I can see now how dragging my feet and refusing surgery for an unstable wrist joint is catching up with me. About 10 years ago, I fell off a ladder and tore the ligament between the scaphoid and lunate bones in my wrist. Before that injury, I couldn’t have told you the name of even one bone in my body but now I feel like a wrist expert. Unfortunately, the bones twisted inside the wrist. There was a lot of pain and “clunking” that I chose to ignore. Now the joint is destroyed. What happens from here? I mean, what are my options? Do I even have any options?

There are almost always options. Even doing nothing is an option. But hopefully we can offer you some information that will help you make some decisions. The first step, of course, is to see a hand surgeon who can evaluate you and offer you some guidance based on the specifics of your situation.

Treatment is important to restore the delicate balance and stability of the scapholunate joint (at least as much as possible). An accurate understanding of the problem (diagnosis) is essential before planning a course of action. Patient history (what happened, how it happened) is linked with physical exam (signs and symptoms of scapholunate instability) to obtain the necessary clues to make the diagnosis. Radiographs comparing one wrist to the other are advised, including flexion stress and clenched pencil views.

The routine use of advanced imaging (e.g., CT scans, MRIs, arthrography) is not always needed. But in cases like yours with longstanding, chronic changes, extra care may be needed to take a careful, closer look inside. Arthroscopic exam of the wrist (sometimes combined with fluoroscopy, a type of real-time X-ray) is the best way to confirm the diagnosis. The surgeon will be looking for location of damage, severity (partial or complete tears) of injury, and the presence of other soft tissue involvement.

Treatment (or more likely management in the case of chronic injuries) are centered around five-key factors including 1) condition of the scapholunate interosseous ligament, 2) amount of tissue left for a repair, 3) position and angle of the scaphoid bone, 4) possibility of realigning the carpal bones, and 5) condition of the cartilage lining the involved wrist joints.

Treatment varies depending on whether there is a partial tear, complete tear, dislocations, or twisted bones.Ssurgical treatment for more minor, acute injuries usually consists of tissue repair. More extensive damage (whether acute or chronic) may require tissue reconstruction using donor tissue as a graft to replace the damaged ligaments.

Preserving motion by stabilizing the joint and restoring the delicate balance provided by the scapholunate joint are always the desired outcomes. In cases of chronic, long-term scapholunate injuries, joint replacement may be an option. This is a joint preserving treatment that works well for many patients. If joint replacement is not an option or if it fails for any reason, then joint fusion becomes the last resort. Fusion is usually the final treatment offered for irrepairable injuries and deformities.

But before you imagine yourself so far gone that the only thing left to do is fuse the wrist, see a specialist. In the skilled hands of a surgeon, you may find relief from your symptoms, improved strength, and preservation of motion and function.