Scapholunate ligament injury (pain in the wrist) (2023)

Anatomy

Signs and symptoms

Diagnosis

(Video) Wrist Sprain: Injury to the Scapholunate Ligament

Diagnostic Ultrasound

Injections

What is a scapholunate ligament injury?

The scapholunate joint is a small joint between two carpal bones at the wrist crease, namely the scaphoid and lunate bones. The scapholunate joint is very important for the stability of the wrist joint. It is often injured during sport, for example, if you fall heavily onto your hand. It can also be injured through chronic overuse, for example, for those who are involved in manual work or lift heavy weights in the gym. It causes localised pain at the wrist, which is often made worse with gripping and weight bearing through the hand, such as during a press-up.

Obtaining the correct diagnosis is essential with scapholunate ligament injuries as a delay or missed diagnosis can result in chronic wrist pain and inability to weight bear through the wrist. Chronic scapholunate ligament injuries can also lead to osteoarthritis. Diagnosis is made using clinical assessment and diagnostic ultrasound. An MRI scan may be required depending on the mechanism and extent of the injury on ultrasound.

(Video) What is a scapholunate ligament injury?

Treatment will depend on the severity of the ligament injury. Non-surgical treatment involves physiotherapy, including activity modification, splinting, exercise, and manual therapy. A referral to an orthopaedic surgeon may be required. If the pain does not improve and the ligament injury is a partial tear (not a full tear), then anultrasound guided steroid injectioncan be carried out.

What are the symptoms of a scapholunate ligament injury?

The symptoms of scapholunate ligament injury are:

  • Pain and swelling at the wrist joint
  • Pain aggravated by weight bearing, for example during a press up
  • Wrist instability and weakness

What other conditions can mimic scapholunate ligament injury?

If this does not sound like your pain, there are other conditions that can mimic the pain of scapholunate ligament injury, such as:

  • Carpal tunnel syndrome
  • DeQuervain’s tenosynovitis
  • Osteoarthritis of the wrist
  • Triangular fibrocartilage complex (TFCC) tear

What is the difference between scapholunate ligament pain and osteoarthritis (OA) of the wrist?

Both scapholunate ligament pain and osteoarthritis of the wrist cause pain at the wrist joint, made worse by putting weight through the wrist, such as leaning on a table.

However, scapholunate ligament pain causes more localised pain on the back of the wrist and is often secondary to a specific incident such as falling onto your hand. Whereas osteoarthritis of the wrist causes more diffuse (less localised) wrist pain and often occurs for no apparent reason. Osteoarthritis of the wrist is also associated with more stiffness and swelling, particularly in the mornings. However, it is important to note that often these conditions co-exist and it is important to differentiate through imaging, such as diagnostic ultrasound.

Anatomy

The wrist is a complex, highly mobile zone comprising of nine bones. The resulting joints articulate with one another to produce the precise, dexterous movements achieved by the wrist and hand.

The wrist complex is made of a series of joints, the radiocarpal joint being the largest. It is created by the radius (long bone of the forearm) and a set of four small known as the proximal carpal row.

The mid carpal joint is created by a series of smaller articulations formed by the eight bones of the carpal rows (the focus of this blog). All the joints which create the wrist complex are surrounded by a common joint capsule. This joint capsule is lined with a lubricating membrane, known as the synovial membrane. This membrane secretes synovial fluid which allows for frictionless movement of the wrist joint.

The mid carpal joints

Scapholunate ligament injury (pain in the wrist) (1)

The proximal carpal row comprises of the following bones:

  • Scaphoid
  • Lunate
  • Triquetrum
  • Pisiform

The proximal carpal row in turn articulates with the distal carpal row of the wrist. The articulation between the proximal and distal carpal rows create the mid carpal joint of the wrist.

The distal carpal row comprises of the following bones:

  • Trapezium
  • Trapezoid
  • Capitate
  • Hamate

This mosaic of eight carpal bones, which create the mid carpal joint, are attached to one another via a series of small ligaments that stabilise the mid carpal joints during movement.

