What is a Volar Lunate Dislocation?
The lunate is one of eight carpal bones located in the wrist. Several ligaments attach to the dorsal and palmar surfaces of these carpal bones, holding them together to provide stability in the wrist.
Volar lunate dislocation is the last stage of perilunate dislocation. It is a fairly uncommon wrist injury that requires prompt management and surgical repair. In this injury, the lunate is displaced and rotated volarly, sometimes into the carpal tunnel. The other carpal bones may remain in a normal anatomical position related to the radius.
Characteristics and Clinical Presentation of Volar Lunate Dislocation
In most cases, patients that have a volar lunate dislocation will present with wrist pain, usually following an accelerated fall or other accident.
This is a painful condition that is more likely to occur in younger individuals or individuals, who experience accidents that exert a lot of force on their wrist.
In patients presenting with a volar lunate dislocation, their wrist may appear swollen and deformed. This swelling often causes patients to present their hands in a partially flexed position due to pain on extension. Numbness and reduced finger motion may be present.
Common symptoms of a volar lunate dislocation include:
- Painful swelling
- Wrist deformity
- Inability to extend digits due to pain
Causes of Volar Lunate Dislocation
Lunate dislocations typically occur in patients who have experienced trauma to a dorsiflexed wrist. Carpal dislocations make for less than 10% of all wrist injuries, with lunate dislocations being less common.
These injuries usually occur when a patient falls onto an outstretched hand (FOOSH injuries) with the wrist in an extended position. However, other accidents, like a car accident, could cause a patient to experience this dislocation as they attempt to brace themselves with their hands. Generally added force is necessary in this dislocation.
Getting a Diagnosis for Volar Lunate Dislocation
An X-ray or magnetic resonance imaging will typically be ordered for a definitive diagnosis of a volar lunate dislocation.
Diagnostic exams for this injury involve palpating and compressing force over the scaphoid while grasping the hand, and passively moving the patient into radial deviation with slight extension. This test may be positive when there are scapho-lunate ligament injuries.
When a patient experiences wrist pain, or had injured their wrist in an accident, they should be seen by a specialized hand and wrist surgeon trained in repairing injuries to the hand, wrist, and elbow in order to get a proper diagnosis. This is especially true for patients experiencing a volar lunate dislocation, as it will cause serious damage to the structures in the wrist when treatment is delayed or incomplete.
Treatment Options for Volar Lunate Dislocation
Lunate dislocations generally require urgent reduction and surgical repair. Repair of the disrupted ligaments is required in order to minimize long term joint dysfunction.
Conservative treatments are provided for temporary symptom relief. These include immobilization with a long wrist control splint. Patients are instructed to avoid axial loading of the wrist, occurring with forceful grasp.
Surgery is recommended in almost all cases in order to complete the bony realignment and ligament repairs.
Your surgeon may elect to perform procedures to the wrist to repair the damaged ligaments that cause instability or uncommonly to fuse carpal bones. Soft tissue repair is often a better means of surgical intervention in acute cases.
Preventing Volar Lunate Dislocation
Injuries to the volar lunate often occur from high impact accidents, sports, or falls. Patients in sports ought to learn to fall without their hands stretched out.
Unfortunately, this injury typically occurs as a result of an accident, so patients oftentimes cannot avoid a volar lunate dislocation if their wrist is damaged under forceful circumstances. Preconditioning may reduce risk.
Prognosis for Volar Lunate Dislocation
Despite treatment, future arthritis and partial loss of motion remain possibilities. Patients require a splint or a cast to immobilize the wrist for a period of at least 8 weeks, followed by physical therapy
Outcomes are typically better after soft tissue repair.
If You Believe You Have Been Injured, Contact HandSport Surgery Institute.
Please contact us as soon as possible to schedule an appointment with our talented team. People who have been hurt should be evaluated to try and prevent further injury and mobility issues.
If you have been injured, it’s important to be evaluated by a highly skilled hand and wrist surgeons. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis best evidence-based treatment plan.