HISTORY: A 32-year-old male was playing in a weekend soccer game when he was kicked in the shin by another player. His legs flipped out from under him, and he landed with his hand outstretched behind him. He had immediate pain in his wrist and felt a "burning pain" shoot up his forearm. He reported an immediate deformity and subsequent swelling. Suspecting a wrist fracture and not wishing to wait in the Emergency Department, he purchased a wrist splint at a local drug store with the plan of going to the doctor the following day. At night he had episodes of paresthesias radiating from the wrist, distally to the first three digits. He presented to the Sports Medicine office the following day reporting no further paresthesia or weakness. His history involved no prior injuries to his right wrist or hand. PHYSICAL EXAM: Examination revealed a moderately swollen wrist and hand with ecchymosis over the palmar surface of his wrist. Exam of his elbow and shoulder was unremarkable. At the wrist, he was able to initiate motion in all planes, but his range was severely limited in flexion, extension, ulnar and radial deviation, supination, and pronation. Flexion and extension caused some tingling in his first three digits. He was tender over the center of the proximal carpal row on both the dorsal and palmar surfaces. There was no snuff-box tenderness, no ulnar styloid tenderness, and no distal radial tenderness. Palpation of the "ulnar snuff box" and manipulation of the TFCC produced no pain. Radial and ulnar pulses were 2+, and his distal sensation was grossly intact. He had no motor deficits. Tinnel's test at the carpal tunnel did not reproduce the reported paresthesias. DIFFERENTIAL DIAGNOSIS: Distal radius and/or ulna fracture Carpal fracture Carpal dislocation Severe sprain Tendon rupture TESTS AND RESULTS: Three radiographic views of the affected wrist and hand were ordered (AP, Lateral, Oblique) revealing a volar dislocation of the lunate and a small ulnar styloid avulsion. No scaphoid fracture was visualized. FINAL / WORKING DIAGNOSIS: Lunate dislocation with intermittent, positional median nerve compression. TREATMENT AND OUTCOMES: The patient was placed in a splint and sent for immediate consultation with a hand surgeon. The patient was taken to surgery for open reduction of the lunate and ligamentous repair.