The Scapholunate joint is formed by the articulation of the scaphoid bone and the lunate bone of the proximal carpal row. It is stabilised by an inter-carpal ligament, known as the scapholunate ligament. Trauma to this ligament has been well documented as the most common cause of radial (Long bone of the forearm leading to the thumb) sided wrist pain (Abe et al., 2006).

Damage to the scapholunate ligament causes the underlying scapholunate joint to become unstable which in turn has been linked with overload of the surrounding mid carpal joints (Abe et al., 2006) and the development of osteoarthritis (Johnson et al. 2013). Scapholunate ligament injury is challenging to diagnose and is often missed or incorrectly diagnosed resulting in chronic wrist pain and instability. It is, therefore, essential, to avoid degenerative changes within the wrist joint, that an accurate diagnosis to made as early as possible to ensure timely treatment is accessed (Coplletta et al., 2020).

How is the scapholunate joint injured?

Scapholunate ligament injury (pain in the wrist) (2)

Scapholunate joint injury occurs predominantly in a young population, mainly of working age and is often linked to trauma. Falling onto an outstretched hand or sustained wrist loading exercising such as weight lifting and gymnastics have been positively cited as common predisposing factors to a scapholunate ligament injury.

(Video) All-Dorsal Scapholunate Reconstruction with InternalBrace™ Ligament Augmentation Repair

What are the symptoms of a scapholunate ligament injury?

Scapholunate ligament injury (pain in the wrist) (3)

Abe et al., (2006) describe scapholunate ligament injury symptoms as;

  • Most commonly pain and swelling start after a traumatic event such as falling or a sudden, unexpected movement of the wrist. Often involving a twisting/extension motion.
  • Pain during exercise which uses the wrist, including gymnastics or weight lifting.
  • Pain which can linger after completing the wrist-based exercise.
  • Dull aching sensation in the wrist.
  • Pain and tenderness to touch directly over the proximal carpal row of the wrist.
  • Pain with twisting and extending the wrist.

How are scapholunate ligament injury diagnosed?

(The below image is an MRI of the wrist the red circle denotes the scaphoid and lunate bones)

Scapholunate ligament injury (pain in the wrist) (4)

As previously discussed, a scapholunate ligament injury is often either missed or incorrectly diagnosed.

Many patients suffering from a traumatic wrist injury attended A&E are imaged using X-ray and sent home with a “soft tissue sprain”. Research has shown X-ray to be highly effective for assessing for scaphoid fractures and degenerative changes such as osteoarthritis however it is not capable of assessing scapholunate ligament injury (Bergh et al., 2012). Bergh et al., (2012) goes further describing MRI as the most appropriate tool for assessing the quality of the scapholunate ligament.

The gold standard imaging tool for assessing the scapholunate ligament is MRI, however, this should be used in conjunction with a clinical assessment (Bergh et al., 2012). With this in mind, if you feel you may have injured your scapholunate ligament you should make an appointment with a physiotherapistor an orthopaedic consultant as soon as possible. If you would like more information or would like to book an appointment please contact us on 0207 4823875 or email injections@complete-physio.co.uk.

A clinical assessment includes an interview and a series of clinical tests which combined help the clinician diagnose the cause of your pain. If a scapholunate ligament injury is suspected then you may be referred for an MRI to confirm your diagnosis.

A clinical assessment includes an interview and a series of clinical tests which combined help the clinician diagnose the cause of your pain. If a scapholunate ligament injury is suspected then you may be referred for an MRI to confirm your diagnosis.

