When can I expect full recovery from a dislocated lunate bone?

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Q: I am a construction worker just getting back to work part-time after a wrist injury that dislocated my lunate bone and tore the ligaments around it. Can I expect to get full recovery?

A: The lunate carpal (wrist) bone doesn't dislocate easily and usually only after significant high-energy trauma. The lunate is well-stabilized because it is neatly tucked in between the two bones of the forearm, the two other carpal bones on either side, and another row of carpal bones next to the fingers. It takes a high-energy trauma to cause this type of injury.

Dislocation of this bone usually means the soft tissues around the lunate have been disrupted. There are a series of events or "stages of injury" that occur to force the lunate out of place. It's a bit like dominoes -- once the first one goes, a whole series of events takes place.

The prognosis (what you can expect after treatment) depends on a couple of factors. These include: 1) timing of treatment (how soon surgery is done after the injury) and 2) quality of the reduction (how well the bones are lined up and stabilized). A delay of more than a month can mean worse results than with early treatment. Even with the best treatment early on, patients can expect some loss of grip strength and motion.

Severe injuries with less than ideal alignment can mean early arthritic changes. But most of these injuries do heal. Patients are able to resume daily activities and even return to work. Manual laborers have greater difficulty with return to full work activities and often report worse outcomes. Patients who are treated surgically using both the front (volar) and back (dorsal) wrist incisions tend to have decreased results as well.

Returning to work part-time is a good way to ease back into full employment. Depending on the type of work you do, it may also be necessary to modify work activities so that you aren't putting full force on the wrist right away. If your rehabilitation program included hand therapy, your therapist can help guide you -- both in preparing to return-to-work and also in planning and performing the actual work load.

Reference: Scott R. Hadley, and Steve K. Lee, M.D. Hand and Wrist: Perilunate Injuries. In Current Orthopaedic Practice. July/August 2012. Vol. 23. No. 4. Pp. 318-321.

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