Our Summary

This research paper is about a common type of wrist injury called a scapholunate ligament tear. This can happen after a trauma to the wrist, such as a fall, and can lead to long-term problems like instability and arthritis. It can also be linked to fractures of certain bones in the wrist. These injuries can be hard to identify, especially in the early stages.

Treating these injuries before they lead to arthritis is challenging for doctors. Traditional treatment generally involves open surgery to reconstruct or repair the ligament. This can help with pain and improve the strength of the person’s grip, but often results in a stiff wrist.

However, the use of arthroscopy (a procedure that uses a tiny camera to look inside a joint) has greatly improved our understanding and treatment of these injuries.

The paper reviews recent research on the anatomy of the wrist and the pathology of these injuries, as well as traditional treatments and the emerging role of arthroscopy. The authors aim to answer five key questions about this topic:

  1. What is the anatomical structure of the scapholunate complex (the group of structures in the wrist that includes the scapholunate ligament)?
  2. How are scapholunate injuries initially diagnosed and classified?
  3. What are the traditional treatments for these injuries?
  4. What principles guide the arthroscopic treatment of these injuries and how effective is it?
  5. What are the limitations and future prospects of arthroscopic treatment?

FAQs

  1. What is the scapholunate ligament and how does a tear in it affect the wrist?
  2. What are the conventional treatments for scapholunate dissociation and how effective are they?
  3. How has the advent of arthroscopy changed the treatment of scapholunate ligament lesions?

Doctor’s Tip

A helpful tip a doctor might tell a patient about wrist arthroscopy is to follow post-operative instructions carefully, including keeping the wrist elevated and avoiding putting weight on it for the recommended period of time. This will help promote proper healing and reduce the risk of complications. Additionally, attending physical therapy sessions as recommended by the doctor can help improve range of motion and strength in the wrist following surgery.

Suitable For

Patients who are typically recommended for wrist arthroscopy are those with chronic scapholunate ligament tears, especially in the aftermath of trauma. These patients may experience chronic wrist instability and may be at risk for developing osteoarthritis. Wrist arthroscopy can help diagnose and treat these conditions, offering a less invasive option compared to open reconstruction or repair. Additionally, patients with associated fractures of the distal epiphysis of the radius or scaphoid may also benefit from wrist arthroscopy as part of their treatment plan.

Timeline

Before wrist arthroscopy:

  • Patient experiences trauma in supination and extension of the wrist
  • Chronic instability leading to osteoarthritis
  • Difficulty in diagnosing the condition in early stages
  • Recommendations for open reconstruction or repair

After wrist arthroscopy:

  • Improved pain and grip strength
  • Potential for wrist stiffness
  • Recent contributions to anatomy of scapholunate complex
  • Classification of scapholunate dissociations
  • Technical principles and results of arthroscopic treatment
  • Limits and perspectives of arthroscopic treatment

What to Ask Your Doctor

  1. What are the potential risks and complications associated with wrist arthroscopy for a scapholunate ligament tear?
  2. How long is the recovery time after wrist arthroscopy for a scapholunate ligament tear?
  3. What are the success rates of wrist arthroscopy compared to open reconstruction or repair for scapholunate ligament tears?
  4. How many wrist arthroscopy procedures have you performed for scapholunate ligament tears, and what is your success rate?
  5. Are there any alternative treatment options to consider for a scapholunate ligament tear, and how do they compare to wrist arthroscopy in terms of outcomes and recovery time?

Reference

Authors: Mathoulin C, Gras M. Journal: Orthop Traumatol Surg Res. 2020 Feb;106(1S):S89-S99. doi: 10.1016/j.otsr.2019.07.008. Epub 2019 Nov 16. PMID: 31740161