Sugat sa mga Ligamento ng Pulso Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang sakit sa loob na bahagi ng iyong pulso, malapit sa iyong maliit na daliri. Ang sakit sa bahaging ulnar na ito ay isang karaniwang sanhi ng kapansanan sa itaas na ekstremitas. Madalas itong nararamdaman na malalim at masakit. Maaari mo ring maramdaman ang pakiramdam ng kawalan ng katatagan, parang ang mga buto ng iyong pulso ay gumagalaw o nakakabit kapag kumikilos ka.

Ang sakit ay karaniwang lumala pagkatapos ng aktibidad. Ang mga simpleng gawain sa araw-araw ay maaaring maging mahirap. Maaari kang magkaroon ng hirap sa pag-abot sa likod ng iyong likod upang isara ang bra. Ang pagtutukoy ng isang kamiseta ay maaaring magdulot ng matulis na pananakit. Ang pag-angat ng mga bagay, lalo na kapag ang palad ay nakaharap pababa, ay maaaring magpalala sa sugat. Kung ikaw ay nakaranas ng fracture ng distal radius, ang mga kaakibat na sugat sa ligamento ay maaaring magdulot ng mas masamang resulta kaysa sa mga fracture lamang.

Ang iyong mga sintomas ay maaaring lumala sa gabi o sa paggising. Ang pagpahinga sa gilid ng sugat na pulso ay madalas na nagpapataas ng discomfort. Ang mga sugat sa scapholunate at lunotriquetral interosseous ligaments ay nangyayari sa humigit-kumulang isang tatlong bahagi ng mga fracture ng distal radius. Ang mga sugat sa mga intrinsic ligament na ito ay kritikal na dapat tugunan. Ang pagpapanumbalik ng function ng ulnolunate ligament ay mahalaga upang maiwasan ang karagdagang paglala ng function ng pulso pagkatapos ng sugat.

Ang mga tear ng lunotriquetral ligament ay bihira at hindi pare-pareho ang pagdi-diagnose. Madalas itong nadidisenyo kasama ng iba pang pathology ng pulso. Dapat maging maingat ang mga kliniko sa pag-aakala ng mga sintomas sa mga anatomikal na pagkakaiba sa mga radiograph sa mga pasyente na may hindi tiyak na sakit ng pulso. Ang mga fracture ng carpal, sugat sa ligamento, at ang resulta na instability ng carpal ay kumakatawan sa isang spectrum ng mga sugat. Maaari itong mangyari sa parehong mga acute traumatic setting at chronic overuse syndromes.

Ang mga high-energy injuries sa pulso ay binubuo ng ilang bone–ligament lesions na dapat matukoy. Ang maagang diagnosis at angkop na paggamot ay nagbibigay-daan sa mga atleta na bumalik sa laro nang mabilis pagkatapos ng pagkuha ng mga fracture o dislocation ng kamay o pulso. Gayunpaman, ang mga plain radiographs ay hindi maaasahan na diagnostic para sa mga sugat sa scapholunate at lunotriquetral interosseous ligaments na kaakibat ng mga fracture ng distal radius. Ang arthrogram ay hindi isang definitive na pag-aaral para sa pagdi-diagnose ng mga clinically important na sugat sa ligamento sa pulso.

Ano ang nangyayari talaga

Ang iyong pulso ay binubuo ng walong maliit na buto na magkasamang dumudulas at umiikot. Ang mga butong ito ay hawak sa kanilang posisyon ng matibay na banda ng tisyu na tinatawag na ligaments. Isipin ang mga ligaments na ito bilang mga lubid ng isang suspension bridge. Pinapanatili nila ang pagkakahanay ng mga buto upang maaaring gumalaw nang maayos ang iyong kamay. Kapag nasugatan ang iyong pulso, maaaring umabot, mabasag, o magsnap ang mga lubid na ito. Ang pinsalang ito ay kilala bilang carpal instability. Pinipigilan nito ang iyong pulso na panatilihin ang kanyang normal na hugis sa ilalim ng pang-araw-araw na mga stress.

