Carpal tunnel crowding and median nerve compression
Scapholunate injury consequences
DISI deformity development
SLAC wrist progression over time
TFCC injury consequences
DRUJ instability
Ulnar sided pain with load
Therapeutic Considerations
Time dependence
Early reduction reduces neurovascular compromise duration
Delayed diagnosis increases need for salvage procedures
Operative rationale
Definitive management typically surgical for lunate and perilunate dislocations
Ligament repair and carpal stabilization to prevent chronic instability
Nonoperative role
Suspected partial ligament injury without instability
Immobilization and early hand surgery assessment
Evidence framing
Class I recommendation by expert consensus for urgent specialist consultation for lunate or perilunate dislocation
ACEP Level C recommendation for repeat neurovascular assessments after splinting and reduction
Patient Discharge Instructions
copy discharge instructions
Discharge instructions
Splint care
Keep splint clean and dry
Do not remove splint unless instructed
Swelling control
Elevation above heart as much as possible for 48 to 72 hours
Ice 15 to 20 minutes at a time with barrier to skin
Pain plan
Acetaminophen as directed on label
Ibuprofen as directed on label if safe for patient
Opioid only if prescribed and avoid driving
Activity restriction
No lifting with injured hand
Finger motion exercises if permitted by splint design
Return to ED immediately
Increasing pain not controlled with medication
New numbness or worsening tingling
Fingers becoming pale, blue, or cold
Increasing tightness or swelling in the splint
Inability to move fingers
Wet or damaged splint
Fever or wound drainage if any open injury
Follow up
Hand surgery or orthopedics appointment timing as arranged
If no appointment, contact within 24 hours for urgent follow up
References
Clinical guidelines and evidence sources
Core references
ACEP clinical policy and procedural sedation guidance for ED sedation monitoring
ATLS principles for initial trauma evaluation and neurovascular documentation
Hand surgery consensus statements on perilunate and lunate dislocation urgent management
Diagnostic imaging references
Radiographic alignment criteria and carpal instability signs in orthopedic and radiology references
MRI and CT use for occult fracture and ligament injury assessment in musculoskeletal imaging guidance
Coding references
ICD-10 S63.0 dislocation of wrist and carpus
ICD-10 S63.5 sprain of joints and ligaments of wrist
ICD-10 G56.0 carpal tunnel syndrome
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