Bilateral absence of a lunate: a case report

Absence of the lunate bone in adults is extremely rare, with few reported cases. Most cases are bilateral and congenital, without syndromic features; some are associated with other carpal anomalies, including absent triquetrum or hypoplastic scaphoid. We report this rare condition with an updated literature review and a suggested treatment algorithm. We conducted a structured literature review of published human cases of unilateral or bilateral lunate absence. Major databases were searched from 1946 until July 2025. We also describe a 51-year-old woman attending our outpatient clinic. Our search identified six articles describing this pathology. Lunate absence is predominantly bilateral, with only three unilateral cases reported. Our patient presented with bilateral wrist pain aggravated by loading and difficulty performing push-ups. Initial radiographs suggested an enlarged scapholunate gap and a deformed lunate fossa. Computed tomography confirmed bilateral lunate absence. Patient’s symptoms improved following night splinting and wrist stretching exercises. As symptoms remained tolerable with conservative treatment, surgery was not performed. Adult lunate absence is a rare congenital abnormality. Diagnosis requires thorough history-taking, clinical examination, and advanced imaging to identify associated abnormalities. Treatment should be individualized according to symptom severity and functional limitations. Conservative management includes activity modification, splinting, physiotherapy, and medication. For patients with persistent pain or significant functional impairment despite conservative treatment, surgical options, including partial or total wrist fusion, may be considered. This case highlights the importance of recognizing this uncommon condition and tailoring management to clinical presentation. Further research is needed to establish standardized diagnostic criteria and treatment recommendations.