Wrist Dislocation, Lunate

Injury and displacement of the lunate bone of the wrist (usually) or of other bones in the hand and wrist (less commonly). The dislocated bone no longer touches the adjoining bones in the normal manner.

Body Parts Involved

• Joints in the hand adjoining primarily the lunate bone. Other hand bones are affected less frequently.
• Soft tissue surrounding the dislocation, including nerves, tendons, ligaments, muscles and blood vessels.

Causes

• Direct blow to the wrist-usually a fall on an outstretched hand.
• End result of a severe wrist sprain.
• Congenital abnormality, such as shallow or malformed joint surfaces.

Signs & Symptoms

• Excruciating pain in the wrist at the time of dislocation.
• Loss of hand and wrist function, as well as severe pain when attempting to move them.
• Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
• Tenderness over the dislocation.
• Swelling and bruising at the injury site.
• Numbness or paralysis below the dislocation from pressure, pinching or cutting of blood vessels or nerves.

Treatment

First Aid

• Keep the person warm with blankets to decrease the possibility of shock.
• Cut away clothing if possible, but don't move the injured area to remove clothing.
• Immobilize the wrist joint and the hand with padded splints.
• Follow instructions for R.I.C.E., the first letters of rest, ice , compression and elevation.
• The doctor will manipulate the dislocated bones with surgery or, if possible, without. Manipulation should be done as soon as possible after injury. Six or more hours after the dislocation, internal bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to a normal position.

Continuing Care

If a cast is not necessary:

• Use ice soaks 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
• After 48 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
• Take whirlpool treatments, if available.
• Wrap the wrist with elasticized bandages between treatments.
• Massage gently and often from the fingers toward the heart to provide comfort and decrease swelling.

If a cast is necessary:

• See Appendix 2 (Care of Casts).
• Actively exercise all muscle groups in the arm and hand that are not immobilized. The resulting muscle contractions promote proper alignment and hasten healing.

Medication

Your doctor may prescribe:

• General anesthesia or muscle relaxants to make joint manipulation possible.
• Acetaminophen or aspirin to relieve modern to pain.
• Narcotic pain relievers for severe pain.
• Antibiotics to fight infection, if surgery is necessary.

Home Diet

• Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
• During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may suggest vitamin and mineral supplements to promote healing.

Diagnostic Measures

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• X-rays of the joint and adjacent bones.

Prevention Tips

• Build' strength and muscle tone with a long-term conditioning program appropriate for your sport.
• Wear protective devices, such as wrapped elastic bandages, tape wraps or leather gauntlet gloves, to protect vulnerable wrist joints.