The Journal of Bone and Joint Surgery, Vol 77, Issue 12 1853-1857, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Median-nerve neuropathy associated with chronic anterior dislocation of the lunate
WS Chen
Department of Orthopedic Surgery, Chang-Gung Memorial Hospital at Kaohsiung, Taiwan.
Ten patients who had median-nerve neuropathy in association with chronic
anterior dislocation of the lunate were managed operatively and were
followed for an average of five years (range, three to eight years). The
average time from the injury to the initial evaluation was twenty-one
months (range, six to sixty-five months). All ten patients had pain as well
as sensory and motor dysfunction in the distribution on the median nerve.
Nerve-conduction-velocity studies revealed a delay in distal motor and
sensory latencies in all patients; the distal motor latency averaged 12.5
milliseconds (range 5.6 to 18.6 milliseconds), and the distal sensory
latency averaged 12.4 milliseconds (range, 4.8 to 16.8 milliseconds). Three
patients had had a failed carpal tunnel release and needed excision of the
lunate for decompression of the median nerve. In the other seven patients,
three distinctive sites of nerve compression were identified: the volar and
dorsal edges of the lunate and the proximal edge of the transverse carpal
ligament. Excision of the osseous protuberance (excision of the lunate in
three patients and a proximal-row carpectomy in four), combined with a
release of the transverse carpal ligament, resulted in relief of the
symptoms, functional improvement, and sensory and motor recovery in the
distribution of the median nerve.
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