Ang paraan ng paggalaw ng iyong pulso ay nakadepende sa hugis ng mga dulo ng buto at sa tibay ng mga ligaments na ito. Ang mga buto sa harap na hanay ng iyong pulso ang karamihan sa paggalaw. Ang likod na hanay ay nananatiling karamihang tahimik upang magbigay ng matatag na base. Kung sira ang isang ligament, nababagay ang koordinasyong ito. Maaaring lumipat ang mga buto mula sa kanilang tamang posisyon. Ang maling pagkakahanay na ito ay nagdudulot ng sakit at kahinaan. Nagbabago rin nito ang paraan ng pagdaloy ng puwa sa pamamagitan ng iyong kamay. Ang mga simpleng galaw ay maaaring maging mahirap o masakit.

Minsan, ang isang basag na buto sa tabi ay maaari ring magdulot ng instability na ito. Ang fracture ng buto ng forearms malapit sa pulso ay maaaring makagambala sa buong istruktura. Ito ay nagbabawas sa kung gaano karami ang maaari mong baluktotin ang iyong pulso at nagpapahina ng iyong hawak. Ang pinsala sa mga ligaments ay madalas na nagpapatibay sa paggaling kaysa sa simpleng basag lamang. Ang pag-unawa sa mekanikal na pagkabigo na ito ay tumutulong magpaliwanag kung bakit ang iyong pulso ay naramdamang unstable o masakit. Ipinapakita nito kung bakit ang pagbawi ng tibay ng mga lubid ng ligament ay napakahalaga para sa iyong pangmatagalang pagganap.

Ano ang maaari naming gawin dito

Ang pamamaraan ng iyong surgeon ay sumasalamin sa paraan ng Dr. Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, sa pamamahala ng mga sugat na ito sa aming klinika. Dumating ang mga pasyente sa aming pag-aalaga sa pamamagitan ng referral mula sa isang GP o physiotherapist. Nagsisimula kami sa isang komprehensibong pagsusuri, kabilang ang history, physical examination, at imaging upang kumpirmahin ang diagnosis. Para sa maraming acute injuries, maaari naming irekomenda ang surgery agad-upang maibalik ang stability. Para sa mga long-standing o degenerative na isyu, karaniwang nagsisimula kami sa non-operative care.

Maaari kang magsimula sa pagpapahinga ng pulso at pag-iwas sa mga galaw na nagdudulot ng sakit. Ang aming mga physiotherapist o hand therapists ay gabayan ka sa mga ehersisyo upang maibalik ang movement at palakasin ang mga kalamnan sa paligid ng joint. Madalas naming ginagamit ang mga splint upang suportahan ang pulso at payagan ang mga ligament na mag-settle. Ang conservative na pamamaraang ito ay naglalayong bawasan ang sakit at mapabuti ang function nang walang invasive na mga proseso. Sa ilang kaso, tulad ng acute scaphoid fractures sa mga bata, ang nonoperative treatment ay nagdudulot ng mataas na rate ng paggaling na may kaunting long-term na sintomas. Gayunpaman, ang conservative na pamamahala ay maaaring hindi sapat para sa lahat ng mga sugat, tulad ng ilang uri ng palmar carpal subluxations.

Kung patuloy ang sakit, maaari naming talakayin ang mga medical na opsyon upang tulungan kang pamahalaan ang mga sintomas habang ang iyong pulso ay gumagaling. Maaari itong kabilang ang mga gamot para sa sakit o anti-inflammatory drugs upang bawasan ang pamamaga. Maaari rin naming isaalang-alang ang mga injection. Ang mga cortisone injection ay maaaring paitigil ang inflammation sa loob ng isang panahon, na tumutulong sa iyo na makilahok sa therapy. Ang mga hyaluronic acid injection ay naglalayong maglubricate ng joint, bagaman ang ebidensya para sa kanilang long-term na benepisyo ay nag-iiba-iba. Ang mga platelet-rich plasma (PRP) injection ay gumagamit ng mga sangkap ng iyong sariling dugo upang hikayatin ang paggaling, ngunit ang mga resulta ay maaaring mag-iba mula sa tao patungo sa tao. Ang mga treatment na ito ay hindi nag-aayos ng mga naputol na ligament ngunit maaaring gawing mas komportable ang mga araw-araw na gawain.

