WRIST DISLOCATION, LUNATE |
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General Information
DEFINITION--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.
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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.
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.
RISK INCREASES WITH
Any sport where falling or stress on the arm and hand is a possibility.
Previous wrist dislocation or sprain.
Repeated wrist injury of any sort.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT
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.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This may include manipulating the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the joint and adjacent bones.
POSSIBLE COMPLICATIONS
Damage to nearby nerves or major blood vessels, causing numbness, coldness and paleness.
Excessive internal bleeding at the dislocation site.
Recurrent dislocations, particularly if the previous dislocation is not healed completely.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the joint may require immobilization with a cast, splints or sling for 2 to 8 weeks. Complete healing of injured ligaments requires a minimum of 6 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
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. See Appendix 1 for details.
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 return 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.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen or aspirin to relieve moderate pain.
Narcotic pain relievers for severe pain.
Antibiotics to fight infection, if surgery is necessary.
ACTIVITY
Begin reconditioning the wrist after clearance from your doctor.
If surgery is necessary, resume your normal activities gradually. Don't drive until healing is complete.
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.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a dislocated wrist, especially if the hand becomes numb, pale, or cold. This is an emergency!
Any of the following occur after treatment or surgery:
Nausea or vomiting.
Swelling above or below the cast or splints.
Blue or gray skin color, particularly under the fingernails.
Numbness or complete loss of feeling below the dislocation site.
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Wrist dislocations occur repeatedly that you can "pop" back into normal position.
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