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Carpal subluxation
 What's the clinical image of a carpal subluxation ?
The examination shows a slight limitation of extension ; when we continue the movement, pain is provoked. Passive flexion is not limited but after some time, it becomes painful because one or more of the dorsal ligaments get involved (due of overstretch because of the carpal subluxation, mostly os capitatum).
The treatment consists of manipulation first, to reduce the subluxed bone, and then the affected ligament(s) should be treated by deep friction massage.
Differential diagnosis includes the following disorders :
dorsal ganglion : this is soft and can be punctured
Kienböck's disease : an aseptic necrosis of the lunate bone. Occurs spontaneously or after trauma, in young patients ("twenties"), can cause constant pain, eventually weakness
a non-union fracture
an isolated osteoarthrosis.
In the last three cases medical imaging is needed.
Remark : a palmar carpal subluxation is a rare possibility too. Mostly the lunate bone subluxes causing a small limitation of flexion and perhaps partial compression on the median nerve.
(Part I, p83 , Part II, p15-17)
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