Ang surgery ay itinuturing kapag ang non-operative care ay hindi nagbigay ng sapat na pag-unlad, o kapag ang sugat ay seryoso at nangangailangan ng agarang structural repair. Ang aming layunin ay maibalik ang normal na alignment at stability ng mga buto ng iyong pulso. Maaari naming ayusin ang mga naputol na ligament nang direkta o gumamit ng mga tendon upang i-reconstruct ang mga ito, na pinapanatili ang kahit gaano man kaunting motion. Sa mga kumplikadong kaso na may kaugnayan sa mga fragment ng buto, maaari naming gamitin ang mga plate at screws upang hawakan ang lahat sa tamang posisyon. Para sa advanced na wear-and-tear arthritis kung saan ang mga motion-preserving na opsyon ay hindi angkop, maaari naming talakayin ang mga fusion procedures upang bawasan ang sakit. Ang pagpili ay nakadepende sa partikular na mga ligament na kinasasangkutan at sa kalusugan ng iyong joint. Sinusuri namin ang ebidensya nang sama-sama, na tinitingnan na habang ang maraming mga pasyente ay nakakaranas ng magandang pagbawas ng sakit at function, humigit-kumulang 20% ng mga operated na pulso para sa chronic scapholunate injuries ay maaaring hindi makakakita ng makabuluhang pag-unlad. Tinitiyak namin na nauunawaan mo ang mga outcomes na ito bago gumawa ng shared decision.

Ano ang inaasahan

Ang katatagan ng iyong pulso ay nakadepende sa malalakas na ligamento na nagpapatibay sa mga maliit na buto. Kapag nasugatan ang mga ligamentong ito, ang pagpapanumbalik ng koneksyong iyon ang susi upang pigilan ang karagdagang pagkasira. Kung makakatanggap ka ng maagang pagdi-diagnose at angkop na paggamot, maaari kang makabalik sa iyong karaniwang mga gawain o sports na medyo mabilis. Gayunpaman, kung hindi maibabalik ang pag-andar ng ligamento, maaaring patuloy na maglala ang pag-andar ng iyong pulso sa paglipas ng panahon.

Ang paggaling ay isang proseso na nag-iiba-iba batay sa kabiguan ng sugat. Sa maraming kaso, makikita mong may pag-unlad sa sakit at pag-andar sa loob ng ilang linggo hanggang buwan. May mga pasyente na bumabalik sa trabaho o paglalaro pagkatapos ng ilang linggo, habang ang iba ay maaaring kailanganin ng hanggang dalawang taon upang maramdaman na ganap na nakakaayos. Kahit sa matagumpay na paggamot, maaaring manatiling matigas o may limitadong galaw ang iyong pulso. Karaniwan ang pagkakaroon ng ilang pangmatagalang katigasan, ngunit karamihan sa mga tao ay nananatiling may tanggap na pangmatagalang pag-andar.

Ang mga resulta ay lubos na nakadepende sa tiyak na uri ng sugat at kung paano ito pamamahalaan. Para sa mga malubhang sugat, maaaring talakayin ng iyong doktor ang iba't ibang opsyon sa operasyon upang matibayan ang kasukasuan. Kahit na ikaw ay magkaroon ng mga prosedura tulad ng pagsasama (fusion) o rekonstruksyon, maaari kang maghanda ng magandang mga resulta sa pag-andar sa pangmatagalan. Halimbawa, ipinapakita ng mga pag-aaral na 73% ng mga pasyente ay may pagbabago sa radiograpiya sa kasukasuan pagkatapos ng ilang mga prosedura sa pagsasama, ngunit nananatili pa rin silang nakakaramdam ng magandang pag-andar. Gayundin, habang may ilang hindi pagkakatibay na maaaring manatili sa mga scan, karamihan sa mga pasyente ay hindi nakakaranas ng malubhang sakit o pagkawala ng pang-araw-araw na pag-andar.

