Sussex CONDITION Hand Scapholunate Surgery ligament injuries CONDITION The scapholunate ligament links two What are small bones in the wrist together. It is the most commonly injured ligament Scapholunate in the wrist. Complete rupture of this ligament eventually leads to arthritis ligament injuries? in the wrist. Normal Wrist Xray How is the diagnosis of a If the ligament is completely Scapholunate ligament ruptured and the diagnosis is Thumb injury made? made early (ideally less than 6 base joint weeks after the injury) a repair of Lunate bone The story of your symptoms and a the ligament might be successful. careful examination usually suggest Scaphoid the diagnosis. It is common for no If the diagnosis is made very late, after arthritis has started, bone specific injury to be recalled. treatments aim to relieve The obvious changes shown in symptoms (see ‘SLAC & SNAC The scapholunate Ulna bone the pictures are unfortunately the wrist’). ligament is in exception rather than the rule (in forearm) If gout or pseudogout is suspected this gap and Xrays will often be normal in the early stages of this condition. medical treatment with drugs can be very useful and this may need A magnetic resonance imaging A Wrist Xray showing a ruptured Scapholunate Ligament to be discussed with your GP or a (MRI) scan with dye injected into Rheumatology Consultant. the joint (an arthrogram) is the most sensitive test for confirming Wide gap the diagnosis. Dye should not leak What is the outcome between between the scaphoid and lunate after a scapholunate Scaphoid bent bones during this test. ligament injury? forwards, almost scaphoid and If a significant ligament injury is Again this depends on the degree seen ‘end on’ lunate bones suspected a wrist arthroscopy of damage the ligament has End of the (looking into the wrist with a suffered and the type of telescope) could be the next step. treatment undertaken. radius bone During this operation the wrist The type of operations joint and the scapholunate mentioned above do seem ligament can be directly inspected. Why is the scapholunate What symptoms does a reasonably reliable at improving stability of the scaphoid and ligament important? Scapholunate ligament What treatments are injury produce? reducing symptoms, at least in The scapholunate ligament links available for a the short to medium term. They the scaphoid and lunate and forces Symptoms from a scapholunate scapholunate ligament will all make the wrist somewhat the two bones to move together in ligament injury are very variable. injury? stiff to a greater or lesser extent. a co-ordinated way. Once the link is Patients often describe pain in The treatment recommended In the longer term there is some broken the two bones don’t sit the wrist sometimes with depends on how damaged the evidence that the ligament properly and start to clunk and swelling in the centre of the back ligament is and whether there are reconstruction operations may click. This wears the joint out and of the wrist. Clicking and clunking any sign of arthritis in the joint. stretch out with time, with some eventually, over about 5-10 years, a with use may be noted. The wrist recurrence of symptoms. pattern of arthritis called will usually be stiffer than the Slight stretching of the ligament scapholunate advanced collapse other side (less flexible). Once can often be managed with a We do not have the perfect solution (see ‘SLAC and SNAC wrist’) occurs. arthritis sets in the swelling and combination of painkillers, splints to this problem at the moment and stiffness can become more and activity modification. more work is underway to consider What causes a marked. Focussed hand therapy can be fresh ways to address scapholunate Scapholunate ligament useful to strengthen muscles that ligament injuries. injury? support the movement of the wrist and scaphoid. The usual cause is a fall onto the outstretched hand. Some If the ligament is more damaged inflammatory conditions, such as surgery to reconstruct the gout, can also weaken the ligament might be indicated. scapholunate ligament. Various options are available. www.sussexhandsurgery.co.uk These notes are intended as a guide and some of the © Sussex Hand Surgery details may vary depending on your individual January 2018 circumstance and at the discretion of your surgeon..