Carpal Tunnel Syndrome and Rupture of Flexor Tendon Associated from Neglected Anterior Lunate Dislocation

Young Yool Chung; Young Jae Jang

doi:10.12790/jkssh.2015.20.1.33

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Chung and Jang: Carpal Tunnel Syndrome and Rupture of Flexor Tendon Associated from Neglected Anterior Lunate Dislocation

Case Report

J Korean Soc Surg Hand 2015;20(1):33-38.

Published online: 11 March 2015

DOI: https://doi.org/10.12790/jkssh.2015.20.1.33

Carpal Tunnel Syndrome and Rupture of Flexor Tendon Associated from Neglected Anterior Lunate Dislocation

Young Yool Chung, Young Jae Jang

Department of Orthopaedic Surgery, Gwangju Christian Hospital, Gwangju, Korea

Correspondence to: Young Yool Chung Department of Orthopaedic Surgery, Gwangju Christian Hospital, 37 Yangnim-ro, Nam-gu, Gwangju, Korea TEL: +82-62-650-5064 FAX: +82-62-650-5066 E-mail: paedic@chol.com

Received 15 March 2015 Accepted 23 March 2015 Accepted 23 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Anterior dislocation of lunate is rare, it can result in median nerve compression and attritional rupture of flexor tendon when delay diagnosed. We report a patient with second finger flexor tendon rupture and carpal tunnel syndrome caused by neglected anterior lunate dislocation. Patient underwent operative treatment for that excised lunate, released carpal tunnel and reconstructed second flexor tendon using palmaris longus tendon. One year after surgery, fucntional and neurologic symptom were recovered. Also carpal alignment was maintained on plain radiographs, even after excision of the lunate.

Keywords: Neglected, Anterior lunate dislocation, Carpal tunnel syndrome, Flexor tendon rupture

References

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Fig. 1.

Preoperative images of left wrist. (A) Radiograph (anteroposterior view) shows destroyed Gilula line. (B) Radiograph (lateral view) shows lunate dislocated anteriorly to the rest of the carpus. (C) Radiograph (carpal tunnel view) shows narrow carpal canal space-occupied by dislocated lunate (arrow).

Fig. 2.

(A) Magnetic resonance image (MRI) (coronal view) shows third, fourth, fifth flexor tendons are ulnar deviated due to lunate dislocation and discontinuity of second flexor tendon (arrow). (B) MRI images (transverse view) show second flexor digitorum profundus & superficialis (left arrow) has continuity at metacarpabone level but second flexor digitorum profundus & superficialis both is abscent (right arrow) at carpal level. (C) MRI image shows anteriorly dislocated lunate compress the median nerve (arrow).

Fig. 3.

(A) Lunate (arrow) was dislocated anteriorly. (B) Median nerve (arrow) was artrophied by compressive force. (C) second flexor tendon totally ruptured by dislocated lunate. but tendon Sheath (arrow) of second flexor digitorum profundus was remnant state. (D) We excised a dislocated lunate bone. (E) second flexor tendon was repaired using autogenous palmaris longus tendon graft.

Fig. 4.

(A, B) Postoperative radiographs (anteriorposterior view, lateral view) show totally excised lunate bone.

Fig. 5.

(A, B) one year after surgery carpal bone alignment maintained and no other degenerative change obseved on radiographs (anteriorposterior view, lateral view).

Fig. 6.

Index finger has a good active flexion and extension function.

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