Scapholunate Dislocation / Ligament Injuries

Scapholunate Dislocation/Ligament Injuries: A Comprehensive Guide

Overview

Scapholunate Dislocation/Ligament Injury

A scapholunate dislocation or ligament injury involves damage to the scapholunate ligament, a key structure in the wrist. The ligament joins the scaphoid bone to the lunate bone, playing a critical role in maintaining wrist stability. When injured, it can lead to instability between these two bones, which may result in altered wrist motion, pain, and long-term joint degeneration.

Anatomy of the Scapholunate Ligament and its Role in Wrist Stability

The scapholunate ligament is a dense, fibrous structure that connects the scaphoid (on the thumb side) to the lunate (in the middle of the wrist). It consists of two primary parts:

  • Dorsal scapholunate ligament: Located on the back of the wrist, it is the stronger of the two ligaments and provides significant resistance to excessive wrist motion.
  • Volar scapholunate ligament: Positioned on the front of the wrist, this ligament plays a secondary role in stabilising the scaphoid and lunate.

These ligaments help prevent excessive separation and rotation of the scaphoid and lunate bones. When they are intact, they ensure the bones move synchronously during wrist motions. Injury to this ligament can lead to abnormal motion and wrist instability.

Types of Scapholunate Injuries

1. Partial Tears

A partial tear of the scapholunate ligament means that the ligament is damaged but not fully ruptured. The joint may still function, though there can be some pain, swelling, and a slight reduction in wrist stability. Partial tears may result from a fall onto an outstretched hand or a twisting injury.

2. Complete Tears

A complete tear of the scapholunate ligament means the ligament has ruptured entirely, causing significant instability between the scaphoid and lunate bones. This injury can lead to a widening of the scapholunate interval (space between the scaphoid and lunate), which may be visible on an X-ray. This type of injury may often require surgical intervention to restore stability.

3. Scapholunate Advanced Collapse (SLAC)

If a scapholunate ligament injury is left untreated or mismanaged, it can lead to Scapholunate Advanced Collapse (SLAC), a form of degenerative arthritis of the wrist. In this condition, the scaphoid and lunate bones, no longer held in proper alignment, begin to wear against each other abnormally, leading to cartilage degradation, joint pain, and eventual loss of wrist function.

How Common Are Scapholunate Injuries?

Scapholunate ligament injuries are relatively common, especially in individuals who do sports or activities that put strain on the wrists, such as:

  • Contact sports (e.g., rugby, football)
  • Gymnastics
  • Extreme activities (e.g., climbing, skateboarding)
  • Falls onto an outstretched hand

While the precise incidence varies, these injuries are considered one of the most common ligament injuries in the wrist, often occurring in combination with fractures of the scaphoid or lunate bones. Scapholunate injuries can be difficult to diagnose early because they may not always present with obvious symptoms, but if left untreated, they can result in long-term problems like SLAC.

Scapholunate dislocations and ligament injuries
Scapholunate ligament injuries are commonly seen in athletes such as gymnasts due to the risk of falls and pressure on the hands and wrists.

Symptoms and Causes

Causes of Scapholunate Dislocation/Ligament Injuries

Scapholunate ligament injuries are usually caused by sudden, high-impact forces or repetitive stress that disrupt the normal biomechanics of the wrist. These injuries are most commonly linked to trauma or forceful movements that affect the wrist joint.

Common Injury Mechanisms

Sports-Related Injuries

Sports that involve frequent wrist stress or impact are common causes of scapholunate injuries. These include:

  • Football: A contact sport with frequent falls and tackles, often causing impact to the wrist.
  • Gymnastics: Weight-bearing on the hands during tumbling or vaulting can stress the wrist ligaments.
  • Rock climbing: The force exerted on the wrist when gripping holds, especially with a twisting motion.
  • Skateboarding and snowboarding: Falls onto an outstretched hand can cause trauma to the wrist ligaments.

Falls on an Outstretched Hand (FOOSH)

One of the most common mechanisms of injury for scapholunate ligament damage is a fall onto an outstretched hand (FOOSH). When the hand strikes the ground, the wrist is hyperextended, and the force can stretch or tear the scapholunate ligament. This mechanism is frequent in activities where falls are common, such as cycling, rollerblading, and sports accidents.

