Understanding the Injury
A lunate or perilunate dislocation is a serious injury of the wrist. It involves bones in the wrist shifting out of place, usually after a strong force or trauma.
- Perilunate Dislocation: The lunate bone stays where it should be, but the rest of the wrist bones move out of place (usually backwards).
- Lunate Dislocation: The lunate bone itself moves out of place, usually into the palm side of the wrist (volar direction), often pressing on nearby nerves.
These injuries are rare but important. If not recognized and treated quickly, they can cause long-term problems, including pain, stiffness, or weakness.
How It Happens
These dislocations typically occur due to a high-energy injury. Common causes include:
- Falls on an outstretched hand
- Road traffic accidents
- Sports injuries
- Industrial or work-related accidents
The wrist is usually forced backwards and twisted during the injury, which stresses the ligaments and sometimes breaks bones.
Common Symptoms
- Sudden and severe wrist pain
- Swelling and bruising
- Deformity or unusual shape of the wrist
- Difficulty moving the wrist or fingers
- Numbness or tingling in the thumb, index, or middle fingers (may indicate pressure on the median nerve)
How We Diagnose It
The doctor will examine your wrist and ask how the injury happened. You will need X-rays of your wrist:
- Posteroanterior (PA) view: From the back of the hand
- Lateral view: From the side
These images help to identify whether the wrist bones are out of line. Additional scans like CT (to look for fractures) or MRI (to check ligament injuries) may be used.
Key signs on X-ray include:
- “Piece-of-pie” shape of the lunate bone (suggests rotation)
- “Spilled teacup sign” (lunate has tipped into the palm)
- Misalignment of bones normally in a straight line (radius, lunate, capitate)
- Widening of the space between two wrist bones (scaphoid and lunate)
Why Quick Treatment Matters
These injuries are often missed at first. If treatment is delayed, it can lead to:
- Chronic wrist instability (looseness and repeated dislocations)
- Post-traumatic arthritis (joint damage and pain)
- Persistent weakness and limited movement
- Nerve damage (especially to the median nerve)
- Reduced ability to use the hand
Immediate attention helps prevent long-term problems.
Initial Emergency Treatment
If your wrist is dislocated, a doctor will usually perform a closed reduction. This means gently pulling the wrist bones back into place using traction, often under sedation or anaesthetic.
Afterwards, your wrist will be supported in a splint or plaster cast. However, this is only a temporary step. Most patients will still need surgery.
Definitive Treatment: Surgery
Surgery is generally required, ideally within 8 weeks of the injury.
Goals of surgery:
- Re-align the wrist bones properly
- Repair torn ligaments
- Fix any broken bones
- Protect healing structures with temporary pins (K-wires)
Surgical Approaches:
- Volar (palm side): Used if the lunate has pushed into the palm or if nerve release is needed
- Dorsal (back of the wrist): Provides better access to key ligaments and fractures
- Combined: Used for more complex injuries, allowing full repair of both sides
Recovery and Rehabilitation
After surgery:
- Your wrist will be immobilised in a splint or cast for at least 6 weeks
- Pins (if used) are typically removed around 8 to 10 weeks
- Physiotherapy will begin after pins are removed to improve movement and strength
Full recovery can take up to a year, and the wrist may never feel completely “normal” again. Some pain, stiffness, or weakness may remain.
Possible Complications
Even with good treatment, complications may include:
- Nerve problems (median nerve compression)
- Arthritis (wear and tear of the wrist joint over time)
- Chronic wrist instability
- Bone death (avascular necrosis of the lunate)
- Stiffness or reduced grip
- Complex Regional Pain Syndrome (CRPS) – a rare but painful condition
You will be monitored closely to help reduce these risks.
Frequently Asked Questions
Will I need physiotherapy?
Yes. Exercises are essential for regaining movement and strength after surgery.
Can I return to sport or work?
This depends on your job or sport. Light activities may resume in a few months, but full strength takes longer.
Will I need more surgery?
In rare cases where healing is incomplete or complications occur, further surgery may be needed.
Can this injury happen again?
With proper surgery and rehabilitation, recurrence is rare. However, long-term stiffness or arthritis may develop.
What to Do Next
If you’ve injured your wrist and suspect a dislocation—or have ongoing pain, swelling or nerve symptoms—seek urgent medical assessment. Early treatment gives the best chance for recovery.
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025