Arch Hand Microsurg.  2018 Sep;23(3):139-149. 10.12790/ahm.2018.23.3.139.

Surgical Treatment of Scapholunate Instability

• Lee YK
• Kang HV
• Jung YR
• Lee JY

• KMID: 2419448
• DOI: http://doi.org/10.12790/ahm.2018.23.3.139

Abstract

The incidence of ligament injuries of the wrist has increased due to sports activities. However, diagnosis and management of these injuries are sometimes difficult because of the anatomic complexity and variable injury patterns. The scapholunate ligament is both a key ligament in the stability of the carpus and one of the most frequently injured. The presentation of scapholunate instability often includes a vague injury history and pain with grip, wrist extension, and sport or labor. To properly diagnose and manage these conditions, thorough understanding of the wrist anatomy and physical and radiologic examination is mandatory. This article will briefly discuss the wrist joint anatomy and biomechanics, and review the diagnosis and surgical management of the scapholunate ligament injury.

Keyword

Wrist injuries; Ligaments; Carpal instability; Scapholunate

MeSH Terms

Diagnosis
Hand Strength
Incidence
Ligaments
Sports
Wrist
Wrist Injuries
Wrist Joint

Figure

• 

  Fig.1. Radiologic findings of the scapholunate dissociation. Wide scapholunate gap, cortical ring sign in the posteroante-rior view and dorsal intercalated segmental instability pattern in the lateral view can be seen.

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  Fig.2. Arthroscopic thermal shrinkage. (A) 42-year-old female patient's left wrist radiocarpal arthroscopy image shows focal dorsal synovitis. (B) Same patient's midcarpal arthroscopy image shows Geissler grade II scapholunate instability (Sca: scaphoid, Lu: lunate). (C) Same patient's midcarpal arthroscopy image shows thermal shrinkage on the volar scaphoilunate interosseous ligament and volar carpal ligament.

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  Fig.3. Modified three-ligament tenodesis using flexor carpi radialis (FCR) tendon. (A) Visible gap between scaphoid and lunate, (B) harvesting the half-slip of FCR tendon, (C) tendon passed through scaphoid bone tunnel, (D) tendon sutured to the lunate and dorsal intercarpal ligament.

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  Fig.4. Antipronation spiral tenodesis using Palmaris longus free tendon graft. (A) Pre-operative X-ray shows static scapholunate dissociation and dorsal intercalated segmental instability defor-mity. (B) The dorsal ligamentous linkage between scaphoid and triquetrum is reestablished by pal-maris longus (PL) graft. (C) Distal stump of PL graft is fixing at scaphoid bone tunnel with bio-composite interference screw. (D) Postoperative X-ray shows reduction of scapholunate dissociation.

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