Scapholunate Ligament Tears
What is it?
A scapholunate ligament (SL) tear is a tear of a ligament within the wrist that stabilizes two small bones–the scaphoid and the lunate.
What causes it?
Most of the time an injury to the wrist, such as a fall or a sporting injury can cause SL tears. High energy injuries, such as falls from heights and motor vehicle accidents, can also cause these injuries. Many times, seemingly benign “wrist sprains” can result in SL tears. As a result, the injury is not infrequently diagnosed late or overlooked initially.
What are the symptoms?
SL tears can cause pain and instability within the wrist. Pain is typically felt centrally within the wrist. Instability may manifest as pain or catching with range of motion and loading of the wrist. However, many times, symptoms may be mild and easily overlooked by the patient, believing the pain to be part of the original wrist sprain. If injuries are neglected for a considerable period of time, arthritis may ultimately settle in. If this happens, pain and swelling may develop over the back of the wrist, and stiffness may develop.
How is it diagnosed?
A history noting any previous injury and treatment are important. A physical examination can help localize the site of pain. Specific exam maneuvers exist that can assess the integrity of the SL ligament. Xrays are important in the diagnostic process. While minor or incomplete tears may not cause any abnormality on xrays, more complete tears or chronic tears can show gapping and/or a change in rotational alignment between the scaphoid and lunate. Xrays can also show any arthritis that may have developed as a result of the injury. Lastly an advanced imaging study such as an MRI can image the soft tissues and therefore provide a more clear picture of the integrity of the SL ligament.
How is it treated?
SL tears that are diagnosed early are typically treated with surgical repair of the ligament and temporary stabilization of the bones with pins to allow healing. When SL tears are diagnosed late, direct repair of the ligament may not be possible because of degeneration of the torn of ligament. In these cases the ligament is reconstructed with a tendon graft secured to the bones, recreating the course of the ligament. After both techniques, the pins are removed between 6-10 weeks and range of motion is started. Recovery can take 3-6 months.
If tears go a very long time without treatment, they may result in a predictable pattern of arthritis called scapholunate advanced collapse. When this occurs, the ligament should not be repaired, and instead the arthritis should be treated.
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