Partial ligament tear - scapholunate area

So a few days ago I fully tore the SL ligament in my left hand, 16 months after I tore my right hand SL ligament. Don't neglect your good hand during recovery! 

Tom Addison wrote:

Interesting thread. Here's a quick version of my story which might be helpful to some.  About 4 years ago I suffered a partial SLL tear, and then maybe 6 months later a complete SLL tear.  I saw 4 different hand surgeons, who told me that essentially climbing or hard climbing was over.  Several were keen to operate.  I researched the plethora of surgical repair options, which frankly tend to have not-so-great outcomes. Some kind folks on MP shared their experiences with me.  I spent a lot of time on PubMed, and talking with surgeons, hand therapists, and others.  After much work in PT to try to rehab the wrist, and not great outcomes, I found a surgeon in San Francisco who had just come up with a new alternative surgical repair.  I met with her, and was one of her very earlier surgeries.  Essentially, it mimics ACL repair, but done in the wrist with smaller cannulated screws.  I've now got 2 pieces of cadaver tendon going from the scaphoid, to the lunate and the triquetrum.  Much PT followed surgery.

The wrist is stable, painfree, and I have almost complete range of motion.  I'm training, hangboarding, campusing, and climbing a lot.  I'm back to where I was pre-injury I'd say in terms of climbing performance (occasionally flashing 12d and redpointing to 13+, and falling off easy boulder problems). So I'm certainly stressing my wrist on a regular basis, and have been back going hard for about 2 years now. YMMV, but I think her surgery (which is still quite new) is definitely a better option than what was previously available.  I'm happy to share the surgeon's contact info if you send me a message, or a poster she put together at an early stage where she had done some cadaver tests with her surgery vs. other more common options.  I think quite a few handsurgeons are now using her technique, but I'm definitely not up on that.  SLAC is out of the picture, and I don't feel limited ever by my wrist.  Before the surgery, I really thought I was done with climbing, which was quite a bummer.  Now I've got my life back.

Who was the surgeon and what was the surgery called? 

I just got my MRI results back and I have SLAC wrist. I'm 36, used to skateboard professionally until injuries retired me. I work with my hands as a restoration ecologist, and climbing is my life - I will do anything not to lose the use of my hand. 

Tom, how long from the injury to the surgery elapsed? Had SLAC began?

Andrew, how bad are your symptoms? I had some nasty symptoms after a complete tear about six years ago. they went in to see if they could fix it with a direct repair and it was too far gone from previous damage(10 years of throwing myself down handrails) While they were in their they did debride the area. Not sure whether that is what helped or just time, but i’m not super limited by it, especially not climbing. I don’t crack climb a ton though and when I do Sometimes it hurts or feels unstable. I climb mid to high 5.11, but I’m 190 lbs so I’d imagine a lighter(fitter) climber would be able to climb asymptomatically much harder. Never really felt it hold me back on trying much harder boulder moves.  Every year it seems a little worse though.

Thanks, Ryan. I don't know how to gauge how bad my symptoms are. Certain motions feel like my hand is falling off. Moving a sleeping dog or pulling a rope out of a stuffed bag or flipping a pancake in a cast iron skillet produces a nauseating clunk. However, I have no pain, even in upward and downward dog. I can even do pull-ups on rings (bar feels weird) and hold a 18mm half crimp dead hang at body weight (150lbs). The wrist orthopedist says the arthritis resulting from the unstable carpal bones wearing away the cartilage is currently mild. Apparently when it finally ruptured all the way I had no pain because it was only scar tissue that broke, since apparently I'd thrashed it years before. It's been 6 weeks since the carpal instability suddenly started (while pulling a dog up a slab on a climbing trip, not even actually climbing), and it never swelled or hurt or was tender to the touch or lost range of motion, it just felt horrifyingly unstable. Stability has improved, and I expect with continued PT it will continue to improve, but I reckon it's just a matter of time till my feet slip on a route and I'm permanently disabled. And even if that doesn't happen, if i understand correctly it's just a matter of time until wrist fusion surgery to alleviate arthritis.

The surgery the specialist proposed is called a brunelli procedure and apparently it will do nothing for the impending arthritis, it will reduce ROM by 25%, and it MAY improve carpal stability, at least for a little while. 

Definitely get second opinions at least. One surgeon wanted to do a partial fusion, the other said if you can use it now without too much pain, wait for better options since loss of strength and ROM are part of every current option, and I would probably need surgery in future due to arthritis anyway. I just live with the ticking time bomb and try to appreciate the time I have left with a mobile wrist hahah. Even once it gets to where I require surgery, I still think I will be fine doing most things with some adjustment.
Right now my best advice is learn to punch hard with your other hand because hitting a heavy bag or anything else with my left makes me want to throw up. Left feint, right cross haha

Hi Guys, I have read all your posts and frankly I am terrified of the future of my wrist, I am not a climber but i play basketball and i know i will need to stop playing but i am  to stubborn to do so. I am 26 years old and fully tore my SL 8-9 months ago and i have no pain anymore. I went to 4 doctors one wanted to do a full reconstruction surgery, the other wanted to do an arthroscopic surgery, and the other was not confident with any surgery because these surgery dont guarantee anything  ,and the last doctor didn't know what to do. I dont know what i should do  and it seems that either way my wrist is F****. I would like your opinions on what i should do your help is greatly appreciated. 

Post the repair of the fully ruptured Sl  8 years ago I have a wrist that can’t bend back  like it used to but I hardly think about it climbing or anything anymore, I can’t do push-ups as they hurt but that’s the only limitation. Get surgery but make sure it is by someone who specialises in this injury and repair as results will vary from awesome in my case to disastrous 

Thank you for your reply, I will take it into consideration. It is just  hard to convince a person with no pain to get surgery. I am from NY and I have found a good doctor to do the surgery but the other doctor thinks that my fibers might still be good and would like to shrink it with heat making it stronger. I am assuming that you would go with the reconstruction surgery. 

Non- surgical interventions are always best to try first as long as there is not an emergency and the non-surgical intervention won’t negatively impact the chances of a later surgery.

Currently 8 weeks out from a partial tfcc tear and recently started climbing again. Hoping to get some answers on a similar topic. Has anyone had issues with their flexor tendon after a tfcc injury/wrist ? Mine feels significantly weaker/tighter both on and off climbing.

Severity of the tear will affect long term prognosis. In my case weakness at first but don’t notice it any longer other than when it hurts.

Re the full rupture of the ligament- wrist manipulation can fix most pain and you don’t lose much strength initially but fusion of the wrist is inevitable in 5 to 10 years to reduce pain as arthritis kicks in from the metacarpals grinding away at the cartilage 

Update on my fully ruptured SL ligament saga, which began in Dec 2018:
Tom Addison (previously posted on similar thread) kindly put me in touch with his surgeon, Dr. Lisa Lattanza at UCSF. She no longer recommends the surgery that worked for Tom, because 50% of other patients had poor results. Apparently Tom got real lucky. She looked at my MRI and recommended a modified brunelli procedure, but said to save it for plan B if PT doesn't work because it will reduce ROM, strength, and there's no empirical evidence it will slow arthritis. I also saw Dr. Randy Viola at the Steadman Clinic in Vail, and he said that for athletes a 4-corners fusion is a more reliable long term surgical option. It will significantly reduce ROM, mostly in extension, but won't reduce strength as much as the other options. However, he also recommended saving that as plan B since PT is really helping. Also saw another surgeon, and another PT, and spoke with several other climbers with the same injury and different surgical and nonsurgical treatments and different outcomes. After 4.5 months of feeling like I'm suffocating with anxiety, and dizzy with conflicting recommendations from experts, here's the conclusion I've come to:
Immobilization in a brace for 4 months allowed my body to produce enough collagen/scar tissue/soft tissue to stabilize the subluxing carpal. Ultrasound imaging actually shows the 4.5mm gap between scaphoid and lunate has shrunk to 1.5mm, even while flexing. I wore the brace 24 hours a day except for typing and PT. I haven't experience that dislocating clunking subluxing sensation in 2.5 months. PT started VERY light after 2 months of "healing" after the injury. Now I'm 2.5 months into PT, I still have almost no pain (just some stiffness and acheyness probably from being immobilized for so long). My grip strength has returned to about 90% of my uninjured hand in all widths and positions, and I can do pull-ups! Annoyingly, I feel like this progress is plateauing, because now I'm getting tingly numbness in the tips of index-ring finger (not a perfect fit for carpal tunnel symptoms, so I'm guessing internal swelling is impinging the nerve, or there's a nerve impingement upstream cause I have a bunch of other old injuries). I'm going to return to very light, vertical climbing, bracing with tape, and see how it feels over the summer. If it's fucked, I'll get the 4-corners fusion next fall. If it continues improving and doesn't regress or hurt, I'll save the fusion for when arthritis becomes a problem in a few years. Hopefully a lot of years. I have had A LOT of injuries in the past, and this is by far the worst one psychologically. My advice is this - even if the surgeons say you'll never climb again, and your hand feels like a floppy fish on the end of your arm, there is still hope! Don't let your brain sabotage the healing potential of your body, and don't rush into surgery! There's a very real chance surgery could do more harm than good, and there's a very real chance PT could postpone all that for years.

Interesting, my docs didn’t recommend PT, as their feeling was usage will result in wear and tear no matter what. I could do pull ups even immediately after the injury however and never felt pain from internal rotation(grabbing and pulling) mainly with external(pushing and twisting) finger locks and hand jams are sometimes problematic still. A four corners is probably in my future as well. I think wait and see is really the gold standard for it right now.

Hi,
I’m a competitive pole dancer and about 4 weeks ago I thought I’d sprained my wrist. But it just wasn’t healing. I would take a few days off, go back to training. Certain things would hurt that never hurt before. I don't have the grip strength to pull myself up for invert or to climb because those require both hands. I would take days off, then go back since I have (well had) a competition coming up. So I finally went to Urgent Care last week, and they recommended a CT-Scan.

I had a CT-Scan showing

"acute rupture of the scapholunate ligament. with a gross widening of the scapholunate articulation, malrotation of the saphoin and dorsal rotaion of the lunate all in keeping with dorsal instercalated segmental instability and a loose bony fragment in the dorsal aspect of the scapholunate joint possibly avulsed insertional bone fragment is demonstrated, there is no significant scapholunate advanced collapse."

I’ve been scouring the internet for information as I await an appointment with an orthopedic hand surgeon.

I had to cancel a pole competition for next week and I’m completely heart broken. I've stopped using my right hand to pole. I'm just going to the studio to work on flexibility and conditioning without that hand. I love pole sports its the joy of my life and this wrist injury has been devastating. I've been going to acupuncture for the pain, but I know it's really not the answer.

I really don't want surgery. I'm seeing a lot of posts saying to not get surgery and just brace it until it heals with physical therapy. But is that "loose boney fragment" a game changer??

I'd appreciate any feedback. Anybody else have an "avulsed bone"?  

I see the orthopedic hand specialist next week. I'm so nervous.  

Sorry to hear that. I would imagine the bone fragment is a pretty significant game changer that would cause pain/further damage unless treated. I would definitely get a second opinion on whatever your original ortho recommends, but if neither seem keen on wait and see I would get surgery.
In the meantime I would try to splint/wrap it and try not to use it at all.

THERE IS HOPE! I was told basically the same thing by 4 surgeons - probably never climbing again. Ruptured SL ligament, bone fragments, grade III SLAC arthrosis degeneration of the cartilage. My scaphoid would clunk out of place many times a day just doing normal stuff like washing dishes. I work with my hands and had a lot of fieldwork planned so I couldn't go ahead and get the 4-corners fusion surgery that was recommended. Thank goodness! After 4 months of immobilization and 200+ hours of physical therapy and I'm now sport climbing 5.12. I have to tape it with leukotape, and it's still too weak to crack climb, but after spending 6 months thinking I'd never climb again I am stoooooooooked to have made so much progress. I ended up doing so much PT that it gave me carpal tunnel, so now I need surgery for that, and eventually the joint will wear out and I'll need the fusion surgery, but my PT thinks if I keep it strong that could be 20 years out. DON'T GIVE UP! You can probably have the bone fragment cleaned out arthroscopically, and then do high frequency high intensity low volume isostatic hypertrophy PT to recruit the tendons to stabilize the carpal with the missing ligament. It worked for me! Another option, if you don't experience carpal subluxing and you just have pain and weakness, you could de-nerve the joint. Dr. Viola at the steadman clinic in vail suggest that as a means to return to climbing. The weakness you're experiencing is mostly from the nerve telling the muscle to back off, so if you get rid of the pain you can regain the strength. Surgeons are always going to recommend surgery, but they don't have any experience with non-surgical outcomes. You just need a climber or pole dance physical therapist. 

Hi All,
to give you an update this injury was psychologically tolling on the body I agree , I eventually held off on the surgery , and it’s been a year and a half . I don’t really have symptoms unless I pick up something heavy or play my PlayStation for a long time it gets stiff . This was a full SL Tear and I’m going to wait for advancements for surgery in the future I am hopping.  My grip and RoM don’t seem to be affected and I have realized that taking a hot bath and massaging of the hand really makes a difference. I hope this helps and remember this is not the worst thing to ever happen.

I want her information! 

Dana G wrote: I want her information! 

Who’s information?

Hi Everyone, it's been interesting reading this thread. I fully tore my SL ligament 1.5 years ago. It was hurting a lot for a few months after falling off a skateboard and the surgeon scheduled me for surgery to avoid degrading the wrist more. They reconstructed the ligament, and put in a titanium plate (forget if in the scaphoid or lunate) for support. After finishing a few months of PT I started using it more (still lightly) including hanging/moving on some boulders and some yoga. Anything in pushup position hurt but was feeling ok.

Maybe I overdid it at some point... For the last 6 months I frequently have a light pain in my wrist, and I'm not climbing at all now. The surgeon recommends doing the reconstruction again to prevent SLAC wrist. I'm a bit uneasy to do that again. He says SLAC will come in 5 years if I do nothing. I'm from the US but currently living in Denmark. I want to consult a couple surgeons in the US but don't have US insurance so am trying to figure out the best way without spending tons of money. 

When you contact surgeons are you able to get through directly to them or do you need to go via hospitals, secretaries, etc...? I called the Hand to Shoulder center in Philadelphia and before scheduling a virtual appointment they wanted a $400 deposit. Just wondering if this is normal or if there is an easier way. I was hesistant to do a lot of PT now that it's hurting, in case it gets worse, but reading this thread seems like that is helping for a lot of people in the long run. Any thoughts or recommendations on surgeons to consult?