intrinsic Wrist Ligaments. Diagnostics, 11(10), 1834. doi: https://doi.org/10.3390/diagnostics11101834
Witters, M., Legre, R., & Jalous, C. (2023). Esguinces y luxaciones del carpo. EMC - Aparato Locomotor, 56(4), 1-20. doi: https://doi.org/10.1016/S1286-935X(23)48514-0
Publicado
2025-02-17
Cómo citar
Vásquez Sandoval, M. A., Salgado Tomaselly , J. G., Altamirano Condemaita, D. C., Pintio Sangoquiza, N. S., & Parra Ullauri, J. A. (2025). Diagnóstico y Manejo de la Inestabilidad del Carpo. Revisión de la literatura . Ciencia Latina Revista Científica Multidisciplinar, 9(1), 3944-3954. https://doi.org/10.37811/cl_rcm.v9i1.16130
Número
Sección
Ciencias Sociales y Humanas
Derechos de autor 2025 Marco Antonio Vásquez Sandoval, Jorge Gonzalo Salgado Tomaselly , Diana Carolina Altamirano Condemaita, Nelson Stalin Pintio Sangoquiza, Joel Alexander Parra Ullauri
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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