What is the treatment for a chronic partial mild scapholunate (wrist) ligament tear?

Treatment of Chronic Partial Mild Scapholunate Ligament Tear

Conservative management with structured rehabilitation should be the initial treatment for chronic partial mild scapholunate ligament tears, as this approach achieves significant pain reduction and functional recovery in the majority of patients, particularly when secondary stabilizers remain intact. 1, 2, 3

Initial Conservative Management Protocol

Immobilization Phase (First 3-6 Weeks)

• Immobilize the wrist initially but avoid complete immobilization beyond 6 weeks to prevent muscular atrophy and joint stiffness 1
• Apply cryotherapy through a wet towel for 10-minute periods during the acute phase for short-term pain relief 1
• Modify activities to reduce movements that provoke pain while maintaining some wrist motion 1

Progressive Rehabilitation Phase (Weeks 3-16)

• Begin gentle range of motion exercises once acute pain subsides, typically after 3-6 weeks 1
• Progress from isometric exercises to eccentric strengthening 1
• Incorporate tensile loading exercises to stimulate collagen production and guide normal alignment of newly formed collagen fibers 1
• A structured 16-week home-based program including scapholunate-stabilizing muscle strengthening and proprioception training can reduce pain by an average of 5.1 cm on VAS and restore near-normal wrist function 3

Diagnostic Imaging Considerations

CT arthrography is the gold standard imaging modality, achieving nearly 100% sensitivity and specificity for detecting partial scapholunate ligament tears, superior to all other modalities. 4, 5

• MR arthrography serves as an alternative with sensitivity of 63-100% and provides critical information about which specific segments of the ligament are torn, important for surgical planning 6, 4
• Standard MRI at 3.0T has only moderate sensitivity (65-89%) and may miss the full extent of injury 4, 5
• Pay particular attention to extrinsic ligament integrity (especially dorsal intercarpal ligament and radiolunotriquetral ligament), as 44% of scapholunate tears have accompanying extrinsic ligament injury 2

Expected Outcomes with Conservative Treatment

• Partial scapholunate ligament tears without secondary stabilizer injury respond well to conservative management regardless of tear location or grade 2
• Pain reduction and functional recovery can be achieved in the majority of patients with conservative treatment 2, 3
• Acute injuries show better treatment response than chronic injuries 2
• Patients with isolated scapholunate tears (without extrinsic ligament injury) have lower baseline pain scores and better outcomes 2

When to Consider Surgical Intervention

Surgical treatment should be considered only after 3-6 months of appropriate conservative management has failed to achieve adequate pain relief and functional recovery. 1, 5

• Arthroscopic debridement of partial intrinsic ligament injuries provides excellent relief of painful crepitant symptoms in 93% of cases (13 of 14 patients), with return to work within 7 weeks 7
• For irreparable tears with persistent instability despite conservative treatment, arthroscopic reduction association of the scapholunate joint (ARASL) can reduce pain from 5.4 to 1.5 on VAS and restore 78% grip strength 8

Critical Pitfalls to Avoid

• Never inject corticosteroids directly into the ligament substance, as this inhibits healing, reduces tensile strength, and may predispose to spontaneous rupture 1
• Avoid prolonged complete immobilization beyond 6 weeks, which leads to muscular atrophy and joint stiffness 1
• Do not rely on standard MRI alone for surgical planning, as it has insufficient sensitivity and may miss critical details about tear location and secondary stabilizer integrity 4

Follow-Up Protocol

• Assess pain levels, range of motion, and functional improvement regularly to guide treatment progression 1
• Re-evaluate at 3-6 months: if symptoms persist despite appropriate conservative management, obtain CT arthrography to evaluate for progression or associated injuries 1
• Consider surgical consultation if conservative measures fail to achieve adequate outcomes by 6 months 1