Diagnostic ultrasound imaging

Diagnostic ultrasound imaging is capable of assessing the quality of the ligament and for signs of swelling and inflammation commonly associated with trauma to the scapholunate ligament. The benefits of diagnostic ultrasound include;

  • No radiation as with X-ray.
  • Short scanning times. The clinician can scan directly over the area of pain quickly and efficiently (a wrist scan often only takes 5 minutes).
  • No need to attend the hospital. All clinicians at Complete are fully trained musculoskeletal sonographers (more later).
  • Dynamic imaging. The clinician is able to talk to you and direct the scan depending on your symptoms throughout the process. You may be asked to move during the scan to help assess how the scapholunate joint and ligament move (assessing for scapholunate joint stability – instability of the scapholunate joint can be caused by a ligament injury, as previously discussed).
  • Diagnostic imaging can be used to accurately direct a needle if an injection is required (again more later).
(Video) Scapholunate Ligament Injuries

How is a scapholunate ligament injury treated?

Treatment for a scapholunate ligament injury is dependant on the level damage that has occurred. If the ligament remains intact and the joint remains stable then a short period of immobilisation (wrist brace), icing, rest and a progressive strengthening program (designed by your physiotherapist) will be enough however, if the ligament is ruptured and the underlaying joint is unstable or if conservative treatments have not been successful then an injection of surgical intervention maybe required (Abe et al., 2006).

Tips and tricks, you may like to try

Scapholunate ligament injury (pain in the wrist) (5)

  • Avoid aggravating your wrist with movements or activities that cause wrist extension or twisting. This includes racquet sports; weight lifting or press-ups. Continuing to aggravate your wrist could prolong your recovery or can even make your prognosis worse.
  • Try wrist support. Use this especially when completing activities such as lifting and carrying. Wearing a brace at night will also help to keep it in a safe, neutral position over night.
  • Apply a small bag of peas in a tea towel to the wrist. This can help to reduce pain and inflammation.
  • Try applying a topical non-steroidal anti-inflammatory cream. Talk to your pharmacist before using any medication.

What if conservative treatment options don’t work?

In the event that conservative treatment options do not resolve your symptoms it may be appropriate to consider a corticosteroid injection. Corticosteroid injections are regularly used to reduce pain and inflammation associated with injury. This powerful anti-inflammatory medication can be used to control your symptoms allowing you to partake in physiotherapy exercises and therefore, rehabilitate your injury. The current research base reveals steroid injections, guided by ultrasound to be significantly more accurate, cause less complications and are capable of eliciting faster pain relief than Landmark guided injections.

Complete offer a same day service on all ultrasound-guided injections. You do not need to be referred via your GP. We have a team of highly experienced clinicians who are fully qualified medical prescribers, physiotherapists and musculoskeletal sonographers who are able to prescribe and perform an ultrasound-guided injection during your initial assessment. If you would like more information or would like to book an appointment please contact us on 0207 4823875 or email injections@complete-physio.co.uk.

Other Wrist & Hand conditions:

Osteoarthritis (OA) wrist joint
Trigger Finger/thumb
Carpal Tunnel Syndrome
Osteoarthritis of the thumb
Triangular fibrocartilage complex (TFCC)
De Quervain’s Tenosynovitis

References

Abe, Y., Katsube, K., Tsue, K., Doi, K. and Hattori, Y., 2006. Arthoscopic diagnosis of partial scapholunate ligament tears as a cause of radial sided wrist pain in patients with inconclusive x-ray and MRI findings.Journal of Hand Surgery,31(4), pp.419-425.

Bergh, T.H., Lindau, T., Bernardshaw, S.V., Behzadi, M., Soldal, L.A., Steen, K. and Brudvik, C., 2012. A new definition of wrist sprain necessary after findings in a prospective MRI study.Injury,43(10), pp.1732-1742.

Cipolletta, E., Smerilli, G., Mirza, R.M., Di Matteo, A., Carotti, M., Salaffi, F., Grassi, W. and Filippucci, E., 2020. Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament.Joint Bone Spine.

Johnson, J.E., Lee, P., McIff, T.E., Toby, E.B. and Fischer, K.J., 2013. Effectiveness of surgical reconstruction to restore radiocarpal joint mechanics after scapholunate ligament injury: an in vivo modeling study.Journal of biomechanics,46(9), pp.1548-1553.

