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J Wrist Surg 2024; 13(03): 260-263
DOI: 10.1055/s-0043-1774774
Case Report

Volar Lunate Dislocation Causing Secondary Carpal Tunnel Syndrome: A Case Report

Andrew M. Gabig 
1   Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
,
Hayden L. Cooke 
1   Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
,
Robert Roundy
1   Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
,
Michael B. Gottschalk 
1   Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
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Abstract

Background Failure of carpal tunnel release is an uncommon occurrence with unique pathologies that may impede proper diagnosis and treatment. Symptoms are most often attributed to an inadequate release of the transverse carpal ligament or pathologic scar tissue resultant of the primary decompression.

Case Description In this report, we describe the case of a 79-year-old male with a history of scaphoid lunate advanced collapse and a prior carpal tunnel decompression presenting with worsening right wrist function and new right palmar mass. The patient had no significant antecedent trauma, and clinical workup revealed volar dislocation of the lunate. After failed conservative treatment and multiple ultrasound-guided corticosteroid injections, the patient was successfully treated surgically with carpal tunnel release, tenosynovectomy, and lunate excision.

Literature Review Volar lunate dislocation without a traumatic mechanism is rare. Progressive carpal destabilization and volar subluxation is not a commonly reported cause of secondary carpal tunnel symptoms. Isolated reports in the literature have been published with nearly identical presentations. Kamihata et al reported a patient, with a history of carpal tunnel decompression, presenting with numbness and tingling in her right hand without traumatic injury. A displaced lunate was found to abut the flexor tendons and median nerve. Ott et al further reported an atraumatic lunate dislocation and palmar swelling 4 weeks after a carpal tunnel release.

Clinical Relevance In the setting of existing arthritic degeneration, carpal tunnel release may destabilize the carpus and predispose patients to carpal dislocation. Further research is required to understand the risks associated with this instability leading to lunate dislocations secondary to carpal tunnel release.

Keywords

carpal tunnel release - recurrent carpal tunnel syndrome - atraumatic - lunate dislocation - carpal instability

Disclosures

Andrew Gabig, Hayden Cooke, and Robert Roundy have nothing to disclose that is relevant to this publication. Michael B. Gottschalk receives research support from Stryker Corporation, Konica Minolta, Arthrex, and Acumed.




Publication History

Received: 28 September 2022

Accepted: 16 August 2023

Article published online:
09 October 2023

© 2023. Thieme. All rights reserved.

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