Wrist Joint Dislocation

What is a Wrist Joint?

Wrist joint is the link between hand and forearm. Wrist joint is formed by 15 bones spread in three sections.

Describe The Three Sections Of The Wrist Joint?

Three Sections of Wrist Joint Are As Follows

  • Proximal Wrist Joint- Close to Forearm.
  • Intermediate Wrist Joint.
  • Distal Wrist Joint- Close to Hand.
Bones of the Hand and Wrist

Describe the Proximal Wrist Joint?

Proximal Wrist Joint Has Two Segments

  • First segment is formed by pivot joint between radius and ulna. Head of distal end of ulna is covered with smooth cartilage, which lies against ulnar notch of radius bone. Joint is covered by synovial capsule. Lax synovial capsule surrounds the wrist joint. Flaccid capsule allows semi-rotation of joint during pronation and supination. Volar dislocation is often difficult to diagnose.
  • Second segment is link or joint between distal end of radius and part of ulna with proximal row of three carpal bones. Proximal row of carpal bone is formed by Scaphoid, Lunate and Triquetrum.

Describe the Intermediate Wrist Joint?

Intermediate Wrist Joint is link or joint between proximal rows of carpal bones (Scaphoid, Lunate and Triquetrum) and distal rows of carpal bones (Trapezium, Trapezoid, Capitate, Hamate and Pisiform). The joint is also known as inter-carpal wrist joint.

Describe the Distal Wrist Joint?

Distal row of carpal bones Trapezium, Trapezoid, Capitate, Hamate and Pisiform are linked with five metacarpal bones.

What Is The Function Of Wrist Joint?

The Wrist Joint Functions Are As Follows

  • The wrist joint links hand to forearm.
  • Wrist joint supports hand movements like flexion, extension, abduction, adduction, lateral tilt, supination and pronation.
  • Wrist joint protects tendon, nerves and blood vessels underneath flexor and extensor retinaculum.

What Is Wrist Joint Dislocation?

Dislocation is a separation of two bones, which are linked to each other. Wrist joint is formed by 15 bones and each bone is linked to one to four bones. Isolated dislocation of carpal bone is rare, since wrist joint dislocation is often associated with fracture of one of the wrist joint bone.

How Common Is Wrist Joint Dislocation Associated With Fracture Of The Wrist Joint Bones?

Most of the wrist joint dislocation is associated with fracture of one of the wrist joint bone. Wrist joint dislocation and fracture is one of the common injury observed in emergency room.

Why Fracture Is Common With Dislocation?

Reason Why Fracture Is Common with Dislocation Is As Follows-

  • Several tough ligaments support wrist joint - Forceful pull of the ligament generates severe force between carpal bones resulting in fracture of one of the wrist bone.
  • Ligamental tear- Severe accelerating force causes tear of the ligament and hairline or complete fracture of one of the wrist bone.
  • Dislocation- Direct impact results in fracture as well as dislocation of less resistant carpal bone.
  • Twist and turn of the wrist joint- Twist and turn of the joint in abnormal position results in severe opposing force between ligaments and causes tear or fracture of the wrist bone.

Which Soft Tissue Injuries Are Associated With Wrist Joint Dislocation?

Soft Tissue Injuries Associated With Wrist Joint Injuries Are As Follows

  • Ligamental Laceration or Tear.
  • Tendon Rupture or Tear.
  • Nerve Injuries.
  • Vascular (blood vessels) Tear Causing Hematoma (blood clots).

What Are The Causes Of Wrist Joint Dislocation?

Wrist Joint Dislocation Is Caused By Trauma and Following Are the Causes of Trauma

  • Automobile Accident Injury.
  • Work Accident.
  • Sport Injuries.
  • Domestic Fall.
  • Slip and Fall On Slippery Surface.

How is Wrist Joint Dislocations Classified?

Wrist Joint Dislocation Is Classified As Follows

  • Anterior Dislocation.
  • Posterior Dislocation.

What Are The Different Types Of Anterior And Posterior Dislocation?

Following Are the Types of Anterior and Posterior Dislocation of Wrist Joint-

  • Dislocation between Radius and Ulna.
  • Dislocation between Radius and Proximal Rows of Carpal Bones.
  • Dislocation between Carpal Bones.
  • Dislocation between Carpal Bone and Metacarpal Bone.

What Causes Anterior or Posterior Dislocations?

