Dr Steve Carter
Scapholunate Ligament Injuries
The scapholunate ligament is possibly the most important ligament in the wrist. It firmly connects the scaphoid to the lunate ensuring that the two bones move in unison. If one has a torn scapholunate ligament and it is not reconstructed, because the two bones scaphoid and lunate are disconnected, the wrist predictably degenerates into what we call a SLAC wrist (scapholunate advanced collapse).
The mechanism of injury is a hyperextended loaded wrist, ie fall on an outstretched hand. Very often this feels like a bad sprain of the wrist and the patient only seeks medical attention some months later.
Typical symptoms are: pain in the wrist, loss of grip strength, unable to do a push up, a feeling of instability or locking & clicking of the wrist.
After a careful clinical examination xrays are performed, but very often this can only be diagnosed with a MRI.
Treatment is surgical. The ligament needs to be repaired and augmented. There is no one single technique that has shown to be consistently superior. Over the years I have done a repair followed by a Palmaris longis graft, or ECR graft (Brunneli) and a Tri ligament repair. My current treatment involves repairing the ligament and supplementing the repair with an Arthrex mini-tightrope (an internal fibre wire stitch drilled through the bone). Results are very encouraging and this has recently been presented at the SASSH Conference 2013.