Scapholunate and Lunotriquetral Instability in the Athlete: Diagnosis and Management

Hand and wrist injuries are common and, if inadequately diagnosed or treated, significant morbidity can occur. Scapholunate ligament tears and lunotriquetral ligament tears are serious disruptions of the proximal carpal row and may lead to carpal instability, degenerative changes, and often pain. An accurate, timely diagnosis will minimize the loss of playing time for the athlete and result in better outcomes. Recognition of the physical findings and use of appropriate imaging examinations will minimize time away from play for the athlete. Advanced imaging studies are expensive, may be misleading, and may not change the initial treatment plan but often are ordered in high-level athletes. After diagnosis, the injury must be assessed regarding age, degree of dynamic or static radiographic instability, the presence of arthritis, and any associated injuries. These multiple variables can provide the rationale for effective treatment. Options include immobilization, arthroscopic debridement with or without intercarpal Kirschner wire pinning, thermal collagen shrinkage with electrothermal probes, ligament repair, ligament substitution or reconstruction, and limited intercarpal arthrodesis. Acute tears that are dynamic are often amenable to arthroscopic debridement with or without percutaneous stabilization, whereas chronic injuries with static diastasis may require extensive reconstruction to restore carpal stability and prevent or limit degenerative changes such as scapholunate advanced collapse syndrome. The rehabilitation time frame for major reconstruction is 4 to 6 months to allow for healing and sufficient tissue remodeling permitting unrestricted activity.