Risk Factors for Scapholunate Injuries

Several factors increase the risk of scapholunate injuries:

  1. Sports Participation: As mentioned, sports with high wrist demands or frequent falls (e.g., football, gymnastics, rock climbing, and snowboarding) increase the risk.
  2. Age: Younger individuals, especially those who do sports and physical hobbies, are more likely to experience these injuries due to higher rates of physical activity and risk-taking.
  3. Previous Wrist Injuries: Individuals who have previously injured their wrists are more prone to future injuries, especially if they have had a prior scapholunate ligament strain.
  4. Occupation or Hobbies: Jobs or hobbies that require frequent use of the wrists (e.g., manual labour, typing, or heavy lifting) can increase stress on the wrist joint.
  5. Biomechanical Factors: Abnormal wrist mechanics or joint instability may predispose someone to scapholunate injuries. Structural issues or alignment problems in the wrist can make ligaments more vulnerable to injury.

Symptoms of a Scapholunate Injury

Acute Symptoms

  • Pain: Pain is often felt on the back of the wrist (dorsal side) and may worsen with movement, especially in positions that stretch or stress the wrist ligaments.
  • Swelling: The wrist may become swollen shortly after the injury, typically around the scaphoid and lunate bones.
  • Tenderness: Direct pressure on the scapholunate joint or certain wrist movements may elicit tenderness.
  • Limited Motion: Due to pain and instability, wrist motion can become restricted, particularly in terms of flexion and extension.
  • Deformity: In severe cases, a visible deformity may be seen, such as a widening of the space between the scaphoid and lunate bones, on an X-ray.
Scapholnate Dislocations and Ligament Injury
Pain, swelling and tenderness in the hand are symptoms of a Scapholnate Ligament injury or other hand injury.

Chronic Symptoms in Untreated Injuries

  • Ongoing Pain: Chronic pain may persist, especially with activities that require gripping or lifting. Pain is often worse with physical exertion.
  • Instability: The wrist may feel weak or unstable, particularly with certain movements, as the ligament’s ability to stabilise the joint is compromised.
  • Decreased Range of Motion: There may be a gradual decrease in wrist flexibility, particularly in wrist extension or radial deviation.
  • Clicking or Popping: Some individuals may experience clicking or popping sensations when moving the wrist due to the abnormal interaction between the scaphoid and lunate bones.
  • Worsening Swelling: Over time, swelling can persist or increase as the injury progresses.

Complications of Scapholunate Injuries

Chronic Instability

If scapholunate ligament injuries are not treated or rehabilitated properly, wrist instability can develop. This is characterised by abnormal movement between the scaphoid and lunate bones, leading to:

  • A sense of wrist weakness
  • Loss of grip strength
  • Difficulty performing tasks that require precise wrist movements.

Scapholunate Advanced Collapse (SLAC)

Untreated scapholunate injuries can lead to Scapholunate Advanced Collapse (SLAC), a condition in which the scaphoid and lunate bones lose their proper alignment. Over time, this causes joint degeneration and cartilage wear, which can result in:

  • Chronic pain
  • Reduced function in the wrist, such as difficulty grasping or lifting objects.
  • Arthritis: The misalignment of the bones causes friction, leading to osteoarthritis.

Osteoarthritis

The prolonged abnormal motion between the scaphoid and lunate bones can lead to the development of osteoarthritis in the wrist joint. This condition results in the deterioration of the cartilage lining the bones, causing:

  • Joint stiffness
  • Pain that increases with activity
  • Limited range of motion
  • Eventually, this may require surgical intervention, such as wrist fusion or joint replacement, if conservative treatments fail.

Diagnosis and Tests

Diagnosing Scapholunate Dislocation/Ligament Injuries

Accurately diagnosing scapholunate ligament injuries is critical to guide appropriate treatment and prevent long-term complications. Diagnosis will involve a combination of physical examination, imaging tests, and sometimes more advanced diagnostic procedures.

Physical Examination for Scapholunate Injuries

A thorough physical assessment is essential to assess for tenderness, instability, and reduced motion. Key components of the examination include:

1. Watson’s Test (Scaphoid Shift Test)

  • Purpose: This test evaluates the integrity of the scapholunate ligament.
  • Method: The examiner holds the patient’s wrist with the thumb over the scaphoid tuberosity and applies pressure to the palm of the hand, then moves the wrist from ulnar deviation to radial deviation.
  • Positive result: A positive test is indicated by a “shift”, or palpable click felt when the scaphoid moves or shifts, which is usually due to scapholunate ligament instability.
  • Significance: A positive Watson’s test suggests scapholunate instability or ligament damage.

2. Scapholunate Ballottement Test

  • Purpose: This test evaluates instability or abnormal motion between the scaphoid and lunate.
  • Method: The examiner uses their thumb and index finger to apply gentle pressure to the scaphoid and lunate bones, pushing them towards each other and assessing for abnormal movement.
  • Positive result: A positive test is when there is increased movement or a “clunk” felt between the two bones, suggesting ligament damage or injury.

