Summary about Disease
Volar Intercalated Segment Instability (VISI) is a type of carpal instability in the wrist. It occurs when the scaphoid and lunate bones lose their normal alignment, causing the lunate bone to tilt volarly (towards the palm). This instability can lead to pain, weakness, and limited range of motion in the wrist.
Symptoms
Wrist pain, often on the dorsal (back) side of the wrist, and sometimes on the volar (palm) side.
Weakness in grip strength.
Clicking, snapping, or clunking sensation in the wrist during movement.
Limited range of motion.
Swelling around the wrist.
Pain aggravated by activities that involve wrist extension or weight-bearing.
Causes
Ligament injuries: Most commonly, VISI is caused by disruption or tear of the scapholunate interosseous ligament (SLIL), and other supporting ligaments like the lunotriquetral ligament.
Trauma: Falls onto an outstretched hand are a common cause.
Repetitive stress: Overuse or repetitive motions that strain the wrist can contribute over time.
Inflammatory conditions: Although less common, inflammatory arthritis could contribute to ligament weakening.
Medicine Used
Pain relievers: Over-the-counter pain relievers like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help manage pain and inflammation. Prescription NSAIDs may be considered for more severe pain.
Corticosteroid injections: Corticosteroid injections into the wrist joint may be used to reduce inflammation and provide temporary pain relief.
Other medications: Medications to manage underlying conditions (e.g. arthritis) may be necessary.
Is Communicable
No, Volar Intercalated Segment Instability (VISI) is not a communicable disease. It is a biomechanical problem resulting from ligament damage, not an infection or transmissible agent.
Precautions
Avoid activities that aggravate wrist pain.
Use wrist supports or splints to stabilize the wrist.
Proper technique: Ensure proper form during activities and sports to minimize wrist strain.
Strengthening exercises: Focus on strengthening wrist and forearm muscles to provide stability.
Ergonomics: Optimize workspace setup to minimize repetitive wrist movements.
How long does an outbreak last?
VISI is not an outbreak, but a chronic condition resulting from structural damage or instability. Without treatment the symptoms can persist for years. With treatment, it can take weeks to months to manage symptoms and recover.
How is it diagnosed?
Physical examination: Assessing range of motion, palpating for tenderness, and performing specific wrist stability tests.
X-rays: Standard X-rays can reveal abnormal carpal alignment. Clenched fist views may highlight instability.
MRI: Magnetic Resonance Imaging (MRI) is useful for visualizing soft tissues, including ligaments, and identifying tears or damage.
Arthroscopy: In some cases, arthroscopy (a minimally invasive surgical procedure to view the inside of the wrist) may be used for diagnosis and treatment.
Timeline of Symptoms
Acute (Initial injury): Sudden onset of pain, swelling, and limited range of motion after a fall or trauma.
Subacute: Pain may decrease slightly but instability symptoms (clicking, weakness) become more apparent.
Chronic: Persistent pain, weakness, instability, and potential development of arthritis in the wrist over time.
Important Considerations
Early diagnosis and treatment are important to prevent long-term complications, such as arthritis.
Treatment depends on the severity of the instability and may range from conservative measures to surgery.
Surgical options include ligament repair or reconstruction, or even carpal fusion in severe cases.
Proper rehabilitation after treatment is crucial for restoring function and preventing recurrence.