Lunate dislocation causing median nerve entrapment

Carpal Tunnel Syndrome: Pathophysiology and Comprehensive Guidelines for Clinical Evaluation and Treatment

In carpal tunnel syndrome (CTS), the median nerve is compressed at the level of the carpal tunnel in the wrist. This entrapment manifests as unpleasant symptoms, such as burning, tingling, or numbness in the palm that extends to the fingers. As the disease progresses, afflicted individuals also report decreased grip strength accompanied by hand weakness and restricted movement. The first half of this review elaborates on CTS pathology by providing readers with a comprehensive understanding of the etiology, relevant anatomy, and disease mechanism.

CTS is considered the most common entrapment neuropathy, affecting around 3-6% of the adult population. Further, CTS prevalence has seen a dramatic increase in the last few decades paralleling the growth of everyday technology usage. Despite how common it is to have CTS, it can be quite challenging for physicians to make a definite diagnosis due to differentials that present with overlapping symptoms. Even more difficult can be deciding on a course of treatment that is the most effective and considerate of patient needs. Thus arises the need for clear clinical direction, and hence we end with a discussion around such guidelines that serve as a starting point toward effective diagnoses and patient treatment.

First-stage scapholunate fusion for the treatment of a chronic lunate dislocation: A case report

RATIONALE

Lunate dislocation is a rare injury to the wrist caused by high-energy trauma, and poor prognosis is often associated with missed initial diagnosis. To date, there is no consensus regarding an effective treatment plan for such cases.

PATIENT CONCERNS

Here, we describe the case of a 36-year-old man who presented with lunate dislocation following a delay in diagnosis of over 7 weeks, and further illuminate its diagnosis and treatment.

DIAGNOSIS

The diagnosis of chronic lunate dislocation was rendered.

INTERVENTIONS

The patient was treated using reduction via the dorsal approach brachial plexus anesthesia. After the reduction, a headless compression screw fixation was performed for first-stage scapholunate fusion, and Kirschner wire fixation of the lunate-triquetrum-hamate was used to stabilize the distal and proximal carpal rows.

OUTCOMES

The patient was followed up for 1 year and showed wrist function recovered well; radiographic examination showed no lunate dislocation and successful scapholunate bony fusion. A satisfactory outcome was achieved.

LESSONS

The case study presented here provide evidence that performing an effective first-stage scapholunate fusion is recommended to achieve better therapeutic outcomes for a chronic lunate dislocation. Furthermore, this approach led to a good long-term clinical outcome in our case.

LUNATE DISLOCATION: PRESENTATION OF TWO CASES OF A RARE CONDITION

Lunate dislocation is a circumambient disruption of the lunate bone. It is an uncommon but devastating wrist injury that can have negative effect on lifestyle with significant morbidity. This injury can go unrecognized by physicians resulting in complications including but not limited to carpal tunnel syndrome and Kienbock's disease. We present two cases of type 4 lunate dislocation that presented within 24 hours of injury; one had fallen off a moving motorcycle while the other had been involved in a motor vehicle accident. The second developed carpal tunnel syndrome. Radiographs showed typical appearances. Both had Open Reduction with Internal Fixation (ORIF), recovered well, and had good function at the outpatient follow-up.