Wrist Dislocation in Emergency Medicine Workup

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

Imaging Studies

Plain x-rays of the wrist, both anteroposterior (AP) and lateral views, are essential to diagnose wrist dislocations (as well as other carpal instabilities).

  • On an AP view (shown below), 2 arcs should be identified. The first arc consists of the radiocarpal row, which should be smooth and continuous. Disruption is suggestive of a lunate dislocation. Dislocations, wrist. Anteroposterior (AP) view of Dislocations, wrist. Anteroposterior (AP) view of a lunate dislocation.
  • The second arc consists of the midcarpal row, which also should be smooth and continuous. Disruption of this arc is suggestive of a perilunate dislocation.
  • The appearance of the lunate is important on the AP view. Normally, the lunate is quadrangular. With lunate dislocations, it becomes triangular. This may be an additional clue to dislocation.
  • On the lateral view (shown below), visualize the column, which consists of the radius, lunate, and capitate. The lunate should lie within the radius cup and the capitate should rest within the lunate cup. Loss of this normal column implies lunate or perilunate dislocation. Dislocations, wrist. Lateral view of a lunate dislDislocations, wrist. Lateral view of a lunate dislocation, with the classic teacup sign.

Stress x-rays of the wrist may be necessary to demonstrate intercarpal ligamentous instability when no evidence of wrist dislocation is apparent on plain films.

Stress x-rays obtained with radial and ulnar deviation of the hand may demonstrate scapholunate dissociation.

Proceed to Treatment & Management
 
 
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].

 
Previous
Next
 
Dislocations, wrist. Lateral view of a lunate dislocation, with the classic teacup sign.
Dislocations, wrist. Anteroposterior (AP) view of a lunate dislocation.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.