What's the Diagnosis? By Dr. Loran Hatch

A 35 yo M presents to the ED complaining of R hand pain after punching a wall in an upward motion. He denies any numbness or paresthesias. On exam, he has an obvious deformity of the dorsum of the R hand, but is neurovascularly intact. Xray is shown below.  What's the diagnosis?  (scroll down for answer)



Answer: Carpo-metacarpal dislocation (4th and 5th in this case)

  • Rare injury, usually involves multiple joints
  • Caused by forceful dorsiflexion and longitudinal impact (ex: boxers, motorcycle crash)
  • Exam reveals pain/swelling/deformity on the dorsum of the hand
  • Treatment: closed reduction then splint immobilization (dorsal vs ulnar gutter) and refer to orthopedics
  • May require ORIF for: unsuccessful closed reduction, unstable fracture, open fracture
  • Complications: compartment syndrome, chronic stiffness, NV injury


Manthey DE, Askew K. Hand. In: Sherman SC. eds.Simon’s Emergency Orthopedics, 7e New York, NY: McGraw-Hill; 2014.