From the Research
The most common tendon tear in a fall on an outstretched wrist is the scapholunate ligament tear. This injury typically occurs when a person falls and lands on their outstretched hand, causing the wrist to hyperextend. The scapholunate ligament connects two important carpal bones (the scaphoid and lunate) and when torn, can lead to instability in the wrist. Symptoms include pain on the thumb side of the wrist, swelling, decreased grip strength, and a clicking sensation with movement.
Diagnosis and Treatment
Treatment depends on severity but often includes immobilization with a splint or cast for 4-6 weeks for partial tears. Complete tears may require surgical repair, especially in younger, active patients. Physical therapy is typically recommended after immobilization to restore strength and range of motion. This injury is important to diagnose early as untreated scapholunate tears can lead to chronic wrist instability and eventual arthritis (known as SLAC wrist - Scapholunate Advanced Collapse). X-rays are the initial imaging test, but MRI or arthroscopy may be needed for definitive diagnosis, as noted in studies such as 1.
Importance of Early Diagnosis
Early recognition and treatment of these injuries can delay or prevent the onset of arthritis, as highlighted in 2. A study found that 35% of cadaveric wrists had some degree of scapholunate tear, and of those wrists with SLIL injury, 29% had evidence of arthrosis 2.
Recent Studies
Recent studies, such as 1, have shown that combined repair of scapholunate ligament and triangular fibrocartilage complex lesions in chronic trauma of the wrist can lead to significant improvement in pain and function. However, the choice of procedure depends on the extent of the tear, quality of the ligament remnants, and reducibility of the joint, as discussed in 3.
Key Points
- The scapholunate ligament is the most commonly injured ligament in the wrist, as noted in 4.
- Early diagnosis and treatment are crucial to prevent chronic wrist instability and arthritis.
- Treatment options include immobilization, surgical repair, and physical therapy.
- Combined repair of scapholunate ligament and triangular fibrocartilage complex lesions can be effective in improving pain and function, as shown in 1.