Wrist Instability (Scapholunate Ligament Injuries): Treatment Options

Wrist Instability (Scapholunate Ligament Injuries): Treatment Options

This video will provide an overview of the treatment options for injuries to the scapholunate ligament of the wrist. In review, this ligament is located between the scaphoid and lunate wrist bones. The scapholunate ligament is the most frequently injured ligament in the wrist and is critical in maintaining the stability of the wrist.

The goal of treatment is to prevent the known progressive instability of the joint that can occur over time. Injuries to this ligament are on a spectrum and can vary widely, leading to a variety of treatment paths, none of which are considered the most accepted. Optimal outcomes for this injury are with early treatment with surgery. However, treatment without surgery may be indicated for those in which surgery is not appropriate due to patient factors and injury severity.

Minor injuries without changes in bony alignment or stability may be treated without surgery. If no surgical treatment is chosen, treatment will consist of a period of immobilization in a splint and a focus on pain management with anti-inflammatories. Rehabilitation therapy may be ordered as well. Patients treated in this manner will be followed closely by the health care provider to assess for progressive changes.

Treatment options with surgery vary, and there are accepted grading systems that surgeons will use to aid in their decision based on the severity of injury. Surgical options for less severe injuries often focus on repair of the ligament. Techniques using arthroscopic surgery with a camera and instruments may be used, or open approaches with an incision may be needed. A procedure called a debridement, in which injured tissue is removed, may be used in less severe injuries. In addition, a radiofrequency device may be used to shrink loose or damaged tissue. This may provide pain relief. A surgeon may also advise using temporary wires to help stabilize the joint while it heals.

For scapholunate injuries that have progressed and are more severe, there are several additional surgical options. These may include ligament reconstruction using tissue grafts such as tendons, or the capsule of tissue that surrounds the wrist joint. Internally placed supportive sutures may be used alongside tendon grafts for reconstruction as well. If the injury has progressed too far, then more aggressive restorative options must be considered. These are procedures that require either a fusion of the wrist bones and/or removal of a portion of the misaligned wrist bones.

Additional treatment and recovery times after surgery will vary based on the procedure chosen. Although these injuries remain a challenge long-term, there are multiple treatment pathways that can be chosen to assist in slowing the progression of injury.