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Cheryl2022-08-19T06:49:55+00:00Comments Off on Scapholunate ligament injury (pain in the wrist)

(Video) Wrist Ligament Sprain - Mayo Clinic

FAQs

Where is the pain with scapholunate ligament tear? ›

The symptoms of scapholunate ligament injury are: Pain and swelling at the wrist joint. Pain aggravated by weight bearing, for example during a press up. Wrist instability and weakness.

What does ligament damage feel like in your wrist? ›

Swollen and painful wrist. Limited movement of the wrist and/or hand. Feeling of popping or tearing sensation in the wrist. Warmth and tenderness around the injury.

Does a torn ligament hurt in wrist? ›

What are the symptoms of a torn wrist ligament? Damage to the ligament of the wrist can cause severe pain and swelling of the wrist, reduced range of motion (ROM), tenderness, bruises, and discoloration (called ecchymosis). Pain and swelling can worsen if care is not provided to repair the ligament.

Can you move your wrist with a torn ligament? ›

If you have any of the following symptoms, you may have a torn ligament in the wrist: Pain when bending the wrist backward. Inability to move your wrist all the way around. Bruising.

What special test indicates a scapholunate ligament injury? ›

The scaphoid shift test is a provocative maneuver used to examine the dynamic stability of the scaphoid and reproduce a patient's symptoms. It is used to diagnose scapholunate interosseous ligament instability (SLIL).

How long does a scapholunate ligament take to heal? ›

The scapholunate ligament may take 8- 12 weeks to heal. You can get back to work in 2-4 weeks if you have a desk job, however might take upto 3 months if your job involves physical work. Regarding return to contact sports, it usually takes 3-6 months and depends on the severity of injury.

How do you fix a scapholunate ligament tear? ›

If the ligament has ruptured recently it may be possible to repair it surgically, often using stitches that are held to the bones with a small permanent metal anchor. The wrist bones are held together by temporary internal wires to allow the repair to heal, and a splint or cast must be worn for weeks.

How do you test for scaphoid injury? ›

There are various imaging options for assessing a patient with a suspected scaphoid injury. They include plain radiographs, magnetic resonance imaging (MRI), ultrasonography, and bone scintigraphy. All of these modalities have advantages and disadvantages when evaluating patients for potential scaphoid fracture.

How do you tell if a ligament is stretched or torn? ›

Tear Symptoms
  1. Sudden, severe pain.
  2. A “pop” sound during the time of the injury.
  3. The feeling of a loose joint.
  4. Inability to bear weight on the affected area.
  5. Immediate bruising.
  6. Immobility of the affected joint.
  7. Visual deformity.
16 Dec 2019

How long does ligament damage take to heal wrist? ›

Your wrist hurts because you have stretched or torn ligaments, which connect the bones in your wrist. Wrist sprains usually take from 2 to 10 weeks to heal, but some take longer. Usually, the more pain you have, the more severe your wrist sprain is and the longer it will take to heal.

How do I know if my wrist pain is serious? ›

See a GP if:

pain in your wrist is stopping you doing normal activities. the pain is getting worse or keeps coming back. the pain has not improved after treating it at home for 2 weeks. you have any tingling or loss of sensation in your hand or wrist.

What is the most commonly injured ligament in the wrist? ›

The most common ligament to be injured in the wrist is the scapho-lunate ligament (see Figure 2). It is the ligament between two of the small bones in the wrist, the scaphoid bone and the lunate bone. There are many other ligaments in the wrist, but they are less frequently injured.

How do you diagnose a torn ligament in your wrist? ›

Magnetic resonance arthrography (MRA). A wrist MRA is a two-step procedure used to diagnose wrist ligament injuries. First, a contrast dye is injected into the location to be examined, then an MRI is performed. This technique allows for a detailed evaluation of the intrinsic ligaments and surrounding soft tissues.

Why does it hurt when I move my wrist? ›

Wrist pain is often caused by sprains or fractures from sudden injuries. But wrist pain also can result from long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome. Because so many factors can lead to wrist pain, diagnosing the exact cause can be difficult.

