Scapholunate and perilunate injuries in the athlete

Abstract

Purpose of the review Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. Recent findings Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Summary Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.

Management of injuries in snowboarders: rehabilitation and return to activity

“…After a ligament injury, the wrist is generally immobilized for 4–6 weeks. 11 For elite athletes in season, one can consider return to sport with the use of a wrist splint or cast. During wrist immobilization, the patient should begin passive and active range-of-motion exercises of the unaffected upper-extremity joints, in order to limit stiffness and deconditioning.…”

“…In instances of acute, unstable ligamentous injuries, operative management may be indicated. 11 If so, rehabilitation afterward mimics that of nonoperative treatment, with a period of immobilization followed by wrist strengthening and proprioceptive training. Return to sport varies widely for ligamentous wrist injuries.…”

“…For more severe injuries, return to sport may not occur for 4–6 months. 11 Timing of return to sport without a cast or splint may be assessed with full, painless range of motion and no tenderness to palpation. Typically, snowboarding is a sport in which return to activity with a cast or splint is acceptable.…”

“… 15 The patient is immobilized in a thumb-spica cast for 3–6 weeks postoperatively, and then active-assisted and gentle passive motion may begin. 15 , 16 The athlete may wear a splint as needed for support once the thumb-spica cast is removed, but dynamic splints should not be used. 15 At 3 months, grip-strength exercises and use of the wrist in activities of daily living begins.…”

Emergency and Trauma of Hand and Wrist

“…PA radiograph and CT may show a widened interval (> 3 mm) between scaphoid and lunate (Terry-Thomas's sign). [87][88][89] LT ligament disruption is rare and usually the result of a sudden axial load with wrist extension, radial deviation, and intercarpal pronation (e.g., falling backward on an outstretched hand). 27,90 LT ligament tears can be accompanied by carpal dislocation.…”