Scapholunate Ligament Tears

What is a scapholunate ligament tear?

The scapholunate ligament is the most important ligament stabilizer in the wrist. Its importance is similar to the ACL in the knee. The wrist joint is composed of 8 bones organized in two rows and multiple ligaments. The basis of wrist function revolves around the bones working in unison. The scapholunate ligament is the cornerstone of this intricate functional mobility. The scapholunate ligament is composed of three sections: Volar, membranous, and dorsal. The dorsal ligament is the most important component.  A scapholunate ligament tear can be either partial or complete because all three of these components can tear wither together or individually.

How does a scapholunate ligament tear occur?

The scapholunate ligament is usually torn from trauma that involves a fall on the outstretched hand. Common mechanisms are skiing, biking and any high injury trauma. Occasionally, the ligament can be weakened from repetitive injuries and complete the tear from a relatively minor injury.

Diagnosing scapholunate ligament tears

Patients will notice swelling over the back of the wrist and may notice swelling. The wrist will be difficult to move but the symptoms may diminish over several days. Patients will continue to have difficulty gripping, loading the wrist and twisting.

On physical exam, there will be tenderness over the back of the wrist centrally over the scapholunate ligament. There may be instability of the wrist with a Watson’s maneuver which involves rotating the wrist while applying pressure to the scaphoid. Patients will experience pain and the wrist will pop. Xrays may show abnormal gapping of the bone between the scaphoid and lunate where the ligament tear occurs. Often, an MRI is performed to further access the injury and look for other injuries.

Non-surgical treatment of scapholunate ligament tears

Partial scapholunate ligament tears may be treated with non operative measures. Splinting or casting may allow for healing if the bone alignment is maintained. This is followed by therapy to strengthen the wrist.

Surgically treating scapholunate ligament tears

Because of the importance of the scapholunate ligament, surgery is often required in complete tears. This is necessary to restore the normal biomechanics of the wrist and decrease the risk of arthritis. The type of surgery performed depends on the degree of ligament injury. Some tears can be treated with wrist arthroscopy alone and some require open repair and reconstruction.

In open reconstruction, a small tendon graft and anchors are used to rebuild the ligament. This is an intricate procedure that involves recreation of the ligament fibers. Dr. Kavi Sachar uses an innovative technique involving suture anchors, a tendon graft, and an internal brace to allow for earlier motion and a more solid repair.

Recovering from scapholunate ligament repair surgery

After reconstruction, cast or split immobilization is required during ligament healing. Finger range of motion and daily activities can resume right away.  Gradual strengthening is performed under throaty guidance. Normal activities can usually be resumed by 3 months.

Schedule a consultation

Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on scapholunate ligament tears. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from a scapholunate tear, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.