Imaging Tests to Diagnose Scapholunate Injuries

Several imaging techniques are used to diagnose scapholunate injuries and to assess the degree of damage. The choice of radiology test depends on the suspected severity and timing of the injury.

1. X-rays

  • Static X-rays: Standard X-rays are often the first imaging method used. In the case of scapholunate injuries, a widening of the scapholunate interval (the space between the scaphoid and lunate) may be visible, which suggests ligamentous disruption.
  • Dynamic X-rays: A dynamic view can be obtained when the wrist is moved in specific directions during the X-ray, helping to visualise any abnormal motion or widening of the scapholunate gap under stress. This can be useful for detecting subtle injuries or instability that may not be visible in static images.

2. MRI (Magnetic Resonance Imaging)

  • Purpose: MRI provides detailed soft tissue assessment and is particularly helpful for evaluating ligament tears and injuries to cartilage or the surrounding structures.
  •  It can identify partial and complete tears of the scapholunate ligament and any associated soft tissue damage, such as cartilage tears, bone contusions, or other ligament injuries. MRI is non-invasive and offers a clear picture of the soft tissues, making it a key tool in assessing scapholunate injuries.

3. Arthroscopy

  • Purpose: Wrist arthroscopy is considered the gold standard for diagnosing scapholunate ligament injuries.
  • Method: In this procedure, a small camera (arthroscope) is inserted into the wrist joint through a small incision, allowing direct visualisation of the ligament and joint structures.
  • Arthroscopy allows the surgeon to directly assess the integrity of the scapholunate ligament, detect tears or damage, and potentially treat the injury in the same session. It is the most accurate method for diagnosing ligament damage but is more invasive than MRI or X-rays.

4. CT Scan (Computed Tomography)

  • Purpose: A CT scan is particularly useful for detecting associated bone fractures that may accompany a scapholunate injury, such as fractures of the scaphoid or lunate bones.
  • It provides detailed images of the bone structures and can be used to assess for any bony abnormalities that may complicate the ligament injury.

Specific Considerations in Diagnosing Scapholunate Injuries

Importance of Early Diagnosis

  • Early Detection: Scapholunate injuries can be subtle, especially in the early stages. Early diagnosis is crucial because timely treatment can prevent complications like chronic instability and scapholunate advanced collapse (SLAC).
  • Wrist Function: If untreated, scapholunate ligament injuries can lead to long-term wrist dysfunction, including weakness, pain, and limited range of motion. Early intervention can significantly improve outcomes and restore wrist stability.

Differentiating Acute from Chronic Injuries

  • Acute Injuries: In the acute phase, scapholunate injuries typically present with more obvious symptoms such as pain, swelling, and tenderness. X-rays may reveal increased scapholunate spacing, while MRI can show recent ligament tears or damage.
  • Chronic Injuries: In chronic scapholunate injuries, the ligament may have healed in an abnormal position or may have led to degenerative changes in the joint. These injuries may present with long-term symptoms like persistent pain, weakness, clicking, or reduced range of motion. Imaging may show a widening of the scapholunate gap and signs of joint degeneration (e.g., arthritis or SLAC).

Conclusion

Scapholunate ligament injuries are diagnosed using a combination of clinical examination, including tests like Watson’s and scapholunate ballottement, and imaging techniques such as X-rays, MRI, arthroscopy, and CT scans. Early diagnosis is essential to prevent chronic complications, and providers will carefully evaluate the injury type, whether acute or chronic, to determine the most appropriate treatment plan.

Access Ortho is an orthopaedic injuries clinic offering rapid assessment for injuries such as Scapholunate ligament injuries. 

Management and Treatment

Treatment of Scapholunate Dislocation/Ligament Injuries

Treatment for scapholunate ligament injuries can vary depending on the severity of the injury, the timing of diagnosis, and the presence of other associated conditions. The goal of treatment is to restore wrist stability, reduce pain, and prevent long-term complications like arthritis or scapholunate advanced collapse (SLAC). Both conservative and surgical approaches are available.

Conservative Treatment Options

Conservative treatment is typically indicated for partial tears or mild instability where the ligament is still intact but weakened. The focus is on reducing inflammation, protecting the wrist from further injury, and restoring function.

1. Immobilisation for Partial Tears

  • Splinting or Casting: For partial tears, immobilisation in a cast or splint is often the first line of treatment. This helps to limit movement and protect the ligament as it heals. A wrist splint is usually worn for several weeks to ensure the joint is stable.
  • Duration: The period of immobilisation depends on the severity of the tear but usually lasts between 4–6 weeks. Patients are encouraged to avoid activities that stress the wrist during this time.

