eMedicine Specialties > Sports Medicine > Wrist and Hand

Wrist Dislocation: Multimedia

Author: Kadeer M Halimi, DO, Department of Emergency Medicine, Texas A&M University Health Sciences Center
Coauthor(s): Derek K Lichota, MD, Assistant Professor, Department of Surgery, Texas A&M University College of Medicine; Senior Staff, Department of Orthopedics, Division of Sports Medicine, Scott and White Memorial Hospital
Contributor Information and Disclosures

Updated: Aug 21, 2008

Multimedia

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Media file 1: Lunate dislocation. Posteroanterior projection of the wrist showing the pie shape of the lunate.

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Lunate dislocation. Posteroanterior projection of the wrist showing the pie shape of the lunate.

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Media file 2: Perilunate dislocation. On the posteroanterior radiograph, crowding is evident between the proximal and distal carpal bones.

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Perilunate dislocation. On the posteroanterior radiograph, crowding is evident between the proximal and distal carpal bones.

(Enlarge Image)

Media file 3: Perilunate dislocation. The lunate is in a normal anatomic position with respect to the radius. The rest of the carpal bones are displaced dorsally.

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Perilunate dislocation. The lunate is in a normal anatomic position with respect to the radius. The rest of the carpal bones are displaced dorsally.

(Enlarge Image)

Media file 4: Scapholunate dislocation. The scapholunate space is usually greater than 4 mm, a scenario also known as the Terry-Thomas sign. Rotation of the scaphoid causes the scaphoid to be viewed end-on, producing the classic signet-ring sign.

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Scapholunate dislocation. The scapholunate space is usually greater than 4 mm, a scenario also known as the Terry-Thomas sign. Rotation of the scaphoid causes the scaphoid to be viewed end-on, producing the classic signet-ring sign.

(Enlarge Image)

Media file 5: Progressive perilunar instability pattern as reported by Mayfield et al.⁷ Stage I involves scaphoid instability; stage II, scaphoid and capitate instability; stage III, scaphoid, capitate, and triquetrum instability; and stage IV, lunate dislocation.

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Progressive perilunar instability pattern as reported by Mayfield et al.⁷ Stage I involves scaphoid instability; stage II, scaphoid and capitate instability; stage III, scaphoid, capitate, and triquetrum instability; and stage IV, lunate dislocation.

(Enlarge Image)

Media file 6: On a normal lateral radiograph, the 4 Cs should be easily visualized. The 4 Cs are the convexity of the distal radius, the convexity and the concavity of the lunate, and the convexity of the capitate. A longitudinal axis aligns the radius, the lunate, the capitate, and the third metacarpal bone. The scapholunate angle is normally 30-60°.

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On a normal lateral radiograph, the 4 Cs should be easily visualized. The 4 Cs are the convexity of the distal radius, the convexity and the concavity of the lunate, and the convexity of the capitate. A longitudinal axis aligns the radius, the lunate, the capitate, and the third metacarpal bone. The scapholunate angle is normally 30-60°.

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References

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References

Larsen CF, Lauritsen J. Epidemiology of acute wrist trauma. Int J Epidemiol. Oct 1993;22(5):911-6. [Medline].
Schwartz DT, Reisdorff EJ. Emergency Radiology. New York, NY: McGraw-Hill Book Co; 2000:47-75.
Cheng CY, Hsu KY, Tseng IC, Shih HN. Concurrent scaphoid fracture with scapholunate ligament rupture. Acta Orthop Belg. Oct 2004;70(5):485-91. [Medline].
Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma. Philadelphia, Pa: WB Saunders Co; 1998:1359-81.
Lichtman DM, Alexander AH, eds. The Wrist and Its Disorders. 2^nd ed. Philadelphia, Pa: WB Saunders Co; 1997.
Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. Dec 1972;54(8):1612-32. [Medline]. [Full Text].
Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg [Am]. May 1980;5(3):226-41. [Medline].
Reid DC. Sports Injury Assessment and Rehabilitation. New York, NY: Churchill Livingstone; 1992.
Meldon SW, Hargarten SW. Ligamentous injuries of the wrist. J Emerg Med. Mar-Apr 1995;13(2):217-25. [Medline].
Carlisle JC, Goldfarb CA, Mall N, Matava MJ. Upper extremity injuries in the National Football League. Part II: elbow, forearm, and wrist Injuries. Am J Sports Med. Jun 30 2008;epub ahead of print. [Medline].
Alt V, Sicre G. Dorsal transscaphoid-transtriquetral perilunate dislocation in pseudarthrosis of the scaphoid. Clin Orthop Relat Res. Sep 2004;426:135-7. [Medline].
Frankel VH. The Terry-Thomas sign. Clin Orthop Relat Res. Nov-Dec 1977;129:321-2. [Medline].
Martinage A, Balaguer T, Chignon-Sicard B, et al. [Perilunate dislocations and fracture-dislocations of the wrist, a review of 14 cases] [French]. Chir Main. Feb 2008;27(1):31-9. [Medline].
Infanger M, Grimm D. Meniscus and discus lesions of triangular fibrocartilage complex (TFCC): treatment by laser-assisted wrist arthroscopy. J Plast Reconstr Aesthet Surg. May 9 2008;epub ahead of print. [Medline].
Park MJ, Kim JP. Reliability and normal values of various computed tomography methods for quantifying distal radioulnar joint translation. J Bone Joint Surg Am. Jan 2008;90(1):145-53. [Medline].

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Keywords

wrist dislocation, wrist pain, dislocated wrist, dislocation of wrist, lunate dislocation, perilunate dislocation, scapholunate dislocation, hyperextension injury of the wrist, carpal bone injuries, carpal injury, ballottement test, volar tilt test, dorsal tilt test

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Contributor Information and Disclosures

Author

Kadeer M Halimi, DO, Department of Emergency Medicine, Texas A&M University Health Sciences Center
Kadeer M Halimi, DO is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Derek K Lichota, MD, Assistant Professor, Department of Surgery, Texas A&M University College of Medicine; Senior Staff, Department of Orthopedics, Division of Sports Medicine, Scott and White Memorial Hospital
Disclosure: Nothing to disclose.

Medical Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

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eMedicine Specialties > Sports Medicine > Wrist and Hand

Wrist Dislocation: Multimedia

Multimedia

Lunate dislocation. Posteroanterior projection of the wrist showing the pie shape of the lunate.

Perilunate dislocation. On the posteroanterior radiograph, crowding is evident between the proximal and distal carpal bones.

Perilunate dislocation. The lunate is in a normal anatomic position with respect to the radius. The rest of the carpal bones are displaced dorsally.

Scapholunate dislocation. The scapholunate space is usually greater than 4 mm, a scenario also known as the Terry-Thomas sign. Rotation of the scaphoid causes the scaphoid to be viewed end-on, producing the classic signet-ring sign.

Progressive perilunar instability pattern as reported by Mayfield et al. 7 Stage I involves scaphoid instability; stage II, scaphoid and capitate instability; stage III, scaphoid, capitate, and triquetrum instability; and stage IV, lunate dislocation.

More on Wrist Dislocation

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor

Progressive perilunar instability pattern as reported by Mayfield et al.⁷ Stage I involves scaphoid instability; stage II, scaphoid and capitate instability; stage III, scaphoid, capitate, and triquetrum instability; and stage IV, lunate dislocation.