Dr Steve Carter


Scapholunate Ligament Injuries

What are 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. Scapholunate ligament injuries are tears of this ligament that can cause a degeneration in the wrist called scapholunate advanced collapse, or SLAC. If the scapholunate ligament is torn and it is not reconstructed, the two bones scaphoid and lunate are disconnected and therefore cannot move together, causing SLAC wrist, which is a severe degenerative arthritis of the wrist leading to pain, weakness and loss of function.

Scapholunate ligament injuries are usually characterised by pain in the wrist, loss of grip strength and the feeling of instability in the wrist. The injury is common among athletes and is caused by a hyperextended loaded wrist, which can often occur when a person uses their hand to break their fall.

How are scapholunate ligament injuries treated?

Dr Carter will first need to perform a careful clinical examination involving X-rays to diagnose a scapholunate ligament injury, but very often, this can only be confirmed with an MRI. Once the injury has been identified the ligament then needs to be repaired and augmented surgically.

There is no one single technique for repairing scapholunate ligament injuries that have shown to be consistently superior. Dr Carter, however, performs a repair followed by a palmaris longis graft, or ECR graft and a tri-ligament repair. This treatment involves repairing the ligament and supplementing the repair with an Arthrex mini-tightrope (an internal fibre wire stitch drilled through the bone). This ensures that the ligament is secure and, after surgery, patients will have to wear a cast to allow the repair to heal before engaging in physical therapy to regain use of their hands.

It is important that these injuries to the scapholunate ligament are not missed and that precise surgical reconstruction is performed in order to preserve normal wrist function.