Scapholunate Ligament Injuries

The scaphoid and lunate are two small bones in the wrist held tightly together by a band of tissue called the scapholunate ligament. When this ligament is injured the unstable wrist bones very gradually develop painful arthritis over months and years. This condition is usually seen in adults but can occasionally occur in younger people with severe wrist injuries like wrist dislocations. Scapholunate ligament injuries can eventually progress to a condition called SLAC wrist, which is a severe wrist osteoarthritis that is often painful and limits function.

Ligaments of the hand

Symptoms

• Pain (thumb side of the wrist)
• Swelling (back of wrist, and more on thumb side)
• Stiffness of the wrist
• Clicking, popping, grinding, or clunking sensations in the wrist

Causes

Most scapholunate ligament injuries occur due to wrist trauma like falling on an outstretched hand, but occasionally no history of injury is recalled, or perhaps just a minor wrist sprain. Some cases of chronic scapholunate ligament injury may be due to repetitive heavy loading of the wrist as seen with obesity, or inflammatory conditions of the wrist that damage the ligament gradually over time.

Diagnosis 

Your symptoms and medical history as well as an examination of your hand and wrist can help to diagnose these injuries. Special x-ray views can detect large ligament tears that affect wrist bone alignment but often miss small tears. We may recommend an MRI or wrist arthroscopy to evaluate the scapholunate ligament and wrist joint surfaces for suspected tears that do not show up on x-ray.

Treatment

There is a wide range of treatment for scapholunate ligament injuries. Deciding which treatment is best for you is a complex process and depends on many factors.

Nonoperative treatment

• Activity modifications
• NSAIDs
• Cast/splinting
• Steroid injections

Operative treatment

Complete tears of the scapholunate ligament due to recent wrist trauma most likely benefit from surgery to repair the ligament. Once the tear is more the a few weeks old, the torn ligament becomes scarred and cannot be directly repaired. Reconstruction with tendon grafts can be considered but is not always successful. Once wrist arthritis is present, various reconstructive procedures can be attempted, or the wrist can be fused to help alleviate pain.  

Wrist arthroscopy