Scapholunate Ligament Injury

A scapholunate ligament injury involves damage to one of the most important stabilising ligaments in the wrist, which connects two small bones called the scaphoid and lunate.

This ligament plays a key role in maintaining normal wrist movement and alignment. When it is injured, the bones can move abnormally, leading to pain, weakness and instability.

The injury may occur suddenly following a fall onto an outstretched hand, or develop over time due to repetitive strain.

If not recognised and treated appropriately, this injury can progress over time to a specific pattern of wrist arthritis known as SLAC wrist.

Treatment depends on the severity of the injury and how long it has been present.

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Diagnosis is based on clinical assessment and imaging.

Investigations may include:

• X-rays to assess bone alignment - Special stress X-ray views may be used to assess widening between the scaphoid and lunate.
• MRI scan to evaluate the ligament
• CT scan or specialised imaging in some cases
• Wrist arthroscopy, which allows direct visualisation of the ligament

These help confirm the diagnosis and guide treatment.

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Treatment depends on the severity of symptoms and the underlying cause.

Non-surgical treatment may include:

• Activity modification
• Wrist splinting
• Anti-inflammatory medication where appropriate
• Hand therapy

If symptoms persist or instability is significant, surgical treatment may be recommended. Options depend on the stage of injury and may include:

• Repair of the scapholunate ligament (in acute injuries)
• Reconstruction of the ligament using a tendon graft
• Temporary pinning to stabilise the wrist during healing
• Salvage procedures in more advanced cases where arthritis has developed

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The aim of treatment is to relieve pain and restore function.

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Surgical treatment varies depending on the severity and timing of the injury.

Procedures may involve repairing or reconstructing the ligament and stabilising the wrist using temporary fixation.

In long-standing cases, different procedures may be required to address joint damage

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Recovery depends on the type of treatment performed.

Recovery typically includes:

• A period of immobilisation in a splint or cast
• Gradual rehabilitation and strengthening
• Hand therapy to restore movement and function

Full recovery may take several months.

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As with any surgical procedure, there are potential risks, although these are uncommon.

Possible complications include:

• Infection (around 1%), usually treated with antibiotics
• Swelling or stiffness, which may take time to settle
• Scar sensitivity
• Nerve irritation or injury (rare)
• Ongoing pain or reduced wrist movement
• Failure of ligament healing or persistent instability which may lead to progressive wrist arthritis over time
• Progression to wrist arthritis over time

Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity

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You should seek medical advice if you have ongoing wrist pain following an injury, particularly if it is associated with weakness, clicking or a feeling that the wrist is not stable.

Early diagnosis is important, as untreated injuries can lead to long-term joint damage.

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