title: Treatment of dynamic scaphoid instability.
abstract: BACKGROUND
  Chronic wrist pain attributable to scaphoid instability without fixed deformity (dynamic instability) presents a treatment dilemma. The diagnosis usually is delayed, missing the opportunity for direct repair. The intercarpal fusion, tenodesis, and capsulodesis procedures create a fixed deformity. This report presents an outcome study of a new treatment for dynamic scaphoid instability that spanned more than 5 years.
  
  
  METHODS
  Arthroscopic evaluation was used to confirm the diagnosis for 105 wrists of 102 patients who had experienced wrist pain for an average of 24.4 months. The treatment for these patients involved transferring two thirds of the extensor carpi radialis longus through the distal pole of the reduced scaphoid volarly to the intact flexor carpi radialis. The postoperative follow-up period averaged 63 months.
  
  
  RESULTS
  The average grip strength increased by 65%. The average active wrist extension-flexion increased by 9%, with an average radial deviation loss of 6 degrees. The overall results, as measured by the modified Green and O'Brien clinical wrist scale, were as follows: excellent (49%), good (24%), and fair (26%). Good to excellent results were reported by 85% of the patients. Pain relief was reported by 94% of the patients, and 93% of the patients would recommend the procedure to others.
  
  
  CONCLUSIONS
  Scaphoid instability without fixed deformity is a complex problem. Conventional treatments have drawbacks. The new technique produced positive results that are quite promising for the management of dynamic scaphoid instability.
authors.affiliation: Orthopaedic and Reconstructive Center, Oklahoma City, Oklahoma, USA.
authors.forename: Houshang
authors.initials: H
authors.lastname: Seradge
authors.forename: Carrie
authors.initials: C
authors.lastname: Baer
authors.forename: David
authors.initials: D
authors.lastname: Dalsimer
authors.forename: Ali
authors.initials: A
authors.lastname: Seradge
authors.forename: R A Raheel
authors.initials: RA
authors.lastname: Shafi
authors.forename: Winfred
authors.initials: W
authors.lastname: Parker
mesh_terms: D001182:Arthroscopy; D001696:Biomechanical Phenomena; D018737:Hand Strength; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries; D011859:Radiography; D012421:Rupture; D021361:Scaphoid Bone / Q000000981:diagnostic imaging; D013709:Tendon Transfer / Q000379:methods*; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000503:physiopathology