From the Guidelines
Treatment for a scapholunate ligament sprain should begin with conservative management, including immobilization and physical therapy, to minimize the risk of chronic wrist pain and degenerative arthritis. The most recent and highest quality study on acute hand and wrist trauma, 1, suggests that MRI without IV contrast can detect fractures and ligament injuries, including tears of the scapholunate ligament, which may affect surgical treatment. However, this study also notes that MRI performed immediately at the time of injury has little added value for determining which patients go on to surgery.
Key considerations in the treatment of scapholunate ligament sprains include:
- Immobilization with a thumb spica cast or wrist splint for 4-6 weeks, followed by a removable wrist splint for an additional 2-4 weeks
- Pain control with NSAIDs, such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks
- Physical therapy to restore range of motion and strength, focusing on wrist proprioception and stabilization exercises
- Regular follow-up with hand imaging (X-rays or MRI) to monitor healing and ensure proper alignment of the scaphoid and lunate bones
It is essential to note that severe sprains with complete tears or those that fail conservative treatment may require surgical intervention, including direct ligament repair, ligament reconstruction, or arthroscopic debridement. Early diagnosis and treatment are crucial to prevent long-term complications, such as scapholunate advanced collapse (SLAC), which can result in chronic wrist pain and degenerative arthritis. The study on ankle sprains, 1, although not directly related to scapholunate ligament sprains, highlights the importance of functional treatment and exercise therapy in the management of ligament injuries.
In contrast, the study on hand osteoarthritis, 1, provides guidance on the management of thumb base OA, but its relevance to scapholunate ligament sprains is limited. Therefore, the treatment approach should be based on the most recent and highest quality evidence available, prioritizing conservative management and physical therapy to minimize the risk of chronic complications.
From the Research
Treatment Options for Scapholunate Ligament Sprain
- Non-operative procedures: Early wrist immobilization, soft tissue manual therapy, low-level laser therapy, proprioceptive and strengthening exercises, and early orthopedic referral are considered for conservative management 2.
- Operative procedures: Acute repair of dynamic scapholunate ligament injuries is the gold standard, while reconstructive surgical procedures are used to manage chronic scapholunate injury 3.
- Arthroscopic treatment: Partial injuries may be treated with arthroscopic methods, which have shown satisfactory results in small studies 4.
- Salvage procedures: Once cartilage loss occurs, salvage procedures are considered, tailored to the degree of arthritis 4.
Management Strategies
- The treatment of scapholunate ligament injuries depends on factors such as injury acuity, presence and reducibility of scapholunate malalignment, and cartilage status 4.
- Classification systems are used to guide treatment options, including nonsurgical, arthroscopic, repair, reconstruction, pain relieving measures, and salvage procedures 5.
- Anatomic repair is usually performed for acute injuries, often augmented with a capsulodesis technique, while chronic injuries may require reconstructive techniques to restore scapholunate function without compromising wrist mobility 3, 4.
Outcomes and Prognosis
- Acute repair of scapholunate ligament injuries can lead to satisfactory results, with motion and grip strength averaging 60-80% and 65-90% of the contralateral side, respectively 4.
- Chronic scapholunate ligament injuries can lead to inferior outcomes, with a higher risk of developing wrist arthritis (SLAC wrist) if left untreated or poorly managed 6, 3.