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Hand & Wrist

Scapholunate Ligament Injury: the wrist sprain that isn't just a sprain.

The scapholunate ligament holds two key wrist bones together. When it tears, the wrist mechanics change, and untreated, the wrist will eventually arthrose. Dr. Lee repairs scapholunate injuries using anchors he helped design.

Written bySteven J. Lee, MD · Chief of Hand and Upper Extremity Surgery, Lenox Hill Hospital
Last reviewed · May 2026

The scapholunate ligament is the most important ligament in the wrist, a small, strong band that holds the scaphoid and lunate bones together so they move as a unit. When this ligament tears, the two bones separate, the wrist mechanics change, and over years the cartilage wears down in a predictable pattern called SLAC wrist (scapholunate advanced collapse).

The challenge with scapholunate injuries is that the initial injury is often dismissed as a sprain, and only diagnosed years later when arthritis is already developing. Catching the injury early opens treatment options that aren't available once the damage is done.

How the injury happens

Most scapholunate injuries result from a fall onto an outstretched, extended wrist, the same mechanism that causes a distal radius fracture. The ligament can also be injured in sports, motor vehicle accidents, or from forceful twisting of the wrist.

What makes the diagnosis tricky is that X-rays may look normal in the days after the injury. The clinical exam is what raises suspicion: tenderness directly over the scapholunate interval (about a centimeter distal to Lister's tubercle), and a positive scaphoid shift test.

How it's diagnosed

MRI with contrast (MR arthrogram) or wrist arthroscopy are the most reliable ways to confirm a scapholunate ligament tear. Plain X-rays can show a widened scapholunate interval ('Terry Thomas sign') in chronic or complete tears but are often normal in partial or acute injuries. Wrist arthroscopy lets Dr. Lee both diagnose the tear and treat it in the same setting.

Dr. Lee's approach

Timing matters enormously with scapholunate injuries. A tear caught within the first few weeks of injury has the best chance of being repaired directly, sewing the ligament back to bone using anchors. After several months, the ligament tissue often can't be repaired and reconstruction becomes necessary.

Dr. Lee helped design suture anchor and internal brace constructs used for ligament reconstruction. In scapholunate reconstruction he typically combines a tendon graft with an internal brace tape to support the repair during healing.

Acute repair (within ~6 weeks)

Acute scapholunate tears, where the ligament can still be identified and tissue quality is good, are repaired by reattaching the ligament to the bone with small suture anchors. The repair is protected with an internal brace tape, a synthetic 'seatbelt' that supports the ligament during healing.

Chronic reconstruction (after ligament quality has degraded)

When the ligament can no longer be repaired, reconstruction can be performed using a tendon graft (often a slip of the flexor carpi radialis or extensor carpi radialis brevis) routed through bone tunnels to recreate the scapholunate connection. Dr. Lee augments these constructs with an internal brace using the anchor system he helped design.

Recovery timeline

Reconstruction recovery typically follows this pattern:

  1. Weeks 0–6
    Non-removable splint immobilization for first week, then removable splint full time for 6 weeks. No wrist motion. Finger, elbow, and shoulder motion encouraged. Dressings should be kept clean and dry for first week.
  2. Weeks 6–10
    Begin gentle active wrist motion under hand therapy guidance. Removable splint used for fall-risk situations.
  3. Weeks 10–16
    Progressive strengthening. Discontinue splint for daily activities. Light occupational use returns.
  4. Months 4–6
    Can be more aggressive with activities and some sports. Contact sport and high-impact or push-up type wrist loading typically deferred to 6 months.

What patients commonly misunderstand

Common misunderstandings about scapholunate injuries:

  • A normal X-ray does not rule it out. Acute scapholunate tears can be invisible on plain films. MRI arthrogram or arthroscopy is often needed when the exam suggests the injury.
  • Delay narrows the options. Repair is possible within weeks of injury. Reconstruction becomes necessary months later. Once arthritis develops, salvage procedures (limited fusion, proximal row carpectomy) are the only options left.
  • It is not just a wrist sprain. A 'sprain' that doesn't improve over a few weeks deserves a closer look. Persistent wrist pain after a fall is the most common missed diagnosis in this region.

This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.

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Patient questions

Scapholunate injuries, answered.

  • How is a scapholunate injury different from a sprain?

    A scapholunate injury is a tear of a specific key ligament in the wrist that holds the scaphoid and lunate bones in alignment. A 'sprain' is a vague term that can mean almost anything. The reason scapholunate injuries get missed is that they often present as 'just a sprain', but unlike most sprains, untreated scapholunate tears lead to wrist arthritis over time.

  • How long do I have to get this treated?

    The ideal window for direct repair is within 6 weeks. After 3–6 months, repair often isn't possible and reconstruction with a tendon graft becomes necessary. After arthritis develops, the only options are salvage procedures (partial fusion, proximal row carpectomy). The earlier the injury is caught, the more options remain.

  • Will my wrist be normal again?

    Outcome depends heavily on timing. Acute repairs in good ligament tissue have excellent outcomes, most patients return to full activity. Late reconstructions are reliable but rarely restore a fully normal wrist. The goal in chronic cases is a pain-free, functional wrist that delays or prevents arthritis.

  • What is the internal brace?

    The internal brace is a strong synthetic tape, anchored into bone, that supports the ligament repair while it heals. Dr. Lee helped design the anchor and tape constructs used for these reconstructions. The internal brace allows for earlier, more confident rehab without overstressing the healing ligament.

  • Can scapholunate injuries be treated arthroscopically?

    Sometimes, acute partial tears can be treated arthroscopically with capsular shrinkage and immobilization, and arthroscopy is invaluable for diagnosis. Complete tears generally require an open procedure to do a durable repair or reconstruction. Dr. Lee uses arthroscopy in nearly every case to confirm the diagnosis and assess the cartilage.

Next step

Still calling it a sprain? Get a real diagnosis.

Persistent wrist pain after a fall deserves more than reassurance. Most scapholunate injuries are diagnosable on a careful exam and confirmed with the right imaging. The earlier the diagnosis, the more your wrist's future is on the table.

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