What are the signs and symptoms of palmar midcarpal instability (PMCI)?

Updated: Apr 26, 2021
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Patients present with painful clunking that occurs with ulnar deviation and pronation of the wrist. A history of trauma may or may not be present. Patients may describe a long period of asymptomatic clunking that has now become painful. The other extremity should be assessed for similar symptoms because the instability is frequently bilateral. Clinical findings may include a volar sag at the ulnar wrist with a prominent-appearing ulnar head when the wrist is at neutral position. If a localized synovitis is present, tenderness may be present over the ulnar carpus, particularly at the triquetrohamate joint. If the patient is unable to reproduce the clunk actively, it may be reproduced passively with the midcarpal shift test.

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