Mahalagang maging realistiko tungkol sa timeline. Habang ang maraming pag-unlad ay nangyayari sa maagang yugto, maaaring tumagal ang ganap na paggaling. Sa ilang kumplikadong kaso, ang huling paggamot ay maaaring hindi mapabuti ang pagkakahanay ng mga buto. Kung mayroon kang kaakibat na mga sugat, tulad ng basag na buto sa pulso kasama ang pinsala sa ligamento, maaaring mas mahirap ang iyong paggaling kaysa sa simpleng fracture lamang. Gabayin ka ng iyong doktor sa prosesong ito, tinitiyak na sinusunod ang mga pangunahing prinsipyo ng paggaling upang bigyan ka ng pinakamataas na pagkakataon para sa isang matatag at may pag-andar na pulso.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong doktor kung mayroon kang patuloy na sakit sa pulso na hindi gumagaling kahit magpahinga. Humingi ng pagsusuri ng espesyalista kung mapansin mo ang kahinaan, kawalan ng katatagan, o pakiramdam ng pagkakasara o pagbagsak ng pulso. Maaaring makagambala ang mga sintomas na ito sa pagtulog o sa trabaho. Ang biglaang paglala ng sakit matapos ang isaksak ay nangangailangan din ng pansin. Ang maagang pagdi-diagnos ay tumutulong na maiwasan ang karagdagang paglala ng kakayahan ng pulso. Maaaring gumamit ang iyong surgeon ng imahe upang suriin kung may sugat sa ligamento. Sa mga kumplikadong kaso, ang diagnostic arthroscopy ang nagbibigay ng pinakamalinaw na tanawin ng sugat. Ito ay nagpapahintulot sa tamang pagpaplano ng paggamot. Huwag balewalain ang patuloy na discomfort, dahil ang hindi naaayos na mga isyu sa ligamento ay maaaring magdulot ng pangmatagalang stiffness o arthritis.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

The ulnar nerve is the most frequently involved nerve in revision total elbow arthroplasty [1].
Radial nerve injury accounts for a substantial proportion of nerve injuries in revision total elbow arthroplasty [1].
Anatomical anterior and posterior reconstruction for scapholunate dissociation resulted in no patients requiring secondary surgery or treatment related to carpal stabilization [2].
A negative MRI result is unable to rule out clinically relevant injury to the triangular fibrocartilage complex (TFCC) of the wrist [4].
A negative MRI result is unable to rule out clinically relevant injury to the scapholunate (SL) ligament of the wrist [4].
A negative MRI result is unable to rule out clinically relevant injury to the lunotriquetral (LT) ligament of the wrist [4].
Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears showed encouraging preliminary results in a series of 36 patients [5].
Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears provided pain relief [5].
Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears allowed recovery of grip strength [5].
Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears had a low incidence of postoperative wrist stiffness [5].
All professional athletes in the series of 36 patients returned to preinjury sports levels following arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears [5].
Radioscapholunate arthrodesis with compression screws and local autograft is an effective method for appropriately selected patients with a preserved midcarpal joint [7].
Radioscapholunate arthrodesis with compression screws and local autograft achieved a 100% union rate at a mean follow-up of 12 months [7].
Radioscapholunate arthrodesis with compression screws and local autograft had no complications in the reported series [7].
There is a lack of consensus in carpal tunnel management for patients with perilunate dislocations [9].
The lack of consensus in carpal tunnel management for perilunate dislocations is due to few studies with small sample sizes and inconsistent follow-up [9].
Both wrist arthrodesis and revision total wrist arthroplasty (TWA) are technically demanding procedures [10].
Revision wrist arthroplasty strategies should be performed with multidisciplinary team input, preferably in a specialist centre [10].

Anatomy & Pathophysiology

A negative MRI result cannot rule out clinically relevant injuries to the triangular fibrocartilage complex (TFCC), scapholunate (SL) ligament, or lunotriquetral (LT) ligament [4].
Four-dimensional computed tomography (4DCT) is a non-invasive and affordable method to assess and quantify wrist kinematics by incorporating the temporal dimension [3].
An individualized, multimodal approach combining clinical examination, imaging, and direct arthroscopic evaluation is essential for early diagnosis of scapholunate injuries and prevention of arthritis progression [12].
Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury without structural instability [14].
A consistent longitudinal branch of the posterior antebrachial cutaneous nerve (PABCN) courses over the interval between the brachioradialis and the extensor carpi radialis longus in the proximal third of the forearm [15].

