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Review
. 2017 Mar;10(1):45-52.
doi: 10.1007/s12178-017-9383-x.

Scapholunate and perilunate injuries in the athlete

Nathan T Morrell  1 , Amanda Moyer  1 , Noah Quinlan  2 , Adam B Shafritz  3
Affiliations
Review

Scapholunate and perilunate injuries in the athlete

Nathan T Morrell et al. Curr Rev Musculoskelet Med. 2017 Mar.

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. 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.

Keywords: Athletic injury; DISI; Lunotriquetral ligament; Scapholunate ligament; Wrist instability; Wrist sprain.

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Conflict of interest statement

Conflict of interest

All of the authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
The Mayfield classification of perilunate injury. The initial injury is initiated with extension and ulnar deviation of the carpus and portends a circle around the lunate. In stage I, the scapholunate ligament is torn. Stage 2, the dorsal capsule is disrupted at the midcarpal joint. Stage 3, the lunotriquetral ligament is torn. Stage 4, the lunate is dislocated out of the proximal row in a volar direction, flipped 180 degrees, tethered by the long and short radiolunate ligaments. Adapted with permission from Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am. 1980;5(3):226-41
Fig. 2
Fig. 2
Reverse perilunate injury. Another proposed mechanism for perilunate injury where the carpus is placed into forced extension, radial deviation, and pronation. Stage 1: the lunotriquetral ligament is torn. Stage 2: the dorsal ulnar midcarpal capsule is torn. Stage 3: the scapholunate ligament is torn. Adapted with permission from Murray PM, Palmer CG, Shin AY. The mechanism of ulnar-sided perilunate instability of the wrist: a cadaveric study and six clinical cases. J Hand Surg Am. 2012;37(4):721-8. doi:10.1016/j.jhsa.2012.01.015
See this image and copyright information in PMC

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