The scapholunate ligament (SLL) is found in the wrist and, as its name suggests, is located between the scaphoid bone and the lunate bone. Its role is very important in the proper functioning of the wrist as this ligament coordinates the movements between the carpal bones. Its injury affects everyday gestures such as tightly clenching the fist or turning of the forearm while simultaneously supporting a weight with the hand.
DESCRIPTION AND SYMPTOMS
WHAT IS THE SCAPHOLUNATE LIGAMENT AND HOW DOES IT GET INJURED?
The scapholunate ligament is one of the intrinsic carpal ligaments. It is made up of three parts: volar, membranous, and dorsal. This ligament has important functions both in movement and at rest. In the movement of ulnar deviation (dart throwing movement), it is responsible for extending the scaphoid. However, when we carry out a load with the wrist (for example, grasping a hard object) it also acts on the scaphoid (moving it up and down and side to side) and on the rest of the carpal bones (as an intracarpal pronator).
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What is a scapholunate ligament (SLL) injury?
An SLL injury is the injury that normally occurs after suffering falls when the palm of the hand is either forced back or twisted sharply.
There are different degrees of ligament injury, from partial injuries to complete injuries. Complete injuries can be further classified as stable or non-stable. The larger the ligamentous surface that is damaged, the greater the pain and the loss of function.
Understanding the timeline of the injury is very important as patients with long-term injuries may present early osteoarthritis of the wrist.
An injury to the scapholunate ligament causes inflammation and pain especially in certain movements. It is also accompanied by:
Pain in the center of the wrist when extending it, for example when doing push-ups or when supporting the hands to get up..
Stiffness and swelling
Popping sounds or sensations when performing movements requiring exertion, such as twisting the wrist.
Loss of strength.
IF THE INJURY IS NOT TREATED IN TIME
Work
Limitation of movement and the inability to pick up loads forces many people to change jobs.
Sport
Racquet sports, which involve grip strength, can be painful. This injury also affects strength training since exercises as simple as doing a push-up on the floor are usually very limited.
Stiffness and Pain
Actions such as supporting the hand or squeezing it causes pain that prevents a natural movement of the wrist.
TREATMENT
WHAT IS THE TREATMENT FOR AN SLL INJURY?
Treatment varies depending on the degree of injury.
In partial ligament injuries, management is conservative, that is, with rehabilitative treatment that focuses on anti-inflammatory therapy and strengthening the wrist muscles. Its objective is to control and stabilize the wrist based on a series of exercises that strengthen the abductor pollicis longus and extensor carpi radialis longus muscles. By making this system work well, the patient can avoid surgery
HOW IS AETHROSCOPIC WRIST SURGERY FOR SLL INJURIES PERFORMED?
In complete ligament injuries it is very important to study several aspects: the ability to repair the injury and the existence of associated cartilage injuries.
Repairable injuries: A ligament repair is performed, that is, it is “sewn” and a capsulodesis (a kind of reconstruction) is performed.
Non-repairable injuries without cartilage damage: A plasty is performed. That is, we take a tendon from the wrist and place it between the scaphoid and the lunate.
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.Non-repairable injuries with cartilage damage: in these injuries, we are too late to reconstruct the ligament so other techniques such as carpectomy (removal of several carpal bones), partial arthrodesis (fusing of the carpal bones), or denervation (removing nerve supply) are performed instead as secondary treatment options.
An arthroscopic surgery procedure for a scapholunate ligament injury can take place in repairable injuries and in non-repairable injuries without cartilage damage. For the other injury types, open surgery is performed instead. The intervention consists of a minimally-invasive technique in which the large incisions that are made in traditional (open) surgery are replaced by much smaller incisions.
One of the main advantages of the arthroscopic procedure for an SLL injury lies in obtaining better mobility of the wrist compared to wrists operated on by open surgery. This is due to the fact that with arthroscopic surgery, there is less scarring of the joint. Arthroscopic intervention also entails less damage to the skin, tendons and ligaments, which provides distinct advantages for the patient in terms of potential postoperative pain.
FREQUENTLY ASKED QUESTIONS
How long does an arthroscopic surgery for an SLL injury take?
Duration time varies depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient, but, in general, a suturing (sewing) procedure usually takes 45 to 60 minutes while a plasty procedure typically lasts 90 to 120 minutes.
What is recovery like after arthroscopic wrist surgery?
Although the total recovery time depends on the type of injury suffered, arthroscopy generally has significantly shortened recovery times due to the less aggressive techniques it uses on soft tissues caused by making ever-smaller incisions. This achieves a shorter postoperative period in which the patient will begin to move the wrist earlier and perform the rehabilitation exercises. However, regardless of the surgical technique used for your scapholunate ligament injury, yous should know that you will not regain mobility and strength until 3 months after surgery and you will not be allowed to play contact sports until 6 months after surgery.
What are possible complications after arthroscopic surgery for SLL injuries?
Infection
Plasty (graph) failure
Osteoarthritis in the wrist
If you want to learn more about treating scapholunate ligament injuries using arthroscopic surgery or would like to speak with Dr. Villanova directly with other questions you may have, click here:
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