Wrist (scapholunate) instability
What is Wrist (scapholunate) instability?
Scapholunate instability occurs when the ligament between the scaphoid and lunate bones is injured. This ligament is central to coordinated wrist movement. Untreated significant instability can lead to progressive arthritis over time.
Common symptoms
Symptoms include dorsal wrist pain, swelling, clicking, clunking, weakness with grip, pain during push-ups and reduced confidence loading the wrist. Some injuries are obvious after a fall, while others present more subtly.
Diagnosis and imaging
Assessment includes examination for scapholunate tenderness and instability tests. X-rays, clenched-fist views, MRI, CT and wrist arthroscopy may be used depending on chronicity and severity. Arthroscopy remains the most direct way to grade some injuries.
Non-surgical treatment
Partial or stable injuries may be treated with immobilisation, hand therapy and load modification. Rehabilitation focuses on proprioception, strength and avoiding provocative weight-bearing until symptoms settle.
Surgical treatment
Surgery is considered for complete, unstable or persistent injuries. Options include ligament repair, pinning, capsulodesis, reconstruction or salvage procedures if chronic instability has already caused arthritis.
Recovery and follow-up
After repair or reconstruction, the wrist is protected while the ligament heals, followed by hand therapy to restore motion and strength. Return to heavy loading is gradual and depends on healing and stability.
Wrist (scapholunate) instability FAQs
Why is scapholunate injury important?
The scapholunate ligament coordinates wrist mechanics. Significant instability can alter joint loading and lead to a predictable arthritis pattern if untreated.
How is wrist scapholunate instability diagnosed?
Diagnosis starts with a focused history and examination, then uses imaging selectively to confirm the pattern of injury, exclude related problems and plan treatment accurately.
Can an old scapholunate injury still be treated?
Yes, but chronic injuries may require reconstruction rather than direct repair. If arthritis has developed, the treatment options change.
Will I need surgery for wrist scapholunate instability?
Many patients improve without surgery. Surgery is considered when symptoms remain limiting despite appropriate non-surgical care, when there is significant structural damage, or when delay may compromise function.
When can I return to push-ups, gym work or manual tasks?
Return depends on the diagnosis, treatment type, tissue healing and the physical demands of the activity. The plan is usually staged, with strength, range of motion and confidence rebuilt before unrestricted loading.
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