Classification

Four-dimensional computed tomography (4DCT) is a method to assess and quantify wrist kinematics by incorporating the temporal dimension [3].
A negative MRI result cannot rule out clinically relevant injury to the triangular fibrocartilage complex (TFCC), scapholunate (SL) ligament, or lunotriquetral (LT) ligament [4].
Dorsal extrinsic ligaments demonstrate MRI signal changes suggestive of acute or chronic injury in patients with an SL interval of 2 mm or greater more often than in patients with an SL interval less than 2 mm [8].
An individualized, multimodal approach combining clinical examination, imaging, and direct arthroscopic evaluation is essential for early diagnosis of SL injuries [12].
Lunate fracture-subluxations are unstable injuries best managed with fixation of the carpal fractures [18].
Lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures, and ligament injuries [18].

Clinical Presentation

Ulnar nerve injury is the most frequently involved nerve injury in revision total elbow arthroplasty [1].
There is a lack of consensus on carpal tunnel management in patients with perilunate dislocations due to few studies with small sample sizes and inconsistent follow-up [9].
Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury [14].
Patients with dorsal radiotriquetral ligament snapping wrist syndrome demonstrated complete resolution of symptoms after debridement of thickened scar tissue on the undersurface of the dorsal radiotriquetral ligament [16].
Lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures, and ligament injuries, and are associated with common complications [18].
Symptomatic improvement can occur following carpal tunnel release in patients with severe carpal tunnel syndrome [26].

Investigations

Four-dimensional computed tomography (4DCT) is a promising, non-invasive, and affordable method to assess and quantify wrist kinematics, extending conventional CT by incorporating the temporal dimension [3].
A negative result from MRI is unable to rule out the possibility of a clinically relevant injury to the TFCC, SL ligament, or LT ligament of the wrist [4].
Dorsal extrinsic ligaments demonstrate MRI signal change suggestive of acute or chronic injury in patients with an SL interval 2 mm or greater more often than in patients with an SL interval less than 2 mm [8].
The sensitivity and specificity of MRI are influenced by the anatomic location of the lesion and technical conditions [35].
There is no evidence for the superiority of 3 Tesla Magnetic Resonance Imaging over 1.5 Tesla Magnetic Resonance Imaging for diagnosing wrist ligamentous lesions [35].
An individualized, multimodal approach that combines clinical examination, imaging, and, when appropriate, direct arthroscopic evaluation is essential for early diagnosis of SL injuries and prevention of arthritis progression [12].

Treatment

Arthroscopic dorsal capsuloligamentous repair in chronic scapholunate ligament tears showed encouraging preliminary results including pain relief, recovery of grip strength, low incidence of postoperative wrist stiffness, and all professional athletes returning to preinjury sports levels [5].
Radioscapholunate arthrodesis with compression screws and local autograft is an effective method for appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications [7].
Surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy showed lasting symptom relief and improved patient-reported outcomes in 7 patients at an average of 34 months after surgery [13].
Staged reduction of neglected transscaphoid perilunate fracture dislocation results in good functional pain-free range of motion if properly executed [17].
Lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures, and ligament injuries, with common complications [18].
Proximal migration of the thumb metacarpal does not appear to influence functional outcome in ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis [6].
Four-corner fusion versus proximal row carpectomy for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists shows that proximal row carpectomy results in better outcomes and a lower complication rate compared to four-corner fusion [28].

Complications

Nerve injury is a complication of revision total elbow arthroplasty, with the ulnar nerve being the most frequently involved and the radial nerve accounting for a substantial proportion of cases [1].
No patient required secondary surgery or treatment related to carpal stabilization in a series of ten patients undergoing anatomical anterior and posterior reconstruction for scapholunate dissociation [2].
Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears is associated with a low incidence of postoperative wrist stiffness [5].
Radioscapholunate arthrodesis with compression screws and local autograft achieved a 100% union rate with no complications in appropriately selected patients with a preserved midcarpal joint [7].
Closed surgical techniques for acute perilunate injuries may result in a smaller postoperative scapholunate gap and better wrist flexion–extension angle and MMW scores compared to open surgery, although the causal relationship is uncertain due to potential differences in injury severity between cohorts [11].
Surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy showed lasting symptom relief and improved patient-reported outcomes in a series of 7 patients at an average of 34 months after surgery [13].
Quadriceps tendon autograft with or without bone block have comparable complications for ACL reconstruction [19].
Ulnar collateral ligament reconstruction (UCLR) demonstrates low complication and revision rates at minimum 48-month mean follow-up [21].
There is an association between longer follow-up and higher revision rate in rotator cuff repair study designs [24].
Shoulder arthroplasties are generally designed to last 10-15 years, but revisions are being performed at a mean of 3.9 years from the primary procedure [34].

