A Review of Perilunate Dislocations and Concomitant Acute Carpal Tunnel Syndrome: When Should the Carpal Tunnel be Released?

Perilunate dislocations (PLDs) are severe injuries of the wrist often resulting from a high-energy trauma. Given the traumatic mechanism and complexity of the injury itself, PLDs often require urgent intervention in the form of early open reduction and surgical stabilization. One potential, but severe, complication of perilunate dislocations is median nerve compression resulting in acute carpal tunnel syndrome. The treatment of acute median nerve compression secondary to PLDs is controversial, leading to the question of when, and in what PLD cases, should the carpal tunnel be released? The purpose of this work was to review the few studies in the literature specifically addressing median neuropathy in the setting of PLDs while offering an opinion and proposing a treatment algorithm as to when the carpal tunnel should be released in these patients.