Scapholunate Ligament Reconstruction

[dibblego]

Hello,
I am a squash player who has had a minor (right) wrist problem for many years. I am right-handed. About 3 years