Recovery

No patient required secondary surgery or treatment related to carpal stabilization following anatomical anterior and posterior reconstruction for scapholunate dissociation [2].
Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears resulted in pain relief, recovery of grip strength, and a low incidence of postoperative wrist stiffness [5].
All professional athletes in the series of arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears returned to preinjury sports levels [5].
Debridement of thickened scar tissue on the undersurface of the dorsal radiotriquetral ligament resulted in complete resolution of symptoms in patients with dorsal radiotriquetral ligament snapping wrist syndrome [16].
Surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy showed lasting symptom relief and improved patient-reported outcomes at an average of 34 months after surgery [13].
Ulnar collateral ligament reconstruction provides excellent patient-reported and clinical outcomes at medium-term follow-up with low complication and revision rates [21].

Key Evidence

[L4] The ulnar nerve is most frequently involved, although radial nerve injury accounts for a substantial proportion of cases. [1] (10.1016/j.jse.2026.04.042)
[L4] No patient required secondary surgery or treatment related to the carpal stabilization. [2] (10.1177/1753193419886536)
[L5] Four-dimensional computed tomography (4DCT) is a promising, non-invasive, and affordable method to assess and quantify wrist kinematics, extending conventional CT by incorporating the temporal dimension. [3] (10.1177/17531934251326028)
[L2] A negative result from MRI is unable to rule out the possibility of a clinically relevant injury to the TFCC, SL ligament, or LT ligament of the wrist. [4] (10.1016/j.arthro.2015.04.090)
[L4] The series of 36 patients shows encouraging preliminary results with pain relief, recovery of grip strength, low incidence of postoperative wrist stiffness, and all professional athletes returning to preinjury sports levels. [5] (10.1016/j.hcl.2011.07.003)
[L1] Furthermore, proximal migration of the thumb metacarpal does not appear to influence the functional outcome. [6] (10.2106/jbjs.d.02630)
[L4] This technique is an effective method to perform radioscapholunate arthrodesis in appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications. [7] (10.1016/j.jhsa.2013.01.026)
[L4] Dorsal extrinsic ligaments demonstrate MRI signal change suggestive of acute or chronic injury in patients with an SL interval 2 mm or greater more often than in patients with an SL interval less than 2 mm. [8] (10.1016/j.jhsa.2019.03.003)
[L4] There is a lack of consensus in carpal tunnel management in perilunate dislocation patients due to few studies with small sample sizes and inconsistent follow-up. [9] (10.1016/j.jhsg.2025.100797)
[L5] Both wrist arthrodesis and revision TWA are technically demanding and should be performed with multidisciplinary team input, preferably in a specialist centre. [10] (10.1177/17531934241297843)
[L1] Closed surgical techniques may result in a smaller postoperative scapholunate gap and better wrist flexion–extension angle and MMW scores compared to open surgery, but these findings may relate to different cohorts in terms of injury severity, making the causal relationship uncertain. [11] (10.1177/17531934221150331)
[L5] Moving forward, an individualized, multimodal approach that combines clinical examination, imaging, and, when appropriate, direct arthroscopic evaluation will be essential for early diagnosis of SL injuries and prevention of arthritis progression. [12] (10.1016/j.jhsa.2025.11.021)
[L4] The surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy has shown lasting symptom relief and improved patient-reported outcomes in 7 patients at an average of 34 months after surgery. [13] (10.1016/j.jhsa.2025.02.010)
[L5] Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. [14] (10.1016/j.jht.2016.03.008)
[L5] In addition, in the proximal third of the forearm, a consistent longitudinal branch of the PABCN courses over the interval between the brachioradialis and the extensor carpi radialis longus. [15] (10.1016/j.jhsa.2019.08.011)
[Case_report] Both patients demonstrated complete resolution of symptoms after debridement of the thickened scar tissue on the undersurface of the dorsal radiotriquetral ligament. [16] (10.1016/j.jhsa.2015.12.029)
[L4] If properly executed, a good functional pain free range of motion is the usual outcome. [17] (10.1186/1749-799x-7-19)
[L4] Lunate fracture-subluxations are unstable injuries that are best managed with fixation of the carpal fractures, while lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures and ligament injuries with common complications. [18] (10.1177/1753193417740850)
[L4] Both grafts are safe and viable options for ACL reconstruction with comparable clinical outcomes, complications and revision rates. [19] (10.1007/s00167-022-07281-z)
[L4] UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. [21] (10.1136/jisakos-2021-000614)
[L1] There was an association between longer follow-up and higher revision rate. [24] (10.1016/j.asmr.2024.100993)
[L4] Symptomatic improvement following carpal tunnel release in patients with severe CTS can occur. [26] (10.1016/j.jhsa.2021.11.015)
[L1] In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. [28] (10.1016/j.jhsa.2024.01.011)
[L4] Generally, shoulder arthroplasties are designed to last 10-15 years; however, revisions are being performed at a mean 3.9 years from the primary procedure. [34] (10.1016/j.jse.2019.12.015)
[L1] The sensitivity and specificity of MRI are influenced by the anatomic location of the lesion and technical conditions. [35] (10.1016/j.arthro.2024.04.029)

