What is the treatment for a partial scapholunate ligament tear or sprain?

Treatment for Partial Scapholunate Ligament Tear or Sprain

Conservative treatment is the recommended initial approach for partial scapholunate ligament tears or sprains, especially in acute cases with intact secondary stabilizers, as it can provide pain reduction and functional recovery without surgery. 1

Diagnostic Evaluation

Before determining treatment, proper diagnosis is essential:

• Initial evaluation should include conventional radiographs with careful attention to positioning to assess for carpal malalignment 2
• When radiographs don't show carpal malalignment, advanced imaging is recommended:
  • CT arthrography has the highest sensitivity (nearly 100%), specificity, and accuracy for detecting scapholunate ligament tears 2
  • CT arthrography detects partial ligament tears more accurately than MR arthrography and has greater interobserver agreement 2
  • MRI (especially 3T) is commonly used with reported sensitivities of 65-89% for scapholunate ligament tears 2
  • High-frequency ultrasound with dynamic "clenched fist" maneuvers can be useful with sensitivity of 46-100% and specificity of 92-100% for tears of the dorsal band 2

Treatment Algorithm

Conservative Management (First-Line)

• Immobilization with wrist splinting or casting for 4-6 weeks 1
• Pain management with NSAIDs and activity modification 1
• Gradual rehabilitation and physical therapy focusing on:
  • Range of motion exercises
  • Progressive strengthening
  • Proprioceptive training 1

Conservative treatment is particularly effective for:

• Acute partial tears (better outcomes than chronic tears) 1
• Cases without significant carpal instability 1
• Patients with intact secondary stabilizers (extrinsic ligaments) 1

Surgical Management (When Conservative Treatment Fails)

For partial tears that fail conservative management after 3-6 months:

• Arthroscopic debridement is the preferred surgical approach for partial tears 3, 4
  • Provides excellent relief of painful symptoms
  • Allows early return of wrist function
  • Results in high patient satisfaction (13 of 14 patients highly satisfied in one study) 3

Advanced techniques include:

• Arthroscopic debridement combined with thermal shrinkage using radiofrequency probes 4
  • Effectively provides pain relief (14 of 16 patients experienced substantial pain relief)
  • Maintains stability radiographically
  • Results in good to excellent outcomes in most patients 4

For more severe or chronic cases with instability:

• Arthroscopic reduction and association of the scapholunate joint (ARASL) may be considered 5
• Open repair with capsulodesis is preferred by many surgeons for chronic cases 6

Important Considerations

• Tear location matters: volar SLIOL is the most commonly damaged portion (45%) 1
• Extrinsic ligament injury accompaniment is associated with higher pre-treatment pain scores 1
• The presence of intact secondary stabilizers is crucial for successful conservative treatment 1
• Early intervention (within 6 weeks of injury) is favored by most hand surgeons for both acute and chronic cases 6
• Partial tears can be a significant source of radial-sided wrist pain even without radiographic signs of instability 4

Treatment Outcomes

• Conservative treatment can achieve significant pain reduction and functional recovery in partial tears, especially in acute cases 1
• Arthroscopic debridement provides excellent relief of painful symptoms in 13 of 14 cases in one study 3
• Thermal shrinkage with radiofrequency probes showed 8 excellent, 6 good, 1 fair, and 1 poor result based on modified Mayo wrist scores 4
• No significant loss of grip or pinch strength was observed after arthroscopic treatment 3