Lisa Turner AHTA Accredited Hand Therapist
Midcarpal instability is a condition that affects your wrist. The symptoms can vary from pain and weakness through to a click or clunk when you move your wrist in certain directions, usually towards the little finger side of your hand. It most commonly arises from joint laxity or weakened ligaments, whether that occurs from a previous injury such as a sprain, or happens with repetitive heavy use of your hand. It can also occur in people who have very hypermobile joints (laxity). The symptoms of pain and instability are not explained by other causes such as a fracture.
Signs of midcarpal instability are:
- Pain in your wrist
- A click when you move your wrist from side to side
- Weakness in grip
- A more noticeable bone (ulna styloid process) on the little finger side of your wrist
Your doctor or therapist may do a special test of your wrist to see if the diagnosis is correct. This involves bending your wrist and holding your arm a certain way to check the integrity of the ligaments.
What causes the click?
Some clicks as you move are normal and everybody usually has a joint that clicks. If you haven’t moved for a while, gas bubbles can build up in your joint and as you move they pop. This is normal. If, however, your wrist clicks every time you move it a certain way and is painful it may be that the ligaments are weakened allowing the bones to move a bit more than normal and this causes the click or clunk.
Recently there have been some new ideas in treating this condition that involve attending hand therapy and working with your therapist on a particular set of exercises to help stop your pain and control the clicking.
How can hand therapy help?
- Splinting is sometimes used for a short period to manage pain and permit strengthening
- Activity modification – teaching you to avoid positions that cause the click or clunk
- Exercises to help to stabilise and strengthen the muscles to support the area of weakness. This may include isometric, eccentric, co-activation and reactive muscle activation exercises and sometimes using mirror therapy or retraining reflexes can help regain control.