From the Guidelines
The initial treatment for scapholunate dissociation or ligamentous injury typically involves immobilization with a short arm thumb spica cast or a removable wrist splint for 4-6 weeks. This approach is based on the principle of stabilizing the wrist to allow the ligament to heal in proper alignment, as the scapholunate ligament has a poor healing capacity due to its limited blood supply 1.
Key Considerations for Initial Treatment
- Immobilization is crucial in the acute phase to prevent further injury and allow healing.
- Pain management is essential and can include NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for inflammation and discomfort.
- Additional measures to reduce swelling and pain include ice application for 15-20 minutes several times daily during the first 48-72 hours and elevation of the wrist above heart level when possible.
- For more severe pain, acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) can be added to the treatment regimen.
Diagnostic Imaging
The use of MRI without IV contrast is beneficial for detecting fractures of the distal radius and carpal bones, as well as concomitant ligament injuries, including tears of the scapholunate ligament 1. However, the immediate use of MRI at the time of injury has little added value for determining which patients will require surgery.
Rehabilitation
After the immobilization period, gradual rehabilitation with physical therapy focusing on wrist strengthening and range of motion exercises should be initiated to restore function while protecting the healing ligament. Early diagnosis and treatment are essential, as chronic injuries often require surgical intervention 1.
Additional Diagnostic Tools
High-frequency US can be useful for visualizing wrist tendons and intrinsic and extrinsic carpal ligaments, with dynamic maneuvers potentially improving the detection of low-grade injuries 1. However, the sensitivity and specificity of US for detecting specific ligament tears can vary, highlighting the importance of a comprehensive diagnostic approach.
From the Research
Initial Treatment for Scapholunate Dissociation or Ligamentous Injury
The initial treatment for scapholunate dissociation or ligamentous injury can vary depending on the severity and acuity of the injury.
- For acute injuries, anatomic repair usually leads to satisfactory results, and many authors augment the repair with a capsulodesis technique 2.
- In cases of dynamic scapholunate instability dissociation, arthroscopy has been found to be a useful tool in treating these injuries, allowing for a less invasive approach and potentially better outcomes 3.
- The use of mini-invasive arthroscopic dorsal repair of the scapholunate complex has also been proposed as an efficient technique for achieving long-term stability 4.
- In chronic injuries, the presence of static malalignment usually leads to inferior outcomes, and various techniques have been devised to provide a more anatomic reconstruction with less loss of motion 2.
Treatment Options
Treatment options for scapholunate dissociation or ligamentous injury include:
- Open procedures, such as reconstruction using tendinous augmentation of the ligamentous structures 5
- Arthroscopic techniques, such as mini-invasive arthroscopic dorsal repair of the scapholunate complex 4
- Non-operative procedures, such as immobilization and physical therapy, although the effectiveness of these methods is not well established in the provided studies.
Challenges in Treatment
The treatment of scapholunate dissociation or ligamentous injury can be challenging due to the complexity of the injury and the limited understanding of the natural history of the condition 6, 2.