Overview
what it is and why it mattersThe scapholunate ligament is a small but critical band of tissue inside your wrist that holds two of the eight wrist bones, the scaphoid and the lunate, in proper alignment. It is the single most important stabilizer in the wrist. When it tears (partly or all the way), those two bones drift apart and start moving in ways they should not. Left alone, that wear pattern leads to a specific kind of wrist arthritis called SLAC wrist (scapholunate advanced collapse), where the cartilage progressively wears out over years.
It almost always tears from a fall onto an outstretched hand. The classic symptoms are pain on the back of the wrist about an inch out from your forearm, a weaker grip, and pain when you push down through the wrist (like pushing yourself up out of a chair).
Symptoms
what you may notice- Pain on the back of the wrist, roughly an inch toward the thumb from center, especially with gripping or pushing
- Swelling on the back of the wrist after a fall onto an outstretched hand
- A weaker grip than you're used to, trouble opening jars or carrying heavy bags
- A clicking or clunking feeling inside the wrist with certain motions
- Pain when pushing down through the wrist, like doing a push-up or pushing yourself out of a chair
- Stiffness and loss of wrist range of motion, especially bending the wrist back (extension)
Diagnosis
exam first, imaging secondDiagnosis starts with a focused physical exam of the wrist. X-rays sometimes show a wider-than-normal gap between the scaphoid and lunate, or the scaphoid appearing tilted and shortened. An MRI with contrast injected into the joint (MRI arthrography) is the most reliable non-invasive test, but the gold standard is wrist arthroscopy, a small camera inserted into the joint, which has the bonus of letting us treat the tear in the same session.
How We Treat It
what we try first, in orderThe right treatment depends on how badly the ligament is torn and how early we catch it. A partial tear that hasn't let the bones drift can often be calmed down without surgery, while a complete tear that has thrown the bones out of alignment usually needs an operation. The non-operative options below are listed in the order we usually reach for them.
1
Cast Immobilization
If the tear is partial and caught early, the wrist goes into a cast for several weeks to let the ligament settle and heal.
2
Activity Splinting
For longstanding partial tears that aren't causing the bones to shift abnormally, a custom splint worn during high-load activities can keep symptoms manageable without surgery.
Surgical Options
if non-operative care isn't enoughComplete tears where the bones have started to drift out of alignment need surgical repair (stitching the original ligament back together) or reconstruction (rebuilding the ligament with a tendon graft from elsewhere). Time matters: the longer you wait after the injury, the harder it gets to repair the original ligament, and the more often we have to reconstruct from scratch.
Providers Who Treat Scapholunate Ligament Injury
sports-medicine team
Frequently Asked
questions we hear in clinicHow does a scapholunate ligament tear happen?
It almost always tears from a fall onto an outstretched hand. The scapholunate ligament is the small band that holds the scaphoid and lunate, two of the eight wrist bones, in proper alignment, and a hard landing through the wrist can stretch or rupture it.
Where will it hurt?
The classic spot is the back of the wrist, roughly an inch toward the thumb from center. The pain is usually worse with gripping or pushing down through the wrist, like doing a push-up or pushing yourself up out of a chair. Many people also notice a weaker grip and a clicking or clunking feeling inside the wrist with certain motions.
Will I need surgery?
Not always. A partial tear caught early can often heal in a cast, and a longstanding partial tear that isn't letting the bones shift can be managed with an activity splint. Complete tears where the bones have started to drift out of alignment do need surgical repair or reconstruction.
Why does it matter how soon I'm seen?
Time matters. The longer you wait after the injury, the harder it gets to repair the original ligament, and the more often the ligament has to be rebuilt with a tendon graft from elsewhere rather than stitched back together.
What happens if a tear is left untreated?
When the ligament tears, the scaphoid and lunate drift apart and start moving in ways they shouldn't. Left alone, that wear pattern leads to a specific kind of wrist arthritis called SLAC wrist (scapholunate advanced collapse), where the cartilage progressively wears out over years.
How is the tear diagnosed?
It starts with a focused physical exam of the wrist. X-rays sometimes show a wider-than-normal gap between the scaphoid and lunate or the scaphoid appearing tilted and shortened. An MRI with contrast injected into the joint (MRI arthrography) is the most reliable non-invasive test, and wrist arthroscopy, a small camera placed into the joint, is the gold standard, with the bonus of letting us treat the tear in the same session.
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: