What is an SL rupture?
The SL ligament (also called ligament) is a firm band between two carpal bones, namely the Scaphoid (ship's bone) and the Lunatum (moon-shaped bone). The SL ligament is very important for the stability and function of the wrist. It can be damaged by a fall on the outstretched hand or by engaging trauma to the hand. If the SL ligament is torn, the carpal bones can begin to move abnormally in relation to each other. We call this carpal instability. In the long run, the abnormal mobility of the bones relative to each other can cause wear and tear in the wrist joint.
What are the symptoms in an SL rupture?
Pain is the most common complaint in a person with an SL ligament injury. The pain is on the thumb side of the wrist and is often aggravated by strain on the wrist and with activities such as pushing up and wringing. There may also be swelling on the thumb side of the wrist. Some people may experience clicking in the wrist.
Diagnosis
Based on the pattern of symptoms and physical examination, the diagnosis is made. There are specific tests to assess the (in)stability of the wrist. Additionally, X-rays are made to assess the bones in the wrist. Again, special recordings can be made specifically for this problem. An MRI scan with contrast can provide information about the ligament, however, an MRI scan is not completely reliable in this problem. Therefore, it is often decided to perform keyhole surgery on the wrist where the SL ligament and the rest of the wrist can be properly assessed.
Treatment
The type of treatment depends greatly on how long the injury has existed and whether there is wear and tear on the wrist joint.
Non-operative (conservative) treatment
When the SL ligament is not completely torn, conservative treatment may suffice. A hand therapist can provide guidance in stabilizing the wrist. Temporarily wearing a brace (splint) during strenuous activities can protect the wrist and reduce symptoms.
Surgical treatment
When the SL ligament is completely torn and there are symptoms, surgery is indicated. The type of surgery depends on the degree of instability and the possible presence of wear and tear on the wrist. The surgeries are all done in day surgery. The entire arm is numbed by a nerve block or general anesthesia is used. The wound is and sutured with stitches that can be removed after 10-14 days. The follow-up treatment depends on the type of surgery performed.
Keyhole surgery
Keyhole surgery involves looking at the inside of the wrist joint through a pair of peepholes and testing the SL ligament.
Suture
If the injury has only been present for a short time, and if there is no wear and tear on the wrist, the SL ligament can be sutured. In this procedure, the severed part is reattached to the bone from which it was torn. The vessel bone and lunate bone are temporarily attached to each other with an iron wire (K-wire). This wire is removed after 6-8 weeks.
Dorsal capsulodesis or so-called Brunelli plasty
If the tear cannot be sutured, or if the injury is older, then a repair of the SL ligament is performed. In a normal radiograph, this is done using the joint capsule. Also after this procedure, the vessel-shaped and lunate legs are temporarily attached to each other with an iron wire (K-wire). This wire is removed after 6-8 weeks.
If the X-ray shows an abnormal position of the carpal bones, but no wear and tear, then repair of the SL ligament is done with a flexor tendon of the wrist. This surgery is called Brunelli plasty.
For arthrosis
When there is arthrosis of the wrist due to SL rupture, we call it a SLAC wrist and other treatments are necessary.
During the consultation hour, you will receive detailed information about the type of procedure that is necessary for you, explanations about post-treatment and recovery, and you will be given an information brochure about the procedure.
