What is a Scapholunate Ligament Injury?

The scapholunate ligament is a small but powerful band of tissue that connects two of the most important small bones in your wrist: the scaphoid and the lunate. It acts like a hinge, ensuring these bones move together in harmony. When this ligament is torn—either partially or completely—this stability is lost. The bones can start to separate, leading to pain, weakness, and if left untreated, a predictable pattern of wrist arthritis known as SLAC wrist (Scapholunate Advanced Collapse).

What are the symptoms?

Pain & Tenderness

A deep, dull ache on the top of your wrist, often pinpointed to a specific spot. It typically worsens with activity.

Clicking or Popping

A noticeable clicking, clunking, or popping sound or sensation when you move your wrist, especially with twisting motions.

Weakness & Instability

Difficulty with gripping or a feeling that your wrist is going to 'give way' when lifting or pushing up from a chair.

Don't Ignore Persistent Wrist Pain

If you've had a wrist injury and the symptoms aren't improving, an accurate diagnosis is the key to preventing long-term problems. Let's find out exactly what's going on.

Get a Clear Diagnosis

How do I diagnose a Scapholunate Injury?

Diagnosing this injury requires a high index of suspicion. It starts with listening carefully to how the injury happened and performing a detailed physical examination. A key part of this is the Scaphoid Shift Test (Watson's Test).

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I will hold your wrist, placing my thumb on your scaphoid bone.

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I will then gently move your wrist from side to side.

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A painful 'clunk' as the scaphoid shifts out of position is a strong indicator of instability.

While X-rays are important, they can be normal in the early stages. An MRI scan is the gold standard for seeing the ligament itself and confirming the diagnosis.

How can we get you better?

Treatment is tailored to you and depends on whether the tear is partial or complete, and how long ago the injury occurred.

Immobilisation For acute, partial tears, a cast or rigid splint for several weeks can allow the ligament to rest and heal in the correct position.

Hand Therapy Once out of the cast, a specialised hand therapist will guide you through exercises to restore motion and strength, focusing on stability.

Arthroscopic Debridement For some partial tears, a keyhole procedure to 'clean up' the frayed ligament edges can relieve mechanical symptoms like clicking.

Injections While not a cure, steroid injections can sometimes help calm inflammation and pain in the short term.

For complete ruptures or chronic injuries where the wrist is unstable, surgery is usually required to restore the connection between the scaphoid and lunate and prevent arthritis.

What it is: This is my preferred technique for most complete tears. It is an open procedure, meaning I make an incision on the back of the wrist to directly see and access the damaged ligament. I then repair the native ligament and augment it with an 'InternalBrace' - a super-strong suture tape held by bone anchors. This acts as an internal seatbelt, protecting the repair and stabilising the bones while they heal.

Benefits

Directly addresses the instability to restore normal wrist mechanics
Provides a strong, durable repair
Preserves natural wrist motion

Your Options: The decision to proceed with surgery is always yours. It's a balance between the risks of surgery and the benefits of a more stable, less painful wrist. We will discuss this in detail, but your options include:

No Treatment: You can choose to live with the injury. However, for a complete tear, this will likely lead to progressive arthritis and worsening symptoms over time.
Non-Surgical Management: We can continue with splinting, activity modification, and pain relief. This manages symptoms but does not correct the underlying instability.
Surgical Reconstruction: The aim is to restore stability, relieve pain, and prevent the onset of arthritis.

Risks & Complications of Surgery

All surgery carries risks. While the goal is to improve your function, it's important to understand the potential downsides:

Stiffness: This is the most common issue after this type of surgery. Your wrist will be very stiff afterwards, and it takes a long and dedicated course of hand therapy (often many months) to regain motion. Some permanent loss of movement is expected.
Persistent Pain: While the goal is pain relief, some level of discomfort can remain, particularly with heavy activities.
Infection: A small risk with any open surgery, usually treated with antibiotics.
Nerve Irritation: Small nerves in the skin can be bruised or cut, leading to numbness or sensitivity around the scar.
Repair Failure: Despite a strong repair, there is a risk the ligament may not heal or could re-tear in the future, which might require further surgery.

What they are: If arthritis has already developed (SLAC wrist), repairing the ligament is no longer an option. Instead, we perform 'salvage' procedures aimed at providing pain relief while maintaining as much function as possible. These include Proximal Row Carpectomy (removing the first row of wrist bones) or a limited wrist fusion. These are reliable operations for reducing pain.

Goal

To provide significant and lasting pain relief
To maintain a functional range of motion and grip strength

Frequently Asked Questions

The symptoms of a scapholunate ligament injury can be subtle at first and mimic a simple wrist sprain. Initial X-rays are often normal, which can be falsely reassuring. A high level of clinical suspicion and an MRI are needed for an accurate diagnosis.

An untreated complete tear leads to progressive wrist instability. Over time, this abnormal movement causes the cartilage in the wrist to wear out, resulting in a predictable pattern of arthritis known as SLAC wrist. This leads to chronic pain, stiffness, and loss of function.

Recovery is a significant commitment. It typically involves a period of immobilisation in a cast for several weeks, followed by a structured hand therapy program. It can take six months or more to regain good strength and function, and return to heavy activities or sports.

Yes. If a partially torn ligament is not protected and allowed to heal, repetitive stress or another minor injury can cause it to tear completely, leading to greater instability.

The goal of treatment is to restore stability to allow you to return to your desired activities. With successful surgery and dedicated rehabilitation, many people, including athletes, can return to a high level of function. I even reconstructed a CrossFit trainer who returned to powerlifting and handstands!

No, the InternalBrace is designed to stay in permanently. It consists of small bone anchors and a strong suture tape that integrates with your own tissue as it heals, providing long-term support to the ligament repair.

They are different structures in the wrist. The scapholunate ligament is in the center of the wrist, and injury causes pain on the top. The TFCC (Triangular Fibrocartilage Complex) is on the little finger side of the wrist, and injuries to it cause pain in that specific area.

For a minor, partial tear with no instability, it may be possible to manage symptoms with activity modification. However, for a complete tear, ignoring it will almost certainly lead to progressive arthritis (SLAC wrist) over time, which is a more difficult problem to treat.

Generally, the sooner the better. Ligament repairs and reconstructions have the best chance of success when performed before the ligament tissue retracts and significant scarring occurs. Early intervention is key to preventing the onset of arthritis.

SLAC stands for Scapholunate Advanced Collapse. It is the specific pattern of arthritis that develops as a direct result of an untreated, chronic scapholunate ligament tear. The instability causes the scaphoid bone to move abnormally, leading to wear and tear between it and the radius (forearm bone).

Scapholunate Ligament Injuries

That 'wrist sprain' that won't heal?