A scapholunate ligament injury is a serious type of injury that occurs as a result of damage to the scapholunate ligament, which connects the scaphoid and lunate bones in the wrist.
This ligament is critical for stability and pain-free movement of the wrist. Injury to the scapholunate ligament can occur as a result of trauma such as a fall, sprain, or sudden impact, and can cause instability, severe pain, and limited movement in the wrist. The degree of injury can range from a simple stretching of the ligament to a complete tear.
In the diagnosis of scapholunate injury, PA wrist X-rays are used to observe the widening of the joint, while in chronic conditions such as DISI deformity, the diagnosis is confirmed when the scapholunate angle exceeds 70 degrees. Treatment options vary according to the severity of the injury; in acute injuries, the wrist can be immobilized with a cast and the ligament can heal, and if the ligament cannot heal on its own in this way, the scapholunate ligament is repaired with surgery.
If acute injuries are not noticed and treated appropriately, calcification in the wrist joint is inevitable within 5 to 10 years. This condition is called degenerative arthritis. The treatment of patients with chronic scapholunate ligament injuries and calcification in the wrist joint is more complex and fusion procedures may be required depending on the patient's complaints.
What is the Scapholunate Ligament?
The scapholunate ligament is an important ligament found in the wrist. It connects the scaphoid and lunate bones, two of the eight small bones in the wrist. This ligament plays a vital role in providing stability to the wrist and allowing for pain-free movements.
Injuries to the scapholunate ligament can cause pain, instability, and limited movement in the wrist. These injuries usually occur as a result of sprains, falls, or trauma and can become chronic if left untreated, causing a DISI deformity.
If you would like to learn more about wrist injuries and treatment methods, you can visit our Wrist Fractures page.
How Does a Scapholunate Ligament Injury Occur?
Scapholunate ligament injury occurs when there is excessive force on the wrist. The most common cause is a fall on the hand. This ligament is usually injured when the wrist is bent backwards or forced into an unusual position.
Sometimes the ligament can loosen over time, either through repeated strain or with age. Long-term inflammation can gradually weaken the ligament. Chronic gout is another factor that can damage the scapholunate ligament.
If scapholunate ligament injuries are not treated in a timely manner, they can lead to serious conditions such as Kienböck's Disease . You can check out our relevant page for detailed information about this disease.
What are the symptoms of a scapholunate ligament injury?
The wrist with an acute scapholunate ligament injury becomes painful and swollen. The joint movements of the wrist are restricted, and the pain increases when movement is attempted. Pain and swelling are particularly evident on the dorsum of the wrist, and patients report that their injured wrists are weak. Athletes in particular report that they cannot do push-ups. There may also be a sound coming from the wrist, a feeling of locking and catching.
Wrist Sprain Symptoms
Scapholunate ligament injury is characterized by pain and swelling, especially after a wrist sprain . Patients usually experience wrist pain and limited movement after this injury. Loss of grip strength and tenderness in the wrist are also common. This type of injury can make daily living activities particularly difficult and can cause permanent damage to the wrist.
The limitation of movement is usually felt clearly and this makes it difficult for patients to use the wrist. During the Watson test , tenderness and pain may be felt over the wrist. Radiographic examination shows an increase in the scaphoid-lunate distance .
These findings help to diagnose scaphoid-lunate dissociation . If not treated early, it can lead to serious problems such as SLAC wrist and cartilage degeneration in the future.
Similarly, Scaphoid Fractures that cause pain and loss of function in the wrist also require early diagnosis and treatment.
How Is a Scapholunate Ligament Injury Diagnosed?
Diagnosis of scapholunate ligament injuries can be difficult. Diagnosis of scapholunate ligament injuries is made with x-rays. Although the ligaments are not directly visible on x-rays, when the scapholunate ligament is injured, the distance between the scaphoid and the lunate bone increases, increasing the scapholunate distance, which is less than 3 mm. This is also seen on x-rays. In chronic cases, the alignment of the wrist bones is also disrupted.
Diagnosis of scapholunate ligament injury may not always be easy. However, the scapholunate ligament may not always be completely torn at first, and even if it is torn, the scapholunate distance may not increase enough to be seen on the first x-rays. In such cases, especially the first x-ray images will be normal.
However, if the patient's pain continues and sensitivity over the scapholunate joint persists during follow-up, MRI imaging methods are used. MRI imaging allows the extent of the ligament injury to be seen.
In some cases, scapholunate may not be diagnosed with MRI. In this case, arthroscopy may be recommended to see directly inside the wrist and examine the ligaments in detail. During arthroscopy, the wrist joint is examined with a small camera and the ligaments are directly assessed.