Do you need a cast for a torn ligament in wrist? ›

A cast may be necessary if the sprain is severe enough that even slight movement of the injured ligaments causes pain, permanent changes to wrist function, or an inability to bear weight on the wrist. Your doctor will be able to determine if you need a cast based on the severity of your injury.

Can a torn ligament in the wrist heal on its own? ›

While a wrist ligament injury may heal on its own, some may require intervention by a hand specialist to heal properly.

Can SLAC wrist be repaired? ›

SLAC reconstruction (limited wrist fusion): Surgical treatment in the form of wrist ligament reconstruction may be indicated in cases where the wrist ligament is completely torn.

Does MRI show ligament damage in wrist? ›

Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings.

What does a scaphoid fracture feel like? ›

Scaphoid fractures usually cause pain and swelling in the anatomic snuffbox and on the thumb side of the wrist. The pain may be severe when you move your thumb or wrist, or when you try to pinch or grasp something. Unless your wrist is deformed, it might not be obvious that your scaphoid bone is broken.

Can a wrist injury be permanent? ›

While hand and wrist injuries are very common, some athletes never seek treatment. Unfortunately, delaying the diagnosis and treatment may result in long-term problems or even a permanent disability.

Can you still move your wrist with a scaphoid fracture? ›

The depression in the skin that occurs at the wrist below the thumb is the snuffbox. A scaphoid fracture will result in pain, tenderness, swelling, and bruising centered around this location. Range of motion of the wrist may be slightly decreased.

Will an xray show a scaphoid fracture? ›

A scaphoid fracture is usually diagnosed by an x-ray of the wrist. However, x-rays do not always show scaphoid fractures. A break in the bone that cannot be seen on x-ray yet is called an “occult” fracture.

How long does scaphoid pain last? ›

Most people need around three months to recover from a scaphoid fracture. There are lots of factors that can affect how long it takes your body to heal. Talk to your healthcare provider or surgeon about a timeline that fits your specific situation.

Is a torn ligament more painful than a break? ›

Sometimes, a sprain can be even more painful than a break. A sprain is caused by trauma that overstretches ligaments and puts stress on a joint. A mild sprain is where the ligaments are stretched but the joint remains stable, while a moderate sprain is where the ligaments are slightly torn, making the joint unstable.

What ligament pain feels like? ›

How does it feel? Round ligament pain feels like a deep, sharp, stabbing or stretching sensation that begins or worsens with movement. Some triggering movements may include rolling over in bed or taking a step. The pain may travel upward or downward, from the hips into the groin.

What does a partially torn ligament feel like? ›

Pain, often sudden and severe. A loud pop or snap during the injury. Swelling within the first 24 hours after the injury. A feeling of looseness in the joint.

Do ligament injuries ever fully heal? ›

The long-term prognosis for ligament tears with the proper treatment is good. Level 1 and level 2 sprains will often be fully recovered within three to eight weeks, meaning you should be able to return to your normal activities and have full mobility in that time.

Do torn ligaments ever fully heal? ›

Beware the fully torn ligament

Complete tears rarely heal naturally. Since there's a disconnect between the tissue and any chance of blood supply, surgery is needed. Surgery also helps the joint heal correctly and reduces the chances of re-injury. For instance, an ACL rupture will require reconstruction.

Can ligament injuries be permanent? ›

These injuries might only include some bruising, but sometimes the force of a collision causes accident victims to suffer a complete tear of a ligament or tendon. These injuries can lead to permanent soft tissue damage.

What type of doctor treats wrist pain? ›

See your orthopedic doctor for an assessment of your wrist pain, because the pain may still be treatable with noninvasive methods if it is caught early.

What causes ulnar sided wrist pain? ›

A common cause of ulnar wrist pain is a fall onto an outstretched hand. This can break bones in the wrist. Sports like tennis, golf, and football can sometimes bend the wrist back too far and this can damage tendons and ligaments.

When should you get a wrist injury checked? ›

If you are in excruciating pain, suspect a fracture, have significant numbness and tingling, or the wrist is clearly deformed, seek medical attention immediately at an urgent care or emergency department.

