Falling onto outstretched hand is a very common mechanism for injuries in the hand and wrist. There is a very important ligament in the wrist that is commonly injured following a fall in this way. It is called the Scapholunate Ligament.
Signs and Symptoms of a Scapholunate Ligament Injury can include: clicking in wrist, pain in the wrist or giving way of the wrist when loaded.
A Physiotherapy Assessment may find:
· Tenderness over the Scapholunate Ligament
· Good wrist movement, but painful at end of range
· Weaker and painful grip
Your Physiotherapy may also do some Special Tests to confirm the diagnosis including:
· Watsons Test (also called the Scaphoid Shift test)
· Scapholunate Ballottement Test
You may be asked to have an X-Ray. If there is a complete tear, an X-ray may show a gap between scaphoid and lunate, which increases with certain movements and with clenched fist.
· Wrist Splinting: This serves as a reminder to limit the painful movements. Splinting is usually for 6 weeks to allow the ligaments to heal. Inadequate support can result in long term instability of the wrist.
· Activity modification: This aims to reduce the forces in the wrist - avoid loading the wrist in end range extension (eg push up off fists [not hands]), larger grip sizes on tools or tools with longer leaver arms.
· Graded Physiotherapy Exercises: Range of motion usually improves easily
More severe tears may require surgery to repair the ligament. After surgery, you are required to wear a cast or splint for 4-6 weeks. Physiotherapy aims to help swelling and scar healing during this time. Any wires are removed after 6 weeks, and then movement is encouraged. Full grip and resistance needs to be avoided until 12 weeks after surgery and after 6-12mths 60-75% of the movement is regained.
If you have any questions or are suffering from wrist pain, contact us to book a time to have your wrist assessed by one of our Physiotherapists. Call us on (02) 4647 3373.