⭐ What is Scapholunate Injury ?
Scapholunate injury (or scapholunate dissociation, SLD) is one of the most common and significant ligament injury of the wrist. (another common wrist ligament tear is TFCC injury)
It usually occurs when the wrist is twisted with loaded hyperextension and ulnar deviation (wrist moving towards little finger), such as falling onto an outstretched hand (so called FOOSH) in skiing or motorcycle accident.
⭐ Signs & Symptoms
* Swelling at dorsal wrist. Clicking or catching in the wrist.
* Dorsal and radial-sided (thumb side) wrist pain.
* Pain increased with loading across the wrist (e.g. push up position).
* In later stage, you may develop significant wrist instability (Scapholunate Advanced Collapse, SLAC) or general wrist arthritis.
⭐ Diagnosing Methods
* Watson’s Test (video credit: Physiotutors)
* X-Ray of the wrist will show a significant gap between scaphoid and lunate bone.
* MRI is usually utilized when all the conservative treatment failed, to examine the actual tear location and severity, and determine if surgery is necessary.
** Please always consult with your hand specialist to diagnose your wrist, all these examination should be done by medical professionals, I’m only sharing these common diagnosing methods so you know what to expect when seeing a doctor.
In this article, we will only introduce rehab principles for scapholunate injury with conservative treatment. NOT rehab protocol after the surgical repair (you should consult with your certified hand therapist for the protocol).
⭐ I. Wrist Immobilization
At first, it essential to immobilize your wrist 6 to 8 weeks when treating scapholunate injury. Because the ligament naturally have poor blood supply, which makes the healing a lot slower than other soft tissue.
Traditionally we cast the thumb and wrist for total immobilization. However, as casting is not removable and more cumbersome, people may not be willing to keep it on for weeks.
Therefore, I’d recommend two kinds of orthosis (custom-made by hand therapists) below:
* Long Thumb Spica
This orthosis helps to fully immobilize your thumb and wrist, providing a better protection to the ligament.
Please note, neoprene thumb spica brace is not recommended as it still allows too much wrist motion.
* Dart Throwing Motion Orthosis
In recent years, many researches believed dart throwing motion (wrist radial extension and ulnar flexion) is beneficial to promote the healing of S-L ligament.
The design of this device helps to restrict the wrist only in dart-throwing movement.
⭐ II. Kinesio Taping
Kinesio Tape is an elastic and adhesive tape, which helps facilitating muscle activation and providing extra support to an unstable joint.
For wrist with S-L ligament injury, taping is a great tool for people who already rested the joint for 6 to 8 weeks, in the process of weaning off the orthosis.
1. Anchor the tape (2″ wide) on the outside of your elbow (lateral epicondyle).
2. Stretching the tape towards your thumb with 35% tension, and place it along your forearm and wrist (for extensor carpi radialis longus/brevis facilitation).
3. Mark your S-L joint area, use 1″ wide tape to support the ligament with 100% tension.
4. Repeat step 3, put the second tape to reinforce the ligament support (cross taping).
Next, let’s see what are the recommended therapeutic exercises for scapholunate injury!