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Final Program


Final Program

Electrodiagnostic / Neuromuscular Medicine

1633 - The Hidden Culprit: Chronic Lunate Dislocation Masquerading as Carpal Tunnel Syndrome

Friday, February 20, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • JM

    John Paul Mauriello, DO

    Resident Physician PGY-3
    Memorial Healthcare System
    Dania Beach, Florida, United States

    • Corresponding Author(s)

  • RK

    Robert Klecz, MD

    Attending
    Memorial Healthcare System
    Hollywood, Florida, United States

    • Submitter(s)

  • JM

    John Paul Mauriello, DO

    Memorial Healthcare System
    Dania Beach, Florida, United States

Case Diagnosis: Left median nerve mononeuropathy secondary to chronic lunate dislocation

Case Description: 32-year-old male who suffered a motorcycle accident 3 months earlier presents for electrodiagnostic evaluation for paresthesia of the left hand. The left side of his body was injured, and he required repair of an open tibia/fibula fracture. Hospital radiographs/CT scans of the left upper extremity and spine didn’t reveal any fractures or acute processes. Outpatient MRI of his cervical spine and brachial plexus were unremarkable, and the patient was referred for NCS/EMG. Left wrist exam noted a firm, tender nodule in the volar region; decreased ROM with supination and extension, positive Tinel’s; and in the hand, decreased sensation in digits 1-3 and thenar region. NCS/EMG indicated severe median mononeuropathy at or proximal to the wrist. He was advised to see a hand specialist given the severity of median mononeuropathy and high suspicion of occult wrist pathology. Further imaging studies revealed a Mayfield type IV lunate dislocation which required surgical intervention.

Discussions:

Lunate/perilunate dislocations are rare high energy injuries constituting less than 10% of all wrist injuries. 25% of lunate dislocations are missed on initial evaluation. Identification of this pathology has been speculated to be due to lack of experience and poor imaging study technique. Furthermore, several studies reported significant incidents of missed or delayed diagnoses in trauma cases despite secondary survey and imaging. If Mayfield stage IV lunate dislocations are left untreated, patients may develop carpal tunnel syndrome and other wrist pathologies that can affect function. 

Conclusions: Our case highlights the importance of early recognition of lunate dislocation after acute trauma. A delayed diagnosis of a Mayfield stage IV dislocation can result in median neuropathy. Acutely diagnosed dislocations that undergo ORIF tend to have better pain and functional outcomes vs chronic, advanced dislocations that often require salvage procedures.