2. Wrist Splinting and Activity Modification

  • Splinting: A more flexible option than a full cast, wrist splinting is commonly used in less severe cases. Splints help to limit motion while still allowing some functionality.
  • Activity Modification: Patients are advised to modify activities that may stress the wrist, such as lifting heavy objects or engaging in sports that require gripping or twisting motions. Early rehabilitation may include gentle exercises to improve range of motion without overstressing the ligaments.

Surgical Interventions for Scapholunate Injuries

Surgery is generally reserved for complete ligament tears, chronic scapholunate instability, or cases where conservative management fails to provide adequate relief. Surgery aims to restore wrist stability and prevent long-term complications like SLAC.

Indications for Surgery

Surgical intervention is indicated when:

  • Complete ligament tears or severe instability are present.
  • Chronic instability leads to functional limitations or pain despite conservative treatment.
  • Scapholunate advanced collapse (SLAC) has developed, resulting in wrist arthritis or degeneration.
  • The patient is young, active, and wants to maintain wrist function, especially for sports or heavy manual labour.

Types of Surgical Procedures

1. Direct Repair
  • Purpose: The direct repair involves surgically reattaching the torn ligament to the scaphoid and lunate bones using sutures or anchors.
  • Method: The surgeon uses arthroscopy or an open approach to access the joint and repair the damaged ligament. The torn ends of the ligament are brought together and fixed in place to allow healing.
  • Indication: This procedure is most successful when the injury is acute and there is sufficient tissue to repair the ligament.
2. Ligament Reconstruction
  • Purpose: In cases where the ligament cannot be repaired directly due to extensive damage, ligament reconstruction involves using a graft (often from the patient’s own tissue) to replace the damaged ligament.
  • Method: The surgeon may use tissue from the palmaris longus tendon or another source to reconstruct the ligament, restoring the connection between the scaphoid and lunate.
  • Indication: This is typically used when the ligament has been completely torn, and there is insufficient tissue for direct repair.
3. Capsulodesis
  • Purpose: This procedure involves tightening or stiffening the joint capsule around the scapholunate joint to reduce instability.
  • Method: The surgeon may use sutures or other materials to restrict excessive movement between the scaphoid and lunate, providing additional stability to the joint.
  • Indication: Capsulodesis is often used when ligament damage is extensive and direct repair or reconstruction is not possible. It is particularly helpful in restoring wrist stability without the need for a full ligament reconstruction.
4. Salvage Procedures for SLAC (Scapholunate Advanced Collapse)

When SLAC has developed due to chronic untreated scapholunate instability, salvage procedures are performed to address the advanced joint degeneration. These procedures may include:

  • Wrist Fusion (Arthrodesis): Fusing the scaphoid and lunate bones together to create a stable but immobile joint.
  • Wrist Arthroplasty (Joint Replacement): Replacing the damaged joint with a prosthetic implant to maintain wrist function.
  • Proximal Row Carpectomy: Removing part of the wrist joint (usually the proximal row of carpal bones) to improve pain and function.

Rehabilitation and Physiotherapy for Scapholunate Injuries

Rehabilitation is an essential part of recovery after both conservative and surgical treatments. Rehabilitation aims to restore movement, strength, and functional use of the wrist. Physiotherapy should be gradual, starting with gentle motion and progressing to strengthening exercises.

1. Wrist Strengthening Exercises

  • Focus: Strengthening the muscles around the wrist to support the injured ligament and improve wrist stability.
  • Exercises: These may include:
    • Wrist flexion and extension with light weights or resistance bands.
    • Grip strengthening exercises using a handgrip or therapy putty.
    • Radial and ulnar deviation exercises to increase wrist stability.

2. Proprioception Training

  • Purpose: Proprioception training helps to restore the body’s ability to sense the position and movement of the wrist, improving coordination and stability.
  • Exercises: Proprioception exercises often include:
    • Balance boards or stability discs to enhance wrist control.
    • Tactile feedback exercises to train the wrist to respond to movements accurately.

Timeline of Rehabilitation

  • Initial phase (0-6 weeks): Focus on protecting the wrist and reducing inflammation through immobilisation or splinting. Gentle range-of-motion exercises may begin after 2-4 weeks.
  • Strengthening phase (6-12 weeks): Begin strengthening exercises and more aggressive rehabilitation to restore wrist function. If surgery was performed, this phase begins after the immobilisation period and when the surgeon deems it appropriate.
  • Return to activity (3-6 months): Full functional rehabilitation may take several months, depending on the severity of the injury and the chosen treatment. For athletes and people with active jobs, the return to full activity may take longer, especially if surgery is required.

