Return to Play
Athletes with wrist injuries, including wrist dislocations, are advised not to return to play until full recovery has been achieved.
Complications
See the list below:
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A missed or late diagnosis may lead to complications.
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Carpal tunnel syndrome may result.
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Malunion or nonunion may occur. This is a misnomer because no fracture occurs; therefore, malunion or nonunion is not technically possible. Stiffness may be present. On rare occasions, late instability or apposition of the carpal bones may occur.
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Degenerative joint disease is possible.
Prevention
Wrist injuries can be prevented by implementing proper technique; maintaining good strength; maintaining good flexibility; and, if the sport permits, using wrist guards.
Prognosis
If the diagnosis is established early (< 3 mo) and if the proper treatment is administered, the prognosis of wrist dislocations is excellent.
Education
Athletes should be educated about how to recognize wrist injuries. Seeking early medical attention for wrist injuries is important and should be emphasized to athletes. Proper technique, flexibility, and strengthening should also be emphasized.
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Lunate dislocation. Posteroanterior projection of the wrist showing the pie shape of the lunate.
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Perilunate dislocation. On the posteroanterior radiograph, crowding is evident between the proximal and distal carpal bones.
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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.
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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.
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Progressive perilunar instability pattern as reported by Mayfield et al. 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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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 degrees.
