Wrist Dislocation, Lunate

ExitCare ImageThe lunate wrist dislocation is an injury to the one of the wrist bones (lunate). The lunate bone becomes displaced from its normal position. Because of this the joint surface no longer touches the joint surface of the bone the lunate is suppose to align with. A lesser, but similar, injury is known as a lunate subluxation. In this injury the lunate is displaced but the joint surfaces still touch. In order for the lunate to be either dislocated or subluxed, there must also be a tear (sprain) in the ligament that holds it in place.

SYMPTOMS

  • Severe pain at the time of injury and when attempting to move the hand and wrist.

  • Loss of hand and/or wrist function.

  • Tenderness, obvious deformity, swelling, and bruising at the injury site.

  • Numbness or paralysis below the dislocation from pinching, cutting, or pressure on the blood vessels or nerves.

CAUSES

  • Direct trauma to the wrist. For example, falling on an outstretched hand.

  • The end result of a severe wrist sprain.

  • You are born with it. This is called congenital abnormality. For example, a shallow or malformed joint surface makes the joint more susceptible to dislocation.

RISK INCREASES WITH:

  • Playing sports in which falling or stress on the arm and hand is possible (football, basketball, soccer or volleyball).

  • Previous wrist sprain or dislocation.

  • Repeated injury to any bone or joint in the wrist.

  • Poor hand and wrist strength and flexibility.

PREVENTION

  • Maintain physical fitness:

  • Cardiovascular fitness.

  • Wrist strength.

  • Flexibility and endurance.

  • Wear preventive taping, bandages, bracing, or wrist guards when participating in sports.

PROGNOSIS

A lunate dislocation requires immediate realigning of the joint (reduction). After reduction, wrist movement will be restricted to allow for healing. Joint movement will be restricted for at least 6 weeks. If the lunate cannot be reduced manually or there is some other complication, then surgery may be necessary. Wrist stiffness is very likely, even after healing and rehabilitation.

RELATED COMPLICATIONS

  • Damage to nearby nerves or major blood vessels in the area.

  • Fracture or joint cartilage injury.

  • Prolonged healing or recurrent dislocation if activity is resumed too soon.

  • Death of bone cells caused by interruption of the blood supply (rare).

  • Excessive bleeding in the wrist and hand at the dislocation site, causing pressure and injury to nerves and blood vessels (rare).

  • Writ stiffness.

  • Recurrent dislocations.

  • Unstable or arthritic joint following repeated injury or delayed treatment.

TREATMENT

A lunate dislocation requires immediate realigning of the joint to be done by a trained individual. After reduction the use of ice and medication may help reduce pain and inflammation. Surgery may be necessary to reduce the joint or if other complications are present. After reduction or surgery, the wrist must be immobilized to allow for healing. Strengthening and stretching exercises may be recommended after immobilization to regain strength and a full range of motion. These exercises may be done at home or with a therapist. If the dislocation causes nerves in the wrist to be compressed, then urgent surgery is required.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak your injury in warm water.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling worsens despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage or bleeding in the surgical area.

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).