Carpal Instability-Wrist Essentials: The Diagnosis and Management of Scapholunate Ligament Injuries

Wrist Essentials: The Diagnosis and Management of Scapholunate Ligament Injuries

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Scapholunate ligament instability is a common form of carpal instability that can lead to wrist arthritis. This article provides an overview of the anatomy and biomechanics of the wrist, as well as the diagnosis and management of scapholunate ligament injuries. The wrist joint consists of four major joints: the radiocarpal, midcarpal, carpometacarpal, and distal radioulnar joints. The ligaments that stabilize the wrist can be divided into two categories: interosseous ligaments, which run between the bones, and extrinsic wrist ligaments, which make up the wrist capsule. Scapholunate ligament injuries typically result from a fall onto an extended wrist and can present as an isolated injury or in association with other fractures or dislocations. The severity of the injury can vary and is usually classified into four categories: predynamic instability, dynamic instability, static scapholunate dissociation, and scapholunate advanced collapse arthritis. Treatment options depend on the severity of the instability and the presence of arthritis. Mildly symptomatic patients can be treated conservatively with splinting and activity modification. Surgical options include ligament repair, capsulodesis, tenodesis, limited intercarpal fusion, proximal row carpectomy, four-corner fusion, or total wrist arthrodesis. The choice of treatment depends on the individual patient's condition and desired outcomes.

Keywords

Scapholunate ligament instability

Carpal instability

Wrist arthritis

Anatomy of the wrist

Diagnosis of scapholunate ligament injuries

Management of scapholunate ligament injuries

Treatment options

Conservative treatment

Surgical options

Ligament repair