Wrist Dislocation in Emergency Medicine Clinical Presentation

Updated: Feb 13, 2015
  • Author: Michael S Beeson, MD, MBA, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

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. [7] 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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