Volar intercalated segment instability

Changed by Craig Hacking, 21 Mar 2019

Updates to Article Attributes

Body was changed:

Show markup changes

Volar intercalated segmental instability (VISI) is a type of instability involving the wrist. It is less often encountered than dorsal intercalated segmental instability (DISI).

Clinical presentation

It presents in most cases with nonspecific wrist pain and a "clunking" on the ulnar deviation of the wrist.

Pathology

VISI can occur because of a disruption of radiocarpal ligaments on the ulnar side of the wrist. The main ligaments involved in this instability are thought to be the ulnar half of the volar arcuate ligament ⁶and the lunotriquetral ligament ^6,7. It may be static or dynamic.

Radiographic features

The main radiographic features are a volar rotation of the lunate and dorsal rotation of the capitate and hamate.

Radiograph

Abnormal carpal angles are seen on any lateral or sagittal imaging of the wrist when the wrist is in a neutral position:

scapholunate angle <30°
capitolunate angle >30°

Treatment and prognosis

The mainstay of treatment is surgery, either by early reduction and casting with K-wires or by capitolunate fusion.

-<p><strong>Volar intercalated segmental instability</strong> (<strong>VISI</strong>) is a type of instability involving the wrist. It is less often encountered than <a href="/articles/dorsal-intercalated-segment-instability">dorsal intercalated segmental instability</a> (DISI).</p><h4>Clinical presentation</h4><p>It presents in most cases with nonspecific wrist pain and a "clunking" on the ulnar deviation of the wrist.</p><h4>Pathology</h4><p>VISI can occur because of a disruption of radiocarpal ligaments on the ulnar side of the wrist. The main ligaments involved in this instability are thought to be the ulnar half of the volar arcuate ligament <sup>6 </sup>and the lunotriquetral ligament <sup>6,7</sup>. It may be static or dynamic.</p><h4>Radiographic features</h4><p>The main radiographic features are a volar rotation of the lunate and dorsal rotation of the capitate and hamate.</p><h5>Radiograph</h5><p>Abnormal carpal angles are seen on any lateral or sagittal imaging of the wrist when the wrist is in a neutral position:</p><ul>
+<p><strong>Volar intercalated segmental instability</strong> (<strong>VISI</strong>) is a type of instability involving the wrist. It is less often encountered than <a href="/articles/dorsal-intercalated-segment-instability">dorsal intercalated segmental instability</a> (DISI).</p><h4>Clinical presentation</h4><p>It presents in most cases with nonspecific wrist pain and a "clunking" on the ulnar deviation of the wrist.</p><h4>Pathology</h4><p>VISI can occur because of a disruption of radiocarpal ligaments on the ulnar side of the wrist. The main ligaments involved in this instability are thought to be the ulnar half of the volar arcuate ligament <sup>6 </sup>and the <a title="Lunotriquetral ligament" href="/articles/lunotriquetral-ligament">lunotriquetral ligament</a> <sup>6,7</sup>. It may be static or dynamic.</p><h4>Radiographic features</h4><p>The main radiographic features are a volar rotation of the lunate and dorsal rotation of the capitate and hamate.</p><h5>Radiograph</h5><p>Abnormal carpal angles are seen on any lateral or sagittal imaging of the wrist when the wrist is in a neutral position:</p><ul>

ADVERTISEMENT: Supporters see fewer/no ads

{"current_user":null,"inclusions":[{"imageId":30733143,"studyId":59874,"caseSlug":"dorsal-and-volar-intercalated-segmental-instability-and-normal-carpal-bone-anatomy-illustrations","caption":"Figure 1: VISI","thumbnail":"https://prod-images-static.radiopaedia.org/images/30733143/353cdd1080d001b4308de162b1357c_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":53273420,"studyId":94486,"caseSlug":"normal-wrist-alignment-dorsal-and-volar-intercalated-segmental-instability-illustration","caption":"Figure 2: VISI","thumbnail":"https://prod-images-static.radiopaedia.org/images/53273420/86fde104153dfcf78edbdf6b27e4f8_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"not_applicable"},{"imageId":53273382,"studyId":94490,"caseSlug":"normal-wrist-alignment-dorsal-and-volar-intercalated-segmental-instability-illustration","caption":"Figure 4: VISI capitolunate angle","thumbnail":"https://prod-images-static.radiopaedia.org/images/53273382/2bea38e50f715a83a54980f7246605_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"not_applicable"},{"imageId":30733233,"studyId":59874,"caseSlug":"dorsal-and-volar-intercalated-segmental-instability-and-normal-carpal-bone-anatomy-illustrations","caption":"Figure 3: capitolunate angle","thumbnail":"https://prod-images-static.radiopaedia.org/images/30733233/0ea4a14dc869bc23540d7712ab91cc_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":53273383,"studyId":94490,"caseSlug":"normal-wrist-alignment-dorsal-and-volar-intercalated-segmental-instability-illustration","caption":"Figure 6: VISI scapholunate angle","thumbnail":"https://prod-images-static.radiopaedia.org/images/53273383/220608d28e47429b8086b655dfca97_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"not_applicable"},{"imageId":30733437,"studyId":59874,"caseSlug":"dorsal-and-volar-intercalated-segmental-instability-and-normal-carpal-bone-anatomy-illustrations","caption":"Figure 5: scapholunate angle","thumbnail":"https://prod-images-static.radiopaedia.org/images/30733437/f0c386e73ab091ce264b2a15180b77_big_gallery.jpeg","isStack":false,"diagnosticCertainty":"not_applicable"},{"imageId":628861,"studyId":12851,"caseSlug":"kienbock-disease-and-volar-intercalated-segmental-instability-1","caption":"Case 1: with concurrent Kienbock disease","thumbnail":"https://prod-images-static.radiopaedia.org/images/628861/82668ec99ed952bddbc237b62e9e7c_big_gallery.jpg","isStack":false,"diagnosticCertainty":"confirmed_unsubstantiated"},{"imageId":40374154,"studyId":69242,"caseSlug":"volar-intercalated-segmental-instability-visi","caption":"Case 2: VISI, lunotriquetral ligament rupture","thumbnail":"https://prod-images-static.radiopaedia.org/images/40374154/7bb342aea3ddbb05dcbcdc9579551a6d8f805c1d54100ba1a5aa706a04c55bed_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_substantiated"},{"imageId":61152501,"studyId":132220,"caseSlug":"volar-intercalated-segmental-instability-visi-1","caption":"Case 3: with distal radius fracture","thumbnail":"https://prod-images-static.radiopaedia.org/images/61152501/d2ee6a7235df5b8496dd6f6fa893ae39b1068aab284fcc367108a619b40b1d40_big_gallery.jpeg","isStack":true,"diagnosticCertainty":"confirmed_unsubstantiated"}],"ddx_inclusions":[],"lang":"us"}