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The Journal of Bone and Joint Surgery 78:1838-43 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Carpal Instability in the Weight-Bearing Upper Extremity*

WILLIAM SCHROER, M.D.{dagger}, STEPHEN LACEY, M.D.{ddagger}, FREDERICH S. FROST, M.D.§ and MICHAEL W. KEITH, M.D.§, CLEVELAND, OHIO

Investigation performed at the Department of Orthopaedic Surgery, Case Western Reserve University and University Hospitals of Cleveland; The MetroHealth Medical Center Rehabilitation Service; and the Spinal Cord Injury Unit of the Wade Park Veterans Administration Medical Center, Cleveland

The prevalence of carpal instability in a paraplegic population was investigated to establish an association between chronic repetitive stress on the wrist and the development of such instability. Nine of 162 paraplegic patients had static carpal instability and no history of an acute injury of the wrist. The predominant pattern of instability, found in eleven wrists (six patients), was non-dissociative volar intercalated segmental instability. The prevalence of carpal instability increased with the duration of weight-bearing on the upper extremity. Eighteen per cent of the patients in whom the spinal cord injury had occurred more than twenty years before the study had carpal instability. Carpal instability in these weight-bearing upper extremities and the increase in its prevalence with the duration of the forces across the wrist demonstrate an association between chronic repetitive stress on the wrist and carpal instability.


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