Wrist Dislocation in Emergency Medicine Clinical Presentation

  • Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 18, 2011
 

History

  • Patients usually present to the ED fairly soon after a fall onto an outstretched hand.
  • The mechanism of injury is ulnar deviation of the wrist coupled with dorsiflexion.
  • The resulting intercarpal supination places great stress on the carpals. The result can be a lunate or perilunate dislocation.[1]
  • Often, the only symptom is wrist pain.
  • Frequently, lunate and perilunate dislocations are not recognized at the time of the initial ED visit.[5] This emphasizes the need to consider lunate or perilunate dislocation when a patient returns to the ED a second or third time for what appears to be chronic wrist pain following an injury.
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Physical

The patient may have diffuse pain on palpation that is difficult to distinguish from other causes of wrist pain, including scapholunate strain, scaphoid fracture, triangular fibrocartilage complex tears, and other disorders.

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Causes

  • Carpal stability is based on the lunate as the central anchor for the proximal and distal carpal rows.
  • The lunate is apposed to the radius, and the capitate rests within the lunate cup.
  • The proximal row of carpals is connected by interosseous ligaments.
  • Carpal stress is characterized as radial or ulnar, with some degree of axial loading. This stress is translated to all bones.
  • Ligamentous injury results in a spectrum of injuries, including lunate and perilunate dislocations.
  • The lunate-scaphoid ligaments may not be disrupted; if this is the case, scaphoid fracture may occur.
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM  Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Hayden SR. A case of peri-lunate dislocation. J Emerg Med. Mar-Apr 1995;13(2):241. [Medline].

  2. Carter PR. Fractures and dislocations of the wrist. In: Common Hand Injuries and Infections. 1983:123-141.

  3. Mital RC, Beeson M. The Wrist and Forearm. Emergency Radiology. 1999;47- 75.

  4. Rockwood CA, Jr, Green DP, Bucholz RW. Fractures and dislocations of the wrist. In: Fractures in Adults. Lippincott Williams & Wilkins Publishers; 1996:745-867.

  5. Sochart DH, Birdsall PD, Paul AS. Perilunate fracture-dislocation: a continually missed injury. J Accid Emerg Med. May 1996;13(3):213-6. [Medline].

  6. Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic pitfalls in the ED: lunate and perilunate injuries. Am J Emerg Med. Mar 2001;19(2):157-62. [Medline].

  7. Kannikeswaran N, Sethuraman U. Lunate and perilunate dislocations. Pediatr Emerg Care. Dec 2010;26(12):921-4. [Medline].

 
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Dislocations, wrist. Lateral view of a lunate dislocation, with the classic teacup sign.
Dislocations, wrist. Anteroposterior (AP) view of a lunate dislocation.
 
 
 
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