In perilunate and lunate dislocations, patients present with generalized pain and swelling to the wrist. Pain is typically worsened with wrist range of motion. Unlike many other joint dislocations, gross deformity is not typically present in carpal dislocations.

Individuals with lunate dislocations typically present after a high impact fall onto an extended wrist. Commonly reported symptoms include wrist pain, swelling and decreased sensation and/or paresthesia in the median nerve distribution secondary to carpal tunnel injury.

Damage to the median nerve is the most commonly associated injury in lunate and perilunate dislocations of the wrist. In certain situations, volar skin lacerations can represent an open dislocation or fracture-dislocation. Symptoms from associated injuries of such fractures of the distal radius and ulna may dominate.

The reduction maneuver involves placing longitudinal traction on the wrist with the elbow flexed at 90°. A thumb is placed on the volar aspect of the lunate to prevent a volar dislocation of the lunate. The wrist is extended and then flexed while maintaining traction.

Symptoms of dislocation or fracture include:

• Bruising.
• Deformity.
• Extreme and immediate pain.
• Inability to use joint or limb normally.
• Numbness.
• Redness.
• Swelling.
• Weakness.

The treatment choices for perilunate and lunate dislocations are closed reduction and casting, open reduction-internal fixation-ligament repair, trapeziolunate external fixation, limited wrist arthrodesis and proximal row carpectomy.

A perilunate dislocation is disruption of the normal relationship between the lunate and capitate. A lunate dislocation is separation of the lunate from both the capitate and the radius. Perilunate and lunate dislocations result when great force is applied to a hyperextended wrist.

Perilunate dislocations and perilunate fracture-dislocations are potentially devastating closed wrist injuries that are often missed on initial imaging. These injuries involve dislocation of the carpus relative to the lunate which remains in normal alignment with the distal radius.

When dislocation occurs in the wrist, it is typically perilunate, meaning that the bones surrounding the lunate lose their continuity with the lunate through disruption of the ligaments. Usually this involves the capitate dislocating dorsally.

Most mild to moderate wrist sprains heal on their own with the proper conservative treatments; Grade 3 sprains and wrist dislocation may need surgery. If surgery occurs, then incorporating hand therapy and rehabilitation exercises serve as an essential part of the healing process.

A wrist X-ray can help find the cause of common signs and symptoms such as pain, tenderness, swelling, or show deformities of the wrist joint. It can also detect broken bones or dislocated joints. After a broken bone has been set, an X-ray can help determine whether the bones are in alignment.

The common symptoms of a perilunate dislocation or fracture-dislocation include: 2  The reason tingling and numbness are common in patients with a perilunate injury is that the lunate is just adjacent to the carpal tunnel in the wrist.

Signs of a Perilunate Injury. 1 Significant pain in the wrist and palm of hand. 2 Swelling of the hand. 3 Limited motion of the wrist and hand. 4 Tingling and numbness of the fingers.

Lunate dislocations (more properly called “perilunate” dislocations) usually occur as part of a major injury such as a fall from a height or an automobile collision. When a perilunate dislocation occurs, one or more of these small carpal bones shifts out of normal alignment in the wrist joint.

Perilunate dislocations and perilunate fracture-dislocations are high-energy injuries resulting from loaded hyperextension and intracarpal axial rotation. All-terrain vehicle or motorcycle accidents are often common mechanisms in these patients.