The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
Expertise · Trust · Access
Hand & Wrist

Wrist Ligament Injuries (Scapholunate / SLAC Wrist)

The wrist depends on a network of intrinsic and extrinsic ligaments to maintain carpal alignment through millions of loading cycles. The scapholunate ligament (SLL) is the most important of these, and its injury (whether acute or chronic) is the most common cause of wrist instability. Left unrecognized, a complete scapholunate ligament tear leads to progressive carpal collapse and wrist arthritis (SLAC wrist). At Maryland Orthopedic Specialists, our hand surgeons diagnose and manage the full spectrum of wrist ligament injuries, from acute tears amenable to primary repair to established collapse requiring reconstructive or salvage procedures.

Ready to get started?

Schedule an appointment with a specialist experienced in treating wrist ligament injuries (scapholunate / slac wrist).

Schedule Now
or call (301) 515-0900

In-network with most major insurance plans. Same-day appointments available for acute injuries.

What is wrist ligament injuries (scapholunate / slac wrist)?

Wrist ligament injuries involve tearing of the ligaments that hold the small wrist bones in alignment, most often the scapholunate ligament. Untreated tears can lead to abnormal bone motion and a pattern of arthritis called SLAC wrist. Symptoms include pain, weakness, swelling, and a sense of instability.

Symptoms — do you recognize these?

  • Wrist pain, often dorsal and radial, after a fall or twisting injury
  • A painful clunk or click with wrist motion (carpal instability)
  • Wrist weakness and reduced grip strength
  • Pain with loading tasks: pushups, weight-bearing on the palm
  • In chronic/SLAC wrist: progressive, diffuse wrist pain and stiffness

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

  • X-rays: PA view (in neutral) may show a widened scapholunate interval (>3 mm = "Terry Thomas sign"); lateral shows DISI deformity (SL angle >60°). However, static X-rays are normal in partial tears.
  • Stress X-rays: Bilateral PA views with axial compression (grip stress views) or bilateral radial deviation views can unmask dynamic instability not visible on static films.
  • MRI arthrogram: The most accurate non-invasive test for SLL integrity. MR arthrography (gadolinium injected into the radiocarpal joint) detects leakage through a torn ligament.
  • Wrist arthroscopy: Gold standard. It allows direct visualization, grading of the tear, and simultaneous treatment.

Treatment options

Non-Operative

Partial ligament tears without instability are treated with splinting and physical therapy; many patients stabilize with conservative care.

Surgical Procedure

Wrist Arthroscopy

Diagnostic and operative arthroscopic evaluation of the wrist joint to assess and treat TFCC tears, scapholunate ligament injuries, synovitis, and loose bodies with minimal disruption to surrounding structures.

Click for more Surgical Procedure

Proximal Row Carpectomy

Motion-preserving wrist salvage procedure that removes the scaphoid, lunate, and triquetrum, allowing the capitate to articulate directly with the lunate fossa. Relieves arthritic pain while preserving meaningful wrist motion in SLAC and SNAC wrist.

Click for more

Recovery & rehabilitation

  • Non-operative: 4–6 weeks immobilization; 2–3 months therapy
  • Primary repair: 8–12 weeks pinning; extensive wrist therapy; return to heavy activities 6–9 months
  • Four-corner fusion / PRC: Cast 6–8 weeks; therapy for 3–4 months; return to full activity 6–9 months

Frequently Asked Questions

Is a scapholunate ligament tear the same as a wrist sprain?
No. A complete SLL tear is a serious carpal instability injury, not a benign sprain. It requires accurate diagnosis and appropriate management to prevent SLAC wrist.
Can SLAC wrist be prevented?
Early recognition and repair of acute SLL tears is the most effective prevention. Once established arthritis develops, salvage procedures rather than preventive treatment become necessary.
Which is better, four-corner fusion or proximal row carpectomy?
Both are effective salvage procedures with high patient satisfaction. PRC is technically simpler and preserves slightly more motion; 4CF may provide better strength for heavier demands. The choice depends on disease stage, patient activity level, and surgeon experience.
How is a scapholunate ligament tear treated, and does it always require surgery?
Treatment depends on whether the tear is partial or complete and how long ago it occurred. Acute partial tears (Grade 1–2) can sometimes be managed with immobilization in a cast or splint for 8–12 weeks, followed by physical therapy. Complete acute tears (Grade 3) almost always benefit from surgical repair to reattach or reconstruct the ligament before the wrist alignment changes permanently. Chronic tears that have already led to early SLAC (scapholunate advanced collapse) wrist deformity are addressed differently. Reconstruction may still be possible in earlier stages, but advanced deformity may require salvage procedures such as partial or complete wrist fusion. Your MOS hand surgeon will stage your injury and recommend the most appropriate intervention for your specific situation.
How long is recovery after wrist ligament surgery?
Recovery after scapholunate ligament repair or reconstruction is measured in months, not weeks. The wrist is typically immobilized in a cast for 8–12 weeks after repair to allow the ligament to heal to bone before any motion is introduced. Physical therapy for motion and strength recovery begins after cast removal and continues for several months. Return to full manual work or sport typically takes 9–12 months, and some patients continue to see improvement for up to 18 months. At MOS, your hand surgeon will provide a clear rehabilitation roadmap and monitor your recovery with serial X-rays to confirm the wrist alignment is being maintained throughout the healing process.

Meet the specialists

Peter G. Fitzgibbons, MD

Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

Meet Dr. Fitzgibbons →

Related conditions

Scaphoid FractureHand & Wrist Arthritis
Medically reviewed by Peter G. Fitzgibbons, MD
Last reviewed May 1, 2026

References

  1. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. Journal of Hand Surgery (American Volume). 1984;9(3):358–365. doi:10.1016/S0363-5023(84)80223-3
  2. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. Journal of Bone and Joint Surgery (American). 1996;78(3):357–365. doi:10.2106/00004623-199603000-00005
  3. Megerle K, Bertel D, Germann G, Lehnhardt M, Hellmich S. Long-term results of dorsal intercarpal ligament capsulodesis for the treatment of chronic scapholunate instability. Journal of Bone and Joint Surgery (British). 2012;94(12):1660–1665. doi:10.1302/0301-620X.94B12.29800
  4. Saltzman BM, Frank JM, Slikker W, et al. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy. Journal of Hand Surgery (European Volume). 2015;40(5):450–457. doi:10.1177/1753193414561038
Call(301) 515-0900Schedule