Scapho-Lunate Ligament Tear
The Scapholunate ligament is a very important ligament that connects the Scaphoid to the Lunate bone in the wrist. This injury most commonly occurs with a fall onto an outstretched hand (i.e. wrist fully extended). Any simple fall or motor vehicle accident can cause this injury, but we see it very commonly during contact sports.
Patients may experience pain on the top part of their wrist at rest, with range of motion, and especially when extending their wrist while weightbearing such as when simulating a push up. There may or may not be much swelling. It is important to note that many patients are surprisingly asymptomatic with this injury, often brushing it off as a wrist sprain hoping it will get better on its own. Unfortunately, this often causes patients to delay seeking medical attention. However, a delay in diagnosis will often lead to a significantly compromised result. Please do not put off seeing a hand surgeon when you think you might just have minor trauma, we can't stress this enough!
Work-up usually first starts with an x-ray. However, because the Scapholunate ligament is not visualized on a Xray, further radiologic studies such as an MRI may be obtained.
Many factors must be considered when deciding whether or not a Scapholunate ligament tear can be treated non-operatively or would benefit from surgery. Important factors include whether or not the tear is partial or complete, the length of time since it was originally injured, the age and the functional demands of the patient.
Dr. Lee will discuss various non-operative treatments if warranted. Partial tears will typically be treated with a thumb spica short arm cast or splint for at least 6 weeks. This can be removed for showering and washing the hands, but in general it is important to otherwise keep the splint/cast on at all times, including sleeping.
Physical Therapy is started after the patient's cast is removed in order to regain back mobility and strength, which because of the lengthy period of immobilization, may require an extended period of time in physical therapy (usually 6-12 weeks).
While there can be exceptions to every rule, Dr. Lee believes most acute complete tears in relatively active individuals without significant evidence of arthritis would benefit significantly from surgical intervention. Failure to address this condition will over time lead to accelerated arthritis, and increased pain and disfunction that at some point would no longer be able to fixed. Eventually this becomes something called a SLAC wrist (see section on this) for which the treatment options become compromised. This is often hard for patients to fathom because as stated above, patients often don't have the most severe symptoms with this injury, and have a hard time believing they need actual surgery.
Dr. Steven Lee has pioneered the newest treatment for Scapholunate ligament injuries and is recognized as one of the leading authorities on this problem. His research on Internal Bracing was originally focused for the treatment of this problem. The addition of Internal Bracing as well as his development of an innovative new anchor implant has significantly increased the strength of the repair and reconstruction constructs, and has changed how surgeons think about this problem. He now instructs other hand surgeons on this technique around the country.
If you are interested in viewing the actual technique, click here. Please be warned that the video may contain graphic content!
Learn more about scheduling surgery.
Patients will be place in a thumb spica splint immediately following surgery. During the post-operative period, patients are encouraged to take 500 mg of Vitamin C daily, abstain from dieting, and to do everything possible to avoid additional trauma. We typically will encourage opening and closing of the fingers, but to refrain from any forced gripping, or lifting anything heavier than the weight of a coffee cup.
Patient's most commonly remain immobilized in a cast or splint for 6 weeks after surgery. If pins have been placed to support the reconstruction, these are typically removed around 6-8 weeks from the time of the surgery. Physical Therapy is usually started after the patient's cast is removed in order to regain back mobility and strength, and can last for at least 2 months. Patients will be encouraged to return to normal activities around 3 months after surgery. However, continued improvement from this difficult problem can continue for up to 1-2 years.
Learn more about post-operative care.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.