Houston Methodist. Leading Medicine

Wrist FAQ

Question:

I had a Grade III scapholunate tear that was repaired surgically. The operation didn't work and I have constant pain. I can't use that hand for hardly anything. Can anything be done to help me?

Answer:

You didn't mention what kind of surgery you had done. This could make a difference in choosing future treatment approaches. In some cases of scapholunate (SL) tears, the torn ligament between the two bones is removed.

The process of cutting out the torn ligament and shaving away its attachment to the bone is called debridement. The idea is to cause bleeding and the formation of scar tissue to help stabilize the wrist joint.

If that's what you had done and the results aren't satisfactory, then you may need a second (revision) surgery. There are several options now. You can have a capsulodesis or an arthrodesis.

A capsulodesis can be done one of several ways. The basic idea is to take a piece of cartilage from the radius (bone above the scaphoid) and attach one end to the scaphoid. The other end stays in place at the radius. This reduces the gap between the bones and holds the scaphoid in place. Arthrodesis is done by grafting bone to fuse the joint solid.

Wrist fusion will often eliminate the pain but it also reduces motion at the wrist. Your age and level of activity may be factors in this decision to trade motion for pain relief. Talk to your surgeon about your options. Seek a second or even third opinion. It may help you line up all the pros and cons of each option before deciding on your next step.

Nickolaos A. Darlis, MD, et al. Arthroscopic Debridement and Closed Pinning for Chronic Dynamic Scapholunate Instability. In The Journal of Hand Surgery. March 2006. Vol. 31A. No. 3. Pp. 418-424.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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