I am a lady weight-lifter with a serious problem. I tore the interosseous membrane of my left wrist and now the bones in there shift around. I never know when I’m going to have a pain free day for lifting. I can’t decide if I should go for a repair of the problem or just have the wrist fused. What do you advise?

Damage to the interosseous membrane of the wrist can result in a condition known as scapholunate instability. Without the tough soft tissue membrane to hold these two bones in place, the scapoid tips forward (flexes) and the lunate tips backwards (extension). The result can be a painful, unstable wrist — certainly a condition that will make bench pressing a challenge.

Treatment for this problem usually begins with anti-inflammatory and/or pain-relieving medications and activity modification. Activity modification would certainly include avoiding lifting heavy objects! Hand therapy might be advised. The goals of this type of conservative (nonoperative) care would be to reduce pain while maintaining wrist alignment until the area scarred over. Ligaments don’t really heal or recover their normal strength and durability. But for the average person, the body’s method of filling in with fibrous tissue may be enough to get by with daily activities.

For someone with heavy load requirements (manual laborers, weight-lifters), surgical options include repair of the tear, reconstruction of the wrist, or wrist fusion. Presently, studies comparing ways to treat this type of instability do not show one approach that has the best results. Short-term results two to five years after stabilizing surgery seems to have a good track record. Nearly all patients report very little pain and are able to get back to work.

But long-term studies (10 to 15 years later) don’t show an ability to maintain these good results. Wrist range-of-motion and grip strength deteriorate over time. X-rays show gapping between the bones and a progressive change in the angle between the scaphoid and lunate. The end-result is arthritis.

In one study, patients were given a bone-retinaculum-bone graft. In this procedure, the surgeon takes a piece of soft tissue called the retinaculum from the patient’s wrist and uses it to replace the torn ligament. Plugs of bone harvested from the back of the distal radius (forearm bone near the wrist) were inserted into the scaphoid and the lunate. The bone plugs were held in place with screws and wires to create a stable wrist unit.

Some of the patients had good results but others did not. Patients who were weight-lifters or manual laborers performing heavy loading had the worst results. It’s not clear yet whether the graft strength/stiffness or the lack of adequate blood supply to the healing graft was the problem. This problem and possible treatment remains under investigation.

Sometimes a patient is advised to have the reconstructive surgery and follow closely the recommendations of surgeon and hand therapist during recovery and rehabilitation. This would require a lengthy period of time away from weights. Failure of reconstructive surgery leaves the patient with two final choices: have the bones removed from the wrist or wrist fusion.

Your best bet is to work closely with your surgeon to find the best solution for your situation. Type of injury and extent of damage along with activity expectations will all be factored into the final decision. Scapholunate instability is a notoriously challenging problem that requires a long-range approach — not just for the immediate question about returning to weight-lifting but also for wrist and hand function for the rest of your life.