Dislocated Wrist

First aid for a suspected dislocated wrist

1. Do not try to pop it back. Forcing the bones can damage nerves and blood vessels.
2. Remove rings, watches and bracelets from that hand straight away, before swelling makes this impossible.
3. Support the wrist in the position you find it, with a rolled magazine or padded splint and a sling.
4. Apply ice wrapped in a cloth for up to 20 minutes.
5. Keep the hand raised above heart level.
6. Do not eat or drink in case sedation or surgery is needed soon.
7. Get to an ER promptly.

What a wrist dislocation is

The wrist joint links the two forearm bones (radius and ulna) to eight small carpal bones, held together by strong ligaments. The lunate, a crescent-shaped bone in the center, is the keystone.

When the hand is forced backward with great force, ligaments tear in a predictable ring around the lunate. Depending on how far the injury goes:

Symptoms

• Severe wrist pain immediately after the injury.
• Rapid swelling and bruising.
• A wrist that looks misshapen or thickened, although swelling can hide this.
• Inability to move the wrist or grip.
• Numbness or pins and needles in the thumb, index and middle fingers, caused by pressure on the median nerve. This happens in a large share of lunate dislocations and is a sign of acute carpal tunnel syndrome.

Why wrist dislocations are often missed

The bones can look almost normal on a quick X-ray, and the injury is often blamed on a sprain. Studies suggest about a quarter of perilunate injuries are missed at the first visit. A delayed diagnosis makes repair harder and results worse, so persistent pain after a heavy fall deserves a second look.

Diagnosis

The doctor checks the shape of the wrist, the pulses, the color and temperature of the fingers, and sensation, especially in the median nerve area. Tests include:

• X-rays: front (PA) and true side (lateral) views. On the side view, the lunate should sit in line with the radius and the capitate. A tilted "spilled teacup" lunate signals lunate dislocation. Broken arcs on the front view and a gap between the scaphoid and lunate are other clues.
• CT scan: shows associated fractures and helps plan surgery.
• MRI: for ligament injury when X-rays are inconclusive.

Treatment

Reduction in the ER

The bones are put back into place (closed reduction) under sedation or a regional nerve block, usually with traction applied to the fingers. This relieves pressure on the median nerve. The wrist is then splinted. If reduction fails or nerve symptoms persist, surgery is done urgently.

Surgery

Almost all perilunate and lunate dislocations need surgery, ideally within days, because the torn ligaments do not heal properly in a cast. The surgeon:

• Repairs the torn ligaments, especially the scapholunate ligament.
• Fixes any fractures, such as the scaphoid, with screws.
• Holds the bones in position with temporary wires for 8 to 12 weeks.
• Releases the carpal tunnel if the median nerve is compressed.

Rehabilitation

After the wires are removed, a hand therapist guides exercises to recover motion, then strength. Expect reduced wrist movement, typically regaining a good functional range but not full motion, and lower grip strength for months.

Complications

• Wrist stiffness and weakness, the most common long-term problems.
• Median nerve damage with lasting numbness.
• Arthritis: wear of the wrist joint over years, especially after delayed treatment.
• Ongoing instability (carpal instability).
• Avascular necrosis: loss of blood supply to the lunate or scaphoid.
• Compartment syndrome or complex regional pain syndrome, rarely.

Recovery time

Plan on 2 to 3 months in a cast or splint and with wires in place, then 3 to 6 months of therapy. Desk work may be possible within weeks. Heavy manual work and contact sports often take 6 months or more. Most people recover a useful, fairly comfortable wrist, but some loss of motion and strength is typical.

Frequently asked questions

How do I know if my wrist is dislocated or sprained?

A dislocation usually follows a very hard force, causes severe pain and swelling, may look deformed, and often causes numbness in the thumb and first fingers. A sprain is usually milder. Because they can look similar, any wrist injury with severe pain, numbness or inability to grip needs an X-ray.

Can a dislocated wrist heal on its own?

No. The bones must be put back in place, and the torn ligaments usually need surgical repair. Leaving a dislocated wrist untreated leads to chronic pain, nerve damage, collapse of the wrist bones and early arthritis.

How long does a dislocated wrist take to heal?

Bones and ligaments need about 8 to 12 weeks of protection after surgery, followed by several months of hand therapy. Most people return to daily tasks within 3 to 4 months, but full strength and the final result can take 6 to 12 months.

What is a perilunate dislocation?

It is a wrist injury in which the ligaments around the lunate bone tear and the other carpal bones dislocate around it, while the lunate stays attached to the radius. It is caused by high-energy falls or crashes, is easily missed on X-ray, and usually needs surgery.

Can you move your fingers with a dislocated wrist?

Often yes, which is why people sometimes delay getting help. Finger movement is controlled by forearm muscles, so the fingers may still bend despite a serious wrist injury. Numbness or tingling in the fingers is more telling and needs urgent assessment.