Pushups and Scapholunate Ligament Tears
Pushups are highly unlikely to cause a full tear of the scapholunate ligament in healthy individuals, as these injuries typically result from acute traumatic impact or high-energy wrist trauma rather than repetitive loading exercises.
Mechanism of Injury
Scapholunate ligament injuries occur through specific mechanisms that differ substantially from pushup biomechanics:
- Acute traumatic impact is the primary mechanism for complete scapholunate ligament tears, typically involving high-energy wrist trauma 1, 2
- Repetitive motion can render the scapholunate interosseous ligament insufficient, but this typically refers to occupational or sports-specific repetitive trauma rather than controlled exercise 2
- The dorsal portion of the scapholunate ligament is the most important for stability, and tears of this portion combined with secondary capsular attachment injuries cause scapholunate dissociation 3
Clinical Context
The epidemiology and natural history of these injuries provide important perspective:
- Scapholunate ligament injuries are most common among young active individuals experiencing acute trauma 1
- Even in the context of displaced distal radius fractures (high-energy trauma), complete scapholunate tears occurred in only 10 of 51 patients, with 22 having partial tears 4
- The natural history is poorly understood, and it remains unknown which scapholunate injuries progress to wrist arthritis 1
Risk Assessment for Pushups
Standard pushups involve controlled, relatively low-force wrist loading that does not replicate the acute traumatic mechanisms associated with complete ligament tears:
- Pushups create axial loading through the wrist in extension, but lack the sudden impact, hyperextension, or rotational forces that typically cause complete tears
- Partial tears are rare overall, and in small studies responded well to conservative treatment including arthroscopic management 1
- In a 13-15 year follow-up of untreated scapholunate tears (both complete and partial), none of the patients developed static scapholunate dissociation or scapholunate advanced collapse wrist 4
Important Caveats
If wrist pain develops during pushups, this warrants evaluation:
- Initial assessment should include conventional radiographs with attention to carpal malalignment, looking for scapholunate diastasis >4 mm or dorsal lunate tilt >10° 5
- If radiographs are normal but symptoms persist, advanced imaging with CT arthrography (nearly 100% sensitivity) or 3T MRI (65-89% sensitivity) can detect ligament pathology 6, 5
- High-frequency ultrasound with dynamic "clenched fist" maneuvers offers 46-100% sensitivity and 92-100% specificity for dorsal band tears 6, 7
Pre-existing ligament laxity or previous wrist injury changes the risk profile, as secondary stabilizers may already be compromised 8.