How Is a Scapholunate Ligament Injury Treated?
Non-surgical Treatment:
If the scapholunate ligament injury is a new injury and there is no opening between the scaphoid and lunate bones, the patient is put in a cast below the elbow and weekly wrist X-rays are taken to monitor. If there is an opening between the scaphoid and lunate bones, surgery is planned.
Scapholunate Ligament Injury Surgeries
Surgical options and indications for scapholunate ligament injuries are determined by various factors. The main surgeries that can be performed for scapholunate ligament injuries are:
1. Scapholunate Ligament Repair:
In this method, the ligament is repaired according to its original anatomy. In addition, the scaphoid and lunate bones can be fixed with external wires for 6-8 weeks.
In what situation is it done?
Patients without acute scapholunate ligament injuries and carpal malalignment.
Chronic scapholunate ligament injuries that occur within 18 months of injury but can be reduced.
If there is a ligament to be repaired as a result of the injury, it is preferred. In some injuries, the ligament is injured in a bursting manner and repair is not appropriate.
2. Scapholunate Reconstruction:
When ligament repair is not possible, reconstruction is performed. The palmaris longus tendon in the forearm is usually the tendon used in scapholunate ligament reconstruction surgery.
Tunnels are opened from the scaphoid and lunate bones, and the palmaris longus tendon is placed in these tunnels to ensure the union of both bones.
In what situation is it done?
In acute scapholunate ligament injuries without carpal malalignment, when the ligament is not suitable for repair.
It is performed in chronic scapholunate ligament injuries that occurred more than 18 months ago but can be reduced, that is, the operating surgeon can manually provide the scapholunate relationship.
3. Various Fusion Surgeries on the Wrist
When is it done?
Rigid and irreducible DISI (dorsal intercalary segment instability) deformity.
If there is calcification in the wrist joint or other small joints of the wrist along with DISI.
If you are interested in treatment options after a scapholunate ligament injury, you can learn about Regenerative Medicine and PRP Therapy .
Technical:
- Scaphotrapezotrapezoidal (STT) fusion: This method involves the fusion of the scaphoid with the trapezium and trapezoid bones and aims to provide stability to the wrist.
- Scapholunocapitate (SLC) fusion: This method provides more comprehensive stabilization by fusing the scaphoid, lunate and capitate bones.
Scapholunate fusion alone is not generally preferred because it has a high nonunion rate, and more stable fusion options are preferred.
How Long Does It Take to Heal a Wrist Sprain?
A wrist sprain can last from a few weeks to a few months, depending on the severity of the injury. The recovery process for mild sprains usually takes 2-3 weeks. During this time, rest and proper rehabilitation are important. Isometric strength exercises and range of motion exercises contribute to the recovery process. These types of exercises are very important for maintaining mobility and strength in the wrist.
More serious scaphoid-lunate ligament injuries may require surgical intervention. The postoperative rehabilitation process is also important and usually lasts for 6-8 weeks.
During this process, isotonic strength exercises and functional strength training are performed. At the end of the treatment process, the patient can usually return to sports and participate in daily activities.
Frequently Asked Questions About Scapholunate Ligament Injury
What does scapholunate ligament mean?
The ligament that connects the scaphoid and lunate bones is called the scapholunate ligament. This ligament plays an important role in wrist stability.
How to treat wrist ligament injury?
It can be relieved with rest, physical therapy, and surgery if necessary. Ligament repair and reconstruction may be necessary.
How many weeks does a ligament injury last?
Depending on the severity of the injury, recovery time varies between 4-8 weeks. Appropriate rehabilitation is important during this process.
What is scapholunate instability?
It is an instability that occurs as a result of damage to the ligament between the scaphoid and lunate bones . This causes pain and limited movement in the wrist.
How many days does it take for a wrist injury to heal?
Minor injuries heal within 1-2 weeks. More serious injuries may take longer and require treatment.
What causes a bone spur in the wrist?
Bone spurs may occur in the wrist due to problems such as carpal instability or scaphoid-lunate dissociation .
Conclusion
Scapholunate ligament injury is a condition that can cause significant pain and instability in the wrist. Early diagnosis and appropriate treatment can minimize the negative effects of these injuries. Ligament repair , ligament reconstruction and appropriate rehabilitation accelerate the healing process and restore wrist functionality.
If you would like to receive expert support regarding scapholunate ligament injuries and wrist problems, you can contact Op. Dr. Utku Erdem Özer . Let's determine the most appropriate treatment methods for your health together.
