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Wrist Instability Part II: Analysis of Movement and
the Features of Instability

Presented by Mirka Normand

The growing need for a more efficient health delivery model is driving a greater number of direct referrals from primary care physicians to certified hand therapists. For that reason, hand therapists must be prepared to perform in-depth evaluations of the wrist and determine if conservative management is warranted prior to seeking surgical consult. The second part of the wrist instability series introduces an analysis of wrist instability based on six main features gathered from different classification systems. The course will discuss the movement of the radiocarpal and midcarpal joints and how it relates to the intricacy of wrist stability and its different components.

This is Part II of a three-part series.

CHTs, when submitting this for recertification through HTCC, this course can be used for CAT B (hand therapy courses < 3 hours in length); however, if this course certificate is submitted with the following course certificates listed below (or any combination totaling 3 hours or more), they can be submitted under CAT A (hand therapy courses > 3 hours in length).
  • Wrist Instability Part I: Anatomy and Biomechanics (1.5 hours)
  • Wrist Instability Part II: Analysis of Movement and the Features of Instability (1.5 hours)
  • Wrist Instability Part III: Assessment and Special Tests (1.5 hours)


    • Meet your instructor

    A smiling person in a blue shirt, wearing glasses, stands before a white background, representing the future of digital healthcare with medbridge.

    Mirka Normand

    Ms. Normand graduated with a Bachelor of Science in Occupational Therapy from Laval University in Québec, Canada. She completed a Hand Therapy Fellowship with Baylor College of Medicine and Texas Woman's University in 1999, in Houston TX and was certified as a hand therapist that same year by the Hand Therapy Certification…

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    Chapters & learning objectives

    Chronicity and Constancy

    1. Chronicity and Constancy

    This chapter introduces the first two features assisting in the description of carpal instability. Chronicity refers to the temporal nature of injury and its effect on healing potential. Constancy elaborates on the severity of the ligamentous injury. Common ligamentous injuries are depicted and classified by gravity.

    Etiology and Location

    2. Etiology and Location

    This chapter extends the description of carpal instability with the addition of features including etiology, considering the underlying disease or pathomechanics of injury and their particular location, allowing for an accurate identification of carpal partners and ligaments involved.

    Direction and Pattern

    3. Direction and Pattern

    This chapter concludes the carpal instability analysis features with the concepts of direction and pattern. The concept of direction will explain how the proximal row can be displaced and describe how dorsal and volar intercalated segmental instability (DISI and VISI) can spawn from midcarpal instability. The concept of pattern will identify the 4 different patterns of carpal instability and recall their defining characteristics.

    More courses in this series

    Wrist Instability Part I: Anatomy and Biomechanics

    Wrist Instability Part I: Anatomy and Biomechanics

    Mirka Normand

    Wrist Instability Part II: Analysis of Movement and the Features of Instability

    Wrist Instability Part II: Analysis of Movement and the Features of Instability

    Mirka Normand

    Wrist Instability Part III: Assessment and Special Tests

    Wrist Instability Part III: Assessment and Special Tests

    Mirka Normand

    Frequently asked questions

    Everything you need to know about Medbridge courses.