Summary Carpal instability nondissociative (CIND) is defined as instability between carpal rows (either radiocarpal or midcarpal) radiocarpal instability (between radius and proximal row) midcarpal instability (between proximal and distal row) Epidemiology incidence rare login to view 1 more bullet Etiology Pathophysiology radiocarpal instability ("inferior arc injury") login to view 4 more bullets Associated conditions intracarpal injury (scapholunate or lunotriquetral ligament) acute carpal tunnel syndrome compartment syndrome Anatomy Volar extrinsic ligaments radioscaphocapitate (RSC) long radiolunate short radiolunate radioscapholunate Classification Overview table of wrist instability Presentation History usually no history of trauma (midcarpal) high energy trauma (radiocarpal) Symptoms subluxation that may or may not be painful complain of wrist giving way irritating clunking sign login to view 1 more bullet Physical exam generalized ligamentous laxity Imaging Radiographs recommended views login to view 4 more bullets findings login to view 3 more bullets Treatment Nonoperative immobilization +/- splinting login to view 3 more bullets Operative immediate open repair, reduction, and pinning login to view 5 more bullets midcarpal joint fusion login to view 5 more bullets osteotomy with malunion correction login to view 2 more bullets wrist arthrodesis login to view 5 more bullets Prognosis volar dislocation is more severe than dorsal