What are 4 common wrist injuries? ›

Carpal tunnel syndrome, which happens when a nerve that runs from your forearm into your palm becomes squeezed at the wrist. Ganglion cysts, which are noncancerous lumps or masses. Gout, which is a form of arthritis caused by a buildup of uric acid in your joints. Fractures (broken bones)

Should you wear a wrist brace to sleep? ›

“When we sleep, we often have our wrists bent forward or backward, which can pinch the nerve and lead to carpal tunnel symptoms at night,” explains Dr. Delavaux. “Initial conservative treatment of wearing a brace that holds the wrist in a neutral position during sleep may help to alleviate symptoms.”

Should I wear my wrist splint at night? ›

It's important to keep moving your wrist as you normally would, but to avoid putting too much strain on it. You can also wear a splint at night.

What helps ligaments heal faster? ›

5 Treatment Solutions for Your Ligament Injury
  1. Rest. The generally accepted wisdom on how to initially treat a ligament injury can be summed up in one acronym: RICE, which stands for Rest, Ice, Compression, and Elevation. ...
  2. Reduce Swelling. ...
  3. Ligament Injections. ...
  4. PRP Therapy. ...
  5. Balance Training.

Can a doctor tell if you have torn a ligament? ›

One way to tell whether or not you have a ligament tear is by physical exam. The ligaments hold you knee joint together. Disruption of any of the ligaments can make this joint unstable. But an MRI is usually needed to evaluate which ligaments are torn and to what extend.

How common is scapholunate ligament tear? ›

The scapholunate ligament is the most frequently injured ligament in the wrist, so is a common cause of wrist "sprains". A significant injury can alter the way the small bones of the wrist interact, and this can lead to cartilage wear and osteoarthritis.

What part of the wrist hurts with tendonitis? ›

Swelling around your wrist or the bases of your fingers. Wrist pain, especially along the side of the wrist near the thumb or pinkie finger.

How long does it take for a scapholunate ligament tear to heal? ›

The scapholunate ligament may take 8- 12 weeks to heal. You can get back to work in 2-4 weeks if you have a desk job, however might take upto 3 months if your job involves physical work. Regarding return to contact sports, it usually takes 3-6 months and depends on the severity of injury.

What are the 4 symptoms of tendonitis? ›

What are the symptoms of tendonitis?
  • pain and tenderness in the affected tendon, which is often worse when you move it.
  • swelling.
  • a grating sensation as the tendon moves.
  • a lump on the tendon.
  • weakness in the affected area.
  • decreased range of motion.

What causes intense wrist pain? ›

Wrist pain is often caused by sprains or fractures from sudden injuries. But wrist pain also can result from long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome. Because so many factors can lead to wrist pain, diagnosing the exact cause can be difficult.

Does tendonitis show up on xray? ›

A small amount of radiation is used to make an image. Tendons can't be seen on an X-ray, but they can show bone. This test can check for arthritis.

How do I know if my wrist tendon is torn? ›

Signs or symptoms include:
  1. Pain.
  2. Swelling.
  3. Bruising.
  4. Weakness in the affected area.
  5. A snapping or popping noise at the time of injury.
  6. Difficulty moving the hand, wrist or elbow.
  7. Increased fatigue during activity.

What helps wrist ligaments heal faster? ›

To speed the healing, you can:
  • Rest your wrist for at least 48 hours.
  • Ice your wrist to reduce pain and swelling. ...
  • Compress the wrist with a bandage.
  • Elevate your wrist above your heart, on a pillow or the back of a chair. ...
  • Take anti-inflammatory painkillers. ...
  • Use a cast or splint to keep your wrist immobile.
13 May 2021

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2. Scapholunate ligament rupture and DISI
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3. UE Hand: Scaphoid Lunate Ballotment Test | IAOM-US
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4. The SLAM Technique for Scapholunate Ligament Injuries
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5. Anatomy of Scapholunate Ligament of the wrist
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6. Scapholunate Ligament Tear
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