Conclusion

Treatment for scapholunate dislocation or ligament injuries can range from conservative management (splinting, activity modification) for mild cases to surgical interventions (ligament repair, reconstruction, or wrist fusion) for more severe or chronic injuries. Rehabilitation, including strengthening and proprioception training, is crucial for restoring full function and ensuring long-term wrist stability. Early diagnosis and starting appropriate treatment are essential to prevent complications like scapholunate advanced collapse (SLAC) or chronic wrist instability.

Access Ortho offers rapid appointments for assessing, diagnosing, treating, and following up on injuries such as scapholunate ligament injuries. 

Prevention

Preventing Scapholunate Dislocation/Ligament Injuries

To reduce the risk of scapholunate ligament injuries, it is important to focus on strengthening and protecting the wrist, especially during high-risk activities.

  1. Proper Wrist-Strengthening Exercises: Regular wrist exercises that target the muscles surrounding the wrist can help improve stability and support the ligaments. Exercises should include wrist flexion, extension, and gripping motions to build strength and proprioception.
  2. Use of Wrist Guards in High-Risk Activities: In sports or activities that involve falls or wrist impact (e.g., gymnastics, skateboarding, snowboarding), wearing wrist guards or braces can provide extra support and decrease the risk of traumatic injuries to the wrist ligaments. Wrist guards help absorb and distribute the force during falls, protecting the scapholunate ligament from overstretching or tearing.

Incorporating these preventive measures can significantly lower the chances of sustaining a scapholunate injury.

Outlook / Prognosis

What to Expect with a Scapholunate Injury

If you have a scapholunate injury, the experience will vary due to how severe the injury is, the type of treatment you receive, and whether the injury is acute or chronic. Here’s an overview of what to expect during recovery:

1. Initial Symptoms

  • Pain: Pain in the wrist is usually experienced, especially with activities that involve gripping, twisting, or weight-bearing. There may also be tenderness around the scaphoid and lunate bones.
  • Swelling and Bruising: Swelling and bruising are very likely to occur in the acute phase, particularly after an accident like falling on an outstretched hand.
  • Instability: In more severe injuries, the wrist may feel unstable or “loose” during movements.
  • Limited Range of Motion: Your ability to fully extend or flex your wrist may be restricted due to pain or ligament damage.

2. Recovery Time from a Scapholunate Injury

Recovery timelines vary significantly based on the severity of the injury and the treatment approach.

Conservative Treatment (Partial Tears or Mild Instability)

  • Immobilisation: If treated conservatively with splinting or casting, the recovery period usually lasts between 4–6 weeks. After immobilisation, you may start rehabilitation exercises to restore motion and strength.
  • Rehabilitation: Full recovery can take an additional 2–3 months, with rehabilitation focusing on strengthening and regaining full wrist function.

Surgical Treatment (Complete Tears or Chronic Instability)

  • Direct Repair or Reconstruction: Recovery from surgery typically involves a longer rehabilitation process.
    • Initial Recovery: The first 4–6 weeks usually involve immobilisation, with splints or casts used to protect the surgical site.
    • Rehabilitation: After immobilisation, you will begin a rehabilitation program focused on improving range of motion, strength, and wrist stability. It can take 3–6 months to reach a full recovery. This timeline will depend on the extent of the surgery.

SLAC (Scapholunate Advanced Collapse) and Salvage Procedures

  • Surgical Recovery: If a salvage procedure (e.g., wrist fusion or joint replacement) is required due to SLAC, recovery time can be longer, typically 6–12 months for a return to full activity, as the wrist joint will need to adapt to the changes.

3. Long-Term Outcomes and Potential Complications

  • Wrist Instability: If the injury is not treated appropriately, you may experience chronic instability, leading to weakness or difficulty performing daily tasks. This can persist even after rehabilitation or surgery.
  • Arthritis: Long-term scapholunate injuries that are not adequately managed can lead to the development of osteoarthritis in the wrist joint, resulting in pain, stiffness, and limited mobility. This is especially common in untreated chronic injuries and may lead to scapholunate advanced collapse (SLAC), a form of wrist arthritis.
  • Recurrent Pain: Some individuals may experience persistent mild pain even after treatment, especially during high-intensity activities or weather changes.

4. Return to Work and Sports Considerations

Return to Work

  • For individuals with desk jobs or jobs that do not require heavy lifting, returning to work may be possible within a few weeks of treatment, depending on pain levels and comfort with wrist movement.
  • For individuals with physically demanding jobs (e.g., construction, manual labour), the return to work may take 2–3 months for conservative treatments or 4–6 months for surgical interventions, as these roles often require strength and stability in the wrist.

