Surgical Management of Scapholunate Injury: From Diagnosis to Rehabilitation

Scapholunate injury is a common and potentially debilitating wrist condition that, if left untreated, can lead to chronic pain, instability, and progressive arthritis. This presentation aims to provide a comprehensive overview of the surgical management of SL injuries, encompassing the journey from accurate diagnosis to successful rehabilitation. I will begin by discussing the anatomy of the scapholunate joint and the mechanisms of injury, emphasizing the importance of early detection. The diagnostic process will be explored, including clinical examination techniques, imaging modalities such as X-rays and MRI, and the role of wrist arthroscopy in confirming the diagnosis and assessing the extent of the injury. The core of the presentation will focus on surgical management strategies. I will review the spectrum of SL injuries, from partial ligament tears to complete dissociation, and discuss how the choice of surgical technique depends on the severity and chronicity of the injury. Surgical options to be covered include direct repair, ligament reconstruction, and salvage procedures for chronic cases. Particular attention will be given to innovative techniques such as the scapholunate-axis-method procedure and the use of internal bracing concepts. I will also mention upon the controversies surrounding certain procedures and the ongoing research aimed at improving outcomes. The final segment will address the critical role of post-operative rehabilitation. I will try to outline a staged rehabilitation protocol, emphasizing the balance between protecting the repair and preventing stiffness. The importance of patient education and compliance with the rehabilitation program will be stressed as key factors in achieving optimal functional outcomes. The aim of this topic is to having a clear understanding of the current best practices in the surgical management of SL injuries, from initial diagnosis through to rehabilitation.