Volar intercalated segmental instability

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

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

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 6 and the lunotriquetral ligament 6,7. It may be static or dynamic.

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


Abnormal carpal angles are seen on a lateral wrist x-ray:

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

Share article

Article Information

rID: 21511
Section: Pathology
Tags: cases, wrist
Synonyms or Alternate Spellings:
  • VISI
  • VISI deformity
  • VISI configuration
  • Volar intercalated segmental instability (VISI)

Support Radiopaedia and see fewer ads

Cases and Figures

  • Drag
    Case 1: with concurrent Kienbock disease
    Drag here to reorder.
  • Updating… Please wait.

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.