Return to Sports

  • Non-Contact Sports: If you’re involved in non-contact sports (e.g., swimming, cycling), you may return to activity after 2–3 months with proper rehabilitation.
  • High-Impact or Contact Sports: For high-impact or contact sports (e.g., basketball, rugby, gymnastics), full recovery may take 6 months or longer. Returning to sports too early can risk reinjury or lead to chronic instability.
  • Sports-Specific Rehabilitation: Working with a physiotherapist for sport-specific rehabilitation can help you improve strength, flexibility, and proprioception needed to return to athletic activities safely.

Conclusion

Recovery from a scapholunate injury depends on the severity and the chosen treatment approach. Conservative treatments may take a few months, while surgical recovery can extend to 6 months or longer. Long-term complications can include wrist instability and arthritis, this is particularly likely if the injury is not properly managed. It’s crucial to follow your healthcare provider’s recommendations, undergo rehabilitation, and allow enough time for healing before returning to work or sports to ensure the best outcomes.

Access Ortho is an urgent orthopaedic clinic located in Brisbane and Ipswich, offering rapid orthopaedic appointments. 

When to Seek Medical Attention

If you suspect you have a scapholunate injury, it’s essential to seek medical attention at the right time to prevent long-term complications. While some mild injuries can be managed conservatively, certain signs and symptoms may require immediate evaluation by a hand specialist (orthopaedic surgeon).

Red Flags: When Immediate Medical Attention is Necessary

  1. Severe Pain or Swelling

Why it’s important: If you experience significant pain, swelling, or bruising in the wrist following a fall or impact, it could indicate a more severe injury, such as a complete ligament tear or bone fracture.

Action: Seek immediate medical attention if the pain is intense and doesn’t improve with rest or over-the-counter pain relievers.

  1. Inability to Move the Wrist

Why it’s important: If you’re unable to move your wrist or hand due to pain or mechanical blockage (e.g., locked wrist), it could suggest significant ligament damage or a more serious underlying condition.

Action: This requires urgent evaluation to determine the degree of injury and prevent further damage.

  1. Deformity or Abnormal Position of the Wrist

Why it’s important: A visible deformity in the wrist (e.g., an abnormal bend, twisting, or obvious displacement) suggests a severe dislocation or fracture.

Action: Seek immediate medical care, as this may require emergency intervention, such as reduction or realignment of bones.

  1. Numbness, Tingling, or Loss of Function

Why it’s important: If you experience numbness, tingling, or weakness in the muscles of the fingers, hand, or wrist, it could be a sign of nerve compression or injury that needs urgent attention.

Action: These symptoms require prompt evaluation to rule out nerve damage or more serious complications.

  1. Persistent Pain Despite Rest

Why it’s important: Persistent pain for more than a few days, even with rest and self-care measures, could indicate an underlying scapholunate injury that requires professional treatment.

Action: Consult a hand specialist to assess the injury and determine if it is a ligament tear, instability, or another issue requiring more advanced treatment.

  1. Failure to Heal After Initial Treatment

Why it’s important: If your symptoms do not improve after initial conservative treatment (rest, splinting, ice), this could signal a more severe injury or inadequate healing.

Action: Follow up with a hand specialist to consider further imaging (MRI, arthroscopy) or potential surgical intervention.

  1. Worsening Symptoms

Why it’s important: If the symptoms worsen over time, such as increasing pain, decreased range of motion, or the wrist “giving way,” this may indicate chronic instability or a developing complication like scapholunate advanced collapse (SLAC).

Action: It’s important to see a hand specialist promptly to avoid long-term disability and prevent further joint damage.

When to See a Hand Specialist (Even Without Red Flags)

If you have sustained a wrist injury (even without severe pain or noticeable symptoms), it’s still a good idea to consult with an orthopaedic hand specialist if:

  • You suspect a ligament injury based on symptoms like clicking, instability, or reduced function.
  • You’re an athlete or have a physically demanding job and need to ensure a proper diagnosis and rehabilitation plan.
  • You want to prevent long-term complications, such as arthritis or wrist instability, which can arise from untreated scapholunate injuries.

Conclusion

If you experience severe pain, swelling, visible deformity, or loss of function following a wrist injury, or if your symptoms do not improve with rest, it’s crucial to seek immediate attention from a hand specialist. Early diagnosis and starting correct treatment are key to preventing chronic issues like wrist instability and scapholunate advanced collapse. If in doubt, it’s always better to err on the side of caution and get a professional evaluation.

