From the Guidelines
Hyperflexion of the wrist during a lacrosse game would most likely damage the scapholunate ligament on the radial side of the wrist. This ligament connects two important carpal bones—the scaphoid and lunate—and is particularly vulnerable during forceful wrist hyperflexion, which commonly occurs when a player falls onto an outstretched hand or experiences sudden resistance against the wrist during play. The scapholunate ligament is critical for maintaining proper alignment and stability between these carpal bones. When damaged, it can lead to scapholunate dissociation, causing pain, instability, and potentially long-term degenerative changes in the wrist if left untreated. According to a study published in the Journal of the American College of Radiology in 2018 1, conventional arthrography has limitations in predicting which fibers of the scapholunate ligament are torn and whether any repairable fibers remain, highlighting the importance of advanced imaging techniques like CT arthrography and MR arthrography for accurate diagnosis. Key points to consider in the diagnosis and management of scapholunate ligament injuries include:
- The mechanism of injury, with hyperflexion being a common cause of scapholunate ligament damage
- The importance of prompt medical evaluation for athletes experiencing wrist pain after hyperflexion injuries
- The use of advanced imaging techniques for accurate diagnosis and treatment planning
- The potential consequences of untreated scapholunate ligament injuries, including long-term degenerative changes in the wrist. Athletes experiencing wrist pain after hyperflexion injuries should seek prompt medical evaluation, as early diagnosis through physical examination and imaging studies allows for appropriate treatment, which may range from immobilization for minor sprains to surgical repair for complete tears.
From the Research
Wrist Ligament Damage Due to Hyperflexion
- The ligament on the radial side of the wrist most likely damaged due to hyperflexion during a lacrosse game is the scapholunate ligament 2, 3, 4, 5, 6.
- Hyperflexion can cause injury to the scapholunate ligament, leading to scapholunate instability and potentially resulting in chronic pain, stiffness, and degenerative arthritis if left untreated 2, 4.
- The scapholunate ligament is a key ligament in the stability of the carpus and is one of the most frequently injured ligaments in the wrist 2.
- Studies have shown that scapholunate ligament injuries can occur in conjunction with distal radius fractures, and that early diagnosis and treatment are crucial to preventing long-term complications such as scapholunate advanced collapse (SLAC) of the wrist 3, 6.
- Arthroscopic dorsal capsulo-ligamentous repair is a treatment option for chronic scapholunate ligament tears, and has been shown to provide reliable results and avoid postoperative stiffness 5.