Diagnosis | Scapholunar dissociationSLD

Diagnosis

The first measure is the clinical examination of the wrist. There should be specific tests (Watson’s shift test) to determine whether SLD can be diagnosed with certainty. As a further measure, an x-ray of the wrist will be performed in two planes.

A third degree scapholunar dissociationSLD can be diagnosed by the extended distance between the scaphoid and the lunar bone (>2 mm). To confirm the diagnosis, the opposite side can also be x-rayed to rule out congenital variants. First- and second-degree injuries can only be detected by MRI (magnetic resonance imaging).

Therapy

Conservative and surgical procedures are available for the therapy of scapholunar dissociation. The conservative therapy is used in cases of minor injuries. It involves repositioning the bones in their anatomical position with subsequent 6-week immobilization in plaster or a wrist bandage.

During this time, the SL ligament should reattach and heal stably. Painkillers can be taken additionally during this time as required. Minimally invasive as well as open operations are available for surgical treatment.

Arthroscopy can be used to remove small pieces of cartilage and ligament that cause pain in the wrist. Within the first weeks after the injury, an attempt can be made to suture the SL ligament. Then ligament plastics, ligament transplants or other procedures can be performed to restore the anatomical conditions.

However, these operations promise only a low success rate. The last therapeutic method for beginning or advanced cartilage wear is stiffening at the carpus. Although this slightly restricts mobility in the joint, the wrist remains painless and stable.

Healing time

Both conservative and surgical therapy take several weeks to heal.In conservative therapy, the wrist must be immobilized and immobilized for about 6 weeks using a plaster cast or bandage. There is also a 6-week grace period after surgical suturing of the SL band or treatment of other concomitant injuries. Even after this period, the load on the wrist should only be increased again slowly. Complete mobility can only be achieved slowly through passive and active movement exercises. As a rule, the wrist reaches complete stability and mobility after about 12 weeks.