Access Ortho is staffed by a medical team trained in orthopaedics, including hand injuries. Visiting Access Ortho is a fast way to get a specialist orthopaedic opinion without waiting. Contact us today for an urgent appointment.

What is a Hand and Wrist Clinic?

Role of Specialised Orthopaedic Clinics in Scapholunate Injury Management

Specialised orthopaedic clinics play a crucial role in diagnosing, treating, and rehabilitating scapholunate injuries. Access Ortho is staffed by orthopaedic surgeons and orthopaedic Nurse Practitioners with expertise in complex wrist and hand conditions. Their role is essential for managing scapholunate injuries, particularly those that are severe, chronic, or complicated.

Key Roles of Specialised Orthopaedic Clinics

  1. Accurate Diagnosis

Advanced Imaging: Specialised clinics will ensure correct referral for imaging techniques such as MRI, CT scans, and X-rays. These allow the specialists to assess the extent of ligament damage, any associated fractures, and the stability of the wrist joint.

  1. Comprehensive Treatment Plans

Conservative Management: If your injury is mild or in the early stages, the clinic will guide you through conservative treatments like immobilisation, splinting, and physiotherapy. The clinic has all required splints and casts on-site or can arrange for a hand therapist to make a custom splint if required. They will monitor your progress and adjust treatment as needed.

Surgical Intervention: If surgery is required (e.g., for complete ligament tears or chronic instability), the orthopaedic team will help explain your options and arrange a suitable surgeon. 

What to Expect During Your Clinic Visit

When you visit a specialised orthopaedic clinic for a scapholunate injury, the process will typically follow these steps:

1. Detailed Medical History

  • Injury History: The clinician will ask about how the injury occurred (e.g., fall, sports-related, or gradual onset of pain) and any previous wrist injuries.
  • Symptoms: You will be asked about your symptoms, such as pain location, swelling, range of motion, and any functional limitations (e.g., difficulty gripping or using the hand).
  • Medical Background: Your medical history will be reviewed to assess any underlying health conditions (e.g., arthritis, diabetes) that could affect healing.

2. Physical Examination

  • Inspection: The doctor will visually examine your wrist for swelling, bruising, and any visible deformities.
  • Palpation: The wrist will be gently palpated to identify areas of tenderness, particularly around the scapholunate region.
  • Movement Tests: The specialist will test your wrist’s range of motion and stability, looking for signs of ligament damage or instability.
  • Specific Tests: The specialist may perform specific diagnostic tests, such as Watson’s Test (scaphoid shift test) or ballottement tests, which help assess scapholunate instability.

3. Imaging and Diagnostic Tests

  • X-rays are typically the first step in checking for bone fractures or dislocations. Special views may be taken to assess scapholunate alignment.
  • MRI: If a soft tissue injury (e.g., a ligament tear) is suspected, an MRI may be arranged to provide a detailed image of the ligament, cartilage, and surrounding structures.
  • Arthroscopy: If necessary, the specialist may recommend arthroscopy to visualise the scapholunate ligament and assess its condition directly.

4. Treatment Plan Discussion

  • Conservative Approach: If the injury is mild, the clinic will devise a treatment plan that includes rest, splinting, and potentially physiotherapy. They will arrange follow-up visits to monitor your progress.
  • Surgical Option: If surgery is indicated (e.g., for complete ligament tears or chronic instability), the clinic will discuss the types of surgical procedures available (e.g., ligament repair, reconstruction) and the expected outcomes. They will help find a surgeon to do the operation.
  • Rehabilitation: The clinic will provide rehabilitation recommendations designed to restore strength and function. This could include exercises, referral to physiotherapy sessions, and recommendations for a gradual return to activity.

5. Follow-Up Appointments

  • Monitoring Progress: The clinic will schedule follow-up appointments to monitor your recovery. For mild injuries, this may involve reassessing wrist function and adjusting the treatment plan. For surgical cases, follow-up visits will occur with the surgeon in their rooms. 

Conclusion

Specialised orthopaedic clinics provide comprehensive care for scapholunate injuries, from accurate diagnosis using advanced imaging to tailored treatment plans that may include both conservative and surgical options. During your visit, you will have a thorough examination, diagnostic testing, and a discussion of treatment options to help you recover fully. Follow-up care and rehabilitation are integral to ensuring long-term wrist stability and function. Access Ortho is a specialised orthopaedic clinic offering care for acute orthopaedic injuries.

Diagnosing hand injuries
A detailed medical history is required to help diagnose hand injuries

Commonly Asked Questions

Can a Scapholunate Ligament Injury Heal on Its Own?

In some cases, mild scapholunate ligament injuries, such as partial tears or mild sprains, may heal on their own with proper rest, immobilisation, and rehabilitation. However, more severe injuries (e.g., complete ligament tears or chronic instability) typically require medical intervention, and conservative treatments alone may not be sufficient for complete recovery.

How is a Scapholunate Injury Different from Other Wrist Sprains?

A scapholunate ligament injury specifically affects the ligament connecting the scaphoid and lunate bones in the wrist, playing a critical role in wrist stability and movement. Unlike other wrist sprains, scapholunate injuries can lead to instability, pain when gripping or twisting, and a noticeable “gap” between the scaphoid and lunate bones. In contrast, general wrist sprains usually involve damage to other ligaments or tissues without causing significant instability.

Will I Need Surgery for My Scapholunate Injury?

Surgical intervention may be required for complete ligament tears or chronic instability that doesn’t respond to conservative treatments. For example:

  • Direct repair or ligament reconstruction is often needed for significant ligament damage.
  • Salvage procedures may be necessary for advanced cases of scapholunate advanced collapse (SLAC), where arthritis and severe instability have developed. For mild or partial injuries, surgery is typically not needed, and conservative treatments may be effective.
How Long Does It Take to Recover from Scapholunate Ligament Surgery?

Recovery from scapholunate ligament surgery generally takes 3 to 6 months. Initially, you will be fitted with a splint or cast for about 4–6 weeks to immobilise the wrist. Afterwards, physiotherapy will be crucial for regaining strength, flexibility, and wrist function. Full recovery, including a return to high-intensity activities or sports, may take up to 6 months or longer, depending on the severity of the injury and surgery.

Can I Still Use My Hand While Recovering from a Scapholunate Injury?

During the initial phase of recovery, particularly if treated with immobilisation or surgery, you will likely need to limit the use of your hand to allow healing. Once the wrist is stabilised, a hand therapist may guide you on the gradual use of your hand for light activities, followed by strengthening exercises to restore function. However, high-impact or strenuous activities should be avoided until your healthcare team clears you to start these.

Are There Any Long-Term Effects of a Scapholunate Injury?

If not properly treated, a scapholunate injury can lead to chronic wrist instability, pain, and limited range of motion. Over time, untreated injuries may contribute to the development of scapholunate advanced collapse (SLAC), a form of wrist arthritis that can cause joint degeneration, stiffness, and progressive pain. Long-term effects depend on how severe the injury is and whether treatment is initiated early.

How Can I Prevent the Worsening of My Scapholunate Injury?

To prevent the worsening of a scapholunate injury, it’s important to:

  • Follow your doctor’s treatment plan: Adhere to recommendations for rest, immobilisation, and rehabilitation exercises.
  • Avoid high-impact activities: Limit activities that stress the wrist, such as heavy lifting, contact sports, or activities requiring intense wrist motion.
  • Monitor your symptoms: Pay attention to any worsening pain, instability, or changes in wrist function and seek follow-up care as needed.
What Activities Put Me at Risk for a Scapholunate Injury?

Activities that put stress on the wrist, especially those that involve falls, twisting motions, or forceful impacts, increase the risk of a scapholunate ligament injury. These include:

  • Sports: High-risk sports such as gymnastics, rugby, snowboarding, skateboarding, and basketball often involve falls on an outstretched hand or forceful wrist movements.
  • Manual Labour: Occupations that require heavy lifting or repetitive wrist movements, such as construction work or assembly-line jobs, can also increase the risk.
  • Motor Vehicle Accidents: In some cases, an injury from an accident can lead to significant wrist trauma, especially in the event of a fall or direct impact.
How Soon After Injury Should I Seek Medical Attention for a Potential Scapholunate Injury?

It’s important to seek medical attention as soon as possible if you suspect a scapholunate injury, particularly if you experience:

  • Severe pain or swelling.
  • Wrist instability or difficulty moving the wrist.
  • Numbness, tingling, or weak muscles in the hand or fingers.

Prompt diagnosis and starting treatment rapidly can help prevent long-term complications, such as chronic instability or arthritis.

Will I Develop Arthritis After a Scapholunate Injury?

If a scapholunate injury is untreated or inadequately treated, it increases the risk of developing osteoarthritis in the wrist, especially in severe or chronic cases. This condition, known as scapholunate advanced collapse (SLAC), can develop over time due to the instability in the wrist joint, leading to joint wear and tear. Early diagnosis and appropriate treatment, including surgery, if necessary, can reduce the risk of arthritis and other long-term complications.