References

[1] Nerve Injury in Revision Total Elbow Arthroplasty - A Systematic Review and Meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.04.042

[2] Anatomical anterior and posterior reconstruction for scapholunate dissociation: preliminary outcome in ten patients. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419886536

[3] Dynamic wrist imaging: How it works and how to assess kinematic changes in wrists with scapholunate instability. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251326028

[4] Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.04.090

[5] Arthroscopic Dorsal Capsuloligamentous Repair in Chronic Scapholunate Ligament Tears. Hand Clinics. 2011. DOI: 10.1016/j.hcl.2011.07.003

[6] Ligament Reconstruction with or without Tendon Interposition to Treat Primary Thumb Carpometacarpal Osteoarthritis. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.d.02630

[7] Radioscapholunate Arthrodesis With Compression Screws and Local Autograft. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.026

[8] Dorsal Extrinsic Ligament Injury and Static Scapholunate Diastasis on Magnetic Resonance Imaging Scans. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.03.003

[9] A Review of Perilunate Dislocations and Concomitant Acute Carpal Tunnel Syndrome: When Should the Carpal Tunnel be Released?. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100797

[10] Revision wrist arthroplasty strategies. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241297843

[11] Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221150331

[12] Imaging for Scapholunate Ligament Injuries: Techniques, Challenges, and Innovations. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.11.021

[13] Culp Midcarpal Reconstruction to Treat Palmar Midcarpal Instability. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.02.010

[14] Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability. Journal of Hand Therapy. 2016. DOI: 10.1016/j.jht.2016.03.008

[15] Anatomy of the Posterior Antebrachial Cutaneous Nerve, Revisited. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.08.011

[16] Dorsal Radiotriquetral Ligament Snapping Wrist Syndrome – A Novel Presentation and Review of Literature: Case Report. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.12.029

[17] Staged reduction of neglected transscaphoid perilunate fracture dislocation: A report of 16 cases. Journal of Orthopaedic Surgery and Research. 2012. DOI: 10.1186/1749-799x-7-19

[18] Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417740850

[19] Quadriceps tendon autograft with or without bone block have comparable clinical outcomes, complications and revision rate for ACL reconstruction: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07281-z

[21] Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2021-000614

[24] Rotator Cuff Repair Study Designs Correlate With Revision Shoulder Surgery Rates: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100993

[26] A Systematic Review of the Outcomes of Carpal Ligament Release in Severe Carpal Tunnel Syndrome. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.11.015

[28] Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.01.011

[34] Revision shoulder arthroplasty: a systematic review and comparison of North American vs. European outcomes and complications. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.015

[35] No Evidence for the Superiority of 3 Tesla Magnetic Resonance Imaging Over 1.5 Tesla Magnetic Resonance Imaging for Diagnosing Wrist Ligamentous Lesions: A Systematic Review and Meta‐analysis. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.04.029