Causes of Anterior or Posterior Dislocation Are As Follows-

Anterior (Ventral or Towards Palm) Dislocation-

Anterior Dislocation Caused By Fall-

  • Wrist joint in extension position.
  • Arm in flexed position.
  • Arm in stretched position during fall.

Anterior Dislocation Cause by High Magnitude Impact-

  • Direct Impact on dorsal or back of the hand.
  • Impact results in an extreme hyperextension of the wrist joint at the time of impact.

Posterior (Dorsal or Towards Back of the Hand) Dislocation-

  • Fall or impact when wrist joint is in flexed position.
  • Arm is stretched at the time of fall or impact.

What Is Isolated Carpal Dislocation?

Isolated carpal dislocation is dislocation of single carpal bone of proximal or distal row. Isolated carpal dislocation is extremely painful and often associated with hairline fracture.

What Are The Characteristics Of Isolated Carpal Dislocation?

Characteristics of Isolated Carpal Dislocations Are As Follows-

  • Extremely Rare
  • Difficult to Treat
  • Most Common Carpal Dislocation Is Dislocation Of Lunate.
  • Dislocation Is Often In A Palmar (Anterior) Direction.
  • The Rare Dorsal Dislocation Occurs During Wrist Flexion Injury.

How Common Is Radio-Ulnar Joint Dislocation?

Isolated acute distal radio-ulnar joint (DRUJ) dislocation is a rare injury. Very few cases of bilateral radio-ulnar dislocation has been documented.

Which Fracture Is Associated With Radius-Ulna Dislocation?

Following Fractures Are Observed With Radius-Ulna Dislocation

  • Fracture of Ulna
  • Fracture of Radius
  • Fracture of Radius Associated With Rupture Of Interosseus Membrane, also known as Essex–Lopresti Injury.

Which Are The Isolated Carpal Dislocations Observed Following Wrist Joint Injuries?

Isolated Dislocations are rare. List of Isolated Dislocations are as Follows

  • Lunate Dislocation As Described By Mayfield et al.
  • Dislocation of Scaphoid Bone Following Scapho-Lunate Ligament Tear.
  • Capitate Dorsal Dislocation.
  • Dislocation of Lunate Following Luno-Triquetral Ligament Disruption. Lunate Often Remains Aligned With The Radius.
  • Lunate Dislocation And Displacement Following Ligamental Tear. The Capitate Remains Aligned With The Radius, While The Lunate Is Squeezed Out In A Volar Direction.

Describe The Symptoms Of Wrist Joint Dislocations?

Symptoms of Wrist Joint Dislocation Are As Follows

  • Wrist Joint Pain.
  • Restricted Wrist Joint Movements.
  • Abnormal Sensory Symptoms Like Tingling And Numbness.

Describe Wrist Joint Pain?

Wrist Joint Pain Is Observed Over Front And Back Of The Wrist.

Characteristic of Pain Is As Follows-

  • Pain is referred to forearm and hand.
  • Pain intensity is increased with movement of wrist joint.
  • Pain is less severe when arm is held above the shoulder.
  • Pain is throbbing and continuous.

What Is Restricted Wrist Joint Movements?

Restricted Wrist Joint Movements Results from Following Abnormalities-

  • Injured patient is unable to move wrist joint.
  • Passive movement is painful and restricted.
  • Wrist joint is often observed in locked position of extension or flexion.

What Causes Tingling And Numbness Following Wrist Joint Dislocation?

Symptoms such of tingling and numbness are observed following irritation or pinch of the sensory nerve fibers of radial, ulnar or median nerve.

Describe Abnormal Sensory Nerve Symptoms Of Ulnar Nerve Injury?

Ulnar nerve injury causes tingling and numbness along the front and back of inner side of hand (includes small finger and ring finger).

Describe Abnormal Sensory Nerve Symptoms Following Median Nerve Injury?

Median nerve injury causes symptoms of tingling and numbness on palmer surface along outer side of hand (includes thumb, index and middle finger).

Describe Abnormal Sensory Nerve Symptoms Of Radial Nerve Injury?

Radial nerve injury causes tingling and numbness of the skin over back of the hand between wrist and thumb as well as lower 2/3rd of index and middle finger.

Abnormal Sensory Nerve Symptoms Of Radial Nerve Injury.

Signs of Wrist Joint Dislocation

Signs of Wrist Joint Dislocation Are As Follows-

  • Muscle Weakness.
  • Ulnar Nerve Palsy.
  • Radial Nerve Palsy.
  • Median Nerve Palsy.

Describe The Signs Of Muscle Weakness Or Paralysis?

Signs of Muscle Weakness or Paralysis Are As Follows-

  • Patient is unable to perform fine activities using fingers like writing and holding paint brush.
  • Patient is unable to flex or extend hand and fingers.

What Is Ulnar Nerve Palsy?

Ulnar Nerve Palsy-

  • Seen following ulnar nerve injury.
  • A hand is in claw position resulting in flexion or curls up position of small and ring finger.
Ulnar Nerve Palsy/claw Hand

What is Radial Nerve Palsy or Wrist Drop?

Radial Nerve palsy-

Clinical Sign Is Evaluated As Follows-

  • Arm is flexed or extended at elbow.
  • Palm is facing ground.
  • Hand is flexed or in drop position.
  • Patient is unable to extend hand at wrist joint in this position.
Radial Nerve palsy/Wrist Drop

What Is Median Nerve Palsy?

Median Nerve Palsy-

  • Patient is unable to count using thumb.
  • Patient is unable to touch other fingers with thumb.
  • Patient is also unable to bring and hold index and middle fingers together.
  • Atrophy of the thumb muscles (thinner muscles.)


Palpation of wrist joint indicates joint is extremely painful. Active (performed by patient) or passive (assisted by examiner) movements of the wrist joint are very painful and restricted.


Joint deformity is observed because of one of the dislocated bone is in out of place from the joint. Joint distortion also interferes and prevents joint movements.


Skin bruising are observed as a result of laceration and subcutaneous hematoma (blood clots)


Soft to firm lump is felt underneath the skin over fractured wrist joint. Lump is secondary to subcutaneous hematoma (blood clot).

How Is Wrist Joint Dislocation Investigated?

X-Ray Will Show Following Abnormalities-

  • Radius and Ulna Dislocation.
  • Carpal Bone Dislocation.
  • Dislocation between Carpal Bone and Metacarpal Bone.
  • X-ray will show fracture.
  • X-ray may not show hairline fracture or ligament tear.

MRI Will Show Following Abnormalities-

  • Radius and Ulna Dislocation.
  • Carpal Bone Dislocation.
  • Dislocation Between Carpal Bone And Metacarpal Bone.
  • Fracture Associated With Wrist Joint Dislocation.
  • Hairline Fracture
  • Hematoma (blood clot)
  • Osteoporosis
  • Necrotic Fracture Bone

CAT Scan Will Show Following Abnormalities-

  • Radius and Ulna Dislocation.
  • Carpal Bone Dislocation.
  • Dislocation Between Carpal Bone And Metacarpal Bone.
  • Fracture Associated With Wrist Joint Dislocation.
  • Hematoma (blood clot).

Ultrasound Will Show Following Abnormalities-

  • Wrist Joint Dislocation.
  • Wrist Joint Fracture.
  • Hematoma Within Wrist Joint.
  • Subcutaneous hematoma.

Blood Examinations

Blood examination is done to rule out joint infections. Following abnormal blood examinations are observed if joint is infected-

  • Increased white blood cell count.
  • Increased Erythrocyte Sedimentation Rate.

What Are The Treatment Options for Wrist Joint Dislocation?

  • Conservative Treatment
  • Medications
  • Physical Therapy
  • Interventional Pain Therapy
  • Close Reduction
  • Surgical Treatment

What Are The Conservative Treatments Advised For Wrist Joint Dislocation?

  • Restrict Activities Of The Wrist Joint.
  • Heat or Cold Therapy for Joint Edema and Swelling.
  • Apply Wrist Joint Braces.
  • Weight Loss- Loss of Weight and Obesity Helps To Reduce Pain.
  • Daily Exercise of Fingers and Forearm Muscles.

Which Oral Medications Are Prescribed For Wrist Joint Dislocation?

Following Medications Are Prescribed For Chronic Pain and Muscle Spasm-

  • NSAIDs.
  • Opioids.
  • Muscle Relaxants.

Why is NSAIDs Prescribed For Wrist Joint Dislocation?

NSAIDS are Non-Steroidal anti-inflammatory Medications.

NSAIDs Are Indicated For Following Symptoms-

  • Chronic Pain.
  • Wrist Joint Inflammation Caused By Dislocation.

Most Frequent NSAIDs Prescribed For Chronic Pain Are-

  • Motrin
  • Naproxen
  • Daypro
  • Celebrex

When Is Opioid Prescribed For Chronic Pain Caused By Wrist Joint Dislocations?

Following Are the Indications for Opioids Medication-

  • NSAIDs Resistance- Opioids Are Prescribed When Pain Is Not Responding To NSAIDS Treatment
  • Pain During Activities Only- If pain is severe during walking and less severe at rest then pain is treated with short acting opioids.
  • Pain at Rest- Severe pain at rest is treated with long acting opioids and breakthrough pain is treated with short acting opioids.

How is Muscle Spasm Associated With Wrist Joint Dislocation Treated?

Muscle pain or spasm is treated with muscle relaxants (medications) or physical therapy.

Which Muscle Relaxants Are Used For Treatment Of Muscle Spasm Or Muscle Pain?

Muscle Spasm or Pain Is Treated With One of the Following Muscle Relaxants-

  • Baclofen
  • Flexeril
  • Skelaxin
  • Robaxin

When Is Physical Therapy (PT) Prescribed For Wrist Joint Dislocation?

Indications for Physical Therapy (PT) Is As Follows-

  • Chronic Pain Not Responding To NSAIDS and Opioids.
  • Following Surgery to Optimize Joint Mobility and Movements.
  • Aggressive Physical Therapy Is Combined With Interventional Pain Therapy.
  • Physical Therapy Is Prescribed For Muscle Spasm If Pain Is Tolerable.
  • Physical Therapy Is Advised For Joint Stiffness Following Surgery.
  • Joint Instability.

When is Interventional Pain Therapy suggested As a Treatment for Wrist Joint Dislocation?

Indications for Interventional Pain Therapy Is As Follows-

  • Chronic Pain Not Responding To Pain Medications.
  • Prior to Physical Therapy or After Failed Physical Therapy.
  • Failed Surgery.
  • Interventional Pain Therapy Is Indicated For Chronic Pain and Inflammation.

What Are The Different Types Of Interventional Pain Therapy?

Choice of Interventional Pain Treatment Is As Follows-

  • Cortisone Injection
  • Local Anesthetic Injection
  • Nerve Ablation
  • Spinal Cord Stimulator
  • Intrathecal Catheter and Pump Placement

When is Cortisone Injection Advised To Treat Symptoms of Wrist Joint Displacement?

Cortisone Injection Is Advised For Following Indications-

  • Inflammation-Cortisone injection is performed to reduce inflammation.
  • Chronic Pain-Pain if not responding to NSAIDs and opioids then chronic pain is treated with frequent cortisone injection scheduled between 3 to 4 months. Treatments last until pain is tolerable and joint movement are improved.
  • Contraindications- Cortisone injection is not recommended for chronic pain associated with Gout and Septic Wrist Joint Arthritis.

When is Local Anesthetic Injection Advised for Wrist Joint Dislocation?

Therapeutic value of just local anesthetic injection is very limited and the procedure is performed only as a diagnostic procedure. Procedure is also performed prior to physical therapy in few cases.

How Is Cortisone Or Local Anesthetic Injection Performed?

Cortisone or local anesthetic Injection is performed either at doctor's office or outpatient surgery. Wrist joint cortisone injection in majority of the patient is performed under local anesthesia. In most of the cases image intensifier (portable X-Ray) is used for placement of needle.

Is The Procedure Painful?

Not really, pain specialist is trained for needle placement. Physician will spray skin with numbing medicine so first prick or insertion of needle is painless and then he will inject local anesthetics to numb all the tissue to be treated including skin. Few patients suffer with "needle phobia" (fear of needle) in such cases physician will provide oral or intravenous antianxiety medications or sedation.

What is Nerve Ablation Treatment?

Treatment is very rarely needed. Wrist joint dislocation after completion of treatment may result in severe continuous chronic pain because of peripheral pinch nerve. Nerve ablation is a lesioning of nerve using cryo probe or radiofrequency heat.

How is Nerve that is Causing Pain Identified?

Pain specialist will conduct detailed examination, which will be followed by nerve study. The examinations and various tests will conclude the diagnosis of nerve causing pain.

How Is Cryo Probe Lesioning Performed?

Treatment is performed under local anesthesia. The skin and subcutaneous tissue is anesthetized using local anesthetics. Cryo probe is carefully passed through tiny skin incision and kept over the nerve. Probe is cooled down to -90 degree C.

How is Radiofrequency Nerve Ablation Procedure Performed?

Radiofrequency needle is much smaller in diameter than cryo probe. Radiofrequency needle is placed just like cryo probe over pinched or irritated nerve. Radiofrequency waves are generated at the tip of the needle, which results in increased temperature. Temperature is maintained between 75 to 90 degree C for 75 to 90 seconds to accomplish nerve ablation.

Is Nerve Ablation Procedure Safe?

Yes, procedure is directed to tiny nerves. Area to be treated is limited to less than a millimeter. Surrounding tissue is not exposed to same temperature.

When is Spinal Cord Stimulator Indicated For Wrist Joint Dislocation Pain?

Spinal Cord Stimulator is rarely indicated for wrist joint pain. Chronic wrist joint pain is considered for spinal cord stimulator therapy if all the treatment including surgical correction of dislocation failed to relieved severe intractable pain.

How Much Pain Relief Should I Expect If I Am Suffering With Excruciating Chronic Pain?

Spinal cord stimulator may not relieve all chronic pain. Procedure is performed in 2 stages. First stage is diagnostic procedure and second is permanent placement of stimulator and generator. During diagnostic procedure, stimulator is placed either over pinched nerve in wrist or epidural space in neck. Stimulator is stimulated using external generator. Pain relief over 50% is considered satisfactory by majority of the patient and permanent placement is considered.

Where Is Stimulator Placed For Wrist Joint Pain?

Stimulator is placed over irritated or pinched nerve over the wrist joint or in the epidural space in neck.

When is Intrathecal Opioids Prescribed For Chronic Pain Caused by Wrist Joint Dislocation?

Intrathecal opioid is prescribed when all other treatment including surgery and spinal cord stimulator fails to relieve chronic intractable pain.

What Is Intrathecal Opioid Treatment?

Intrathecal opioid therapy means delivering opioid into CSF. Three layers of membrane called pia, arachnoid and dura covers Spinal Cord. The space between pia and arachnoid contains fluid known as Cerebro Spinal Fluid or CSF. A tiny catheter is placed into the CSF and opposite end is connected to an electronic small pump known as intrathecal opioid delivery pump or morphine pump. Opioid medication is stored in one of the chamber of morphine pump. The electronic motor controlled by computer device delivers opioid from opioid chamber into CSF.

Why Is Opioid Medications Delivered Into CSF?

Pain receptors are located over posterior (back) surface of spinal cord. Intrathecal catheter lies and floats over the posterior surface of spinal cord. Opioids when delivered into spinal cord blocks the pain impulses passing to brain at the pain receptors. Blocking of pain impulses going to brain decreases pain intensity by 50% or more.

What is Close Reduction of Wrist Joint Dislocation?

Orthopedic Surgeon performs close reduction in out-patient surgery. Isolated wrist joint dislocation is often treated with close reduction of dislocation. Close reduction is done under sedation or general anesthesia. Patient is given deep sedation so muscles of the hand and forearm arm are relaxed. Wrist joint is stretched to optimum level by pulling forearm and hand in opposite direction. Procedure does not involve any surgery. Distal radio-ulnar joint dislocation is often irreducible with close reduction.

Which Other Surgical Options Are Available As Treatment For Wrist Joint Dislocation?

Following Are the Surgical Treatments for Wrist Joint Dislocation-

  • Reduction of Dislocation- Open Reduction- Dislocated wrist joint is reduced using special equipment after joint is exposed by surgery.
  • Stabilization of Wrist Joint- After open reduction of the dislocation, the joint is stabilized to prevent recurrence of dislocation.

Following Procedures Are Performed To Stabilize the Joint-

Radius and Ulna Dislocation Is Stabilized By Following Procedures-
  • Placement of Plate between adjacent bones.
  • Insertion of rod or wire between dislocated bone and adjacent bone.
  • Double breasted slip to stabilize extensor retinaculum.
Carpal Bone Dislocation-
  • Insertion of wires between dislocated bones and adjacent bone.
  • Placement of nail between dislocated and adjacent carpal bone.


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    Clinical Orthopedic and related research

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    Skeletal Radiol. 1995;24:91–94.

  • Acute irreducible distal radioulnar joint dislocation.

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  • Stabilisation of the distal radioulnar joint with a double-breasted slip of the extensor retinaculum.

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Written, Edited or Reviewed By:


Last Modified On: September 8, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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