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Wrist Ligament Injury and Instability (Scapholunate)
Understanding injuries to the scapholunate ligament, a key stabiliser of the wrist, and why timely diagnosis matters.
What is Wrist Ligament Injury and Instability (Scapholunate)?
The scapholunate ligament connects two of the small carpal bones, the scaphoid and lunate, on the back of the wrist, and helps keep them moving together correctly. A tear of this ligament can allow the two bones to move abnormally relative to each other, known as instability.
Wrist Ligament Injury and Instability (Scapholunate) at a glance
What is it?
An injury to the scapholunate ligament, which connects two small bones on the back of the wrist
Common symptoms
Pain on the back of the wrist, worse with gripping, with clicking or a feeling of weakness
Who it affects
Can follow a fall onto an outstretched hand or a forceful wrist injury
Is it serious?
Untreated instability can lead to abnormal wear and wrist osteoarthritis over time
Treatment options
Splinting for milder injuries, or surgical repair or reconstruction for more significant tears
First step
A consultation and examination, often with x-rays and further imaging
Symptoms and how Wrist Ligament Injury and Instability (Scapholunate) presents
The main symptoms are pain on the back of the wrist, worse with gripping or pushing up from a chair, along with clicking or clunking with wrist movement, swelling, and a feeling of weakness or that the wrist is giving way. Individuals who have hypermobility can have wrist instability (‘weak wrists”) without a traumatic injury.
Causes and risk factors for Wrist Ligament Injury and Instability (Scapholunate)
- A fall onto an outstretched hand
- A forceful or twisting wrist injury
- Sporting injuries
- Hypermobility
How is Wrist Ligament Injury and Instability (Scapholunate) diagnosed?
Diagnosis is based on examination, including specific stress tests, and x-rays, which may show a widened gap between the scaphoid and lunate bones if there is a substantial scapholunate ligament injury. An MRI or wrist arthroscopy (a keyhole examination of the joint) is sometimes used to fully assess the ligament.
Treatment options for Wrist Ligament Injury and Instability (Scapholunate)
Milder or partial injuries without significant instability are often treated with splinting and activity modification under the guidance of a hand therapist.
More significant tears with instability may benefit from surgery to repair or reconstruct the ligament, which helps prevent the bones moving abnormally and reduces the long-term risk of arthritis.
When to see a hand surgeon about Wrist Ligament Injury and Instability (Scapholunate)
Persistent wrist pain after a fall or wrist injury, especially with clicking, clunking or a feeling of weakness, is worth assessing. If you have wrist instability or weak wrists without a prior injury you may benefit from seeing a hand therapist for a specialised wrist strengthening program including isometric exercises.
What to expect at your Wrist Ligament Injury and Instability (Scapholunate) appointment
At your appointment, Dr Tomlinson will examine your wrist and arrange x-rays, with further imaging if needed. Together you will discuss splinting versus surgical repair or reconstruction.
Frequently Asked Questions
What is it?
The scapholunate ligament connects two of the small carpal bones, the scaphoid and lunate, on the back of the wrist, and helps keep them moving together correctly. A tear of this ligament can allow the two bones to move abnormally relative to each other, known as instability.
What causes it?
Causes include a fall onto an outstretched hand, a forceful or twisting wrist injury, and sporting injuries.
What can I do myself?
Persistent wrist pain after a fall or wrist injury, especially with clicking, clunking or a feeling of weakness, is worth assessing.
What can a hand therapist do?
For milder or partial injuries without significant instability, a hand therapist can help with splinting and guidance on activity modification. After surgery, a hand therapist supports rehabilitation of wrist movement and strength. Wrist instability due to hypermobility is treated with hand therapy guided strengthening of the forearm muscles and wrist.
What can a hand surgeon do?
Dr Tomlinson will examine your wrist and arrange relevant tests and investigations. Milder or partial injuries without significant instability are often treated with splinting and activity modification. More significant tears with instability generally need surgery to repair or reconstruct the ligament, which helps prevent the bones moving abnormally and aims to reduce the long-term risk of arthritis.
What can I expect from treatment?
At your appointment, Dr Tomlinson will examine your wrist and imaging, and arrange further imaging if needed. Together you will discuss splinting and hand therapy management versus surgical repair or reconstruction.
What happens if it's left untreated?
Untreated severe instability can lead to abnormal wear and wrist osteoarthritis over time. Persistent wrist pain after a fall or wrist injury, especially with clicking, clunking or a feeling of weakness, is worth assessing promptly.
Related conditions and treatments
Left untreated, this injury is a recognised cause of wrist osteoarthritis. Pain on the other side of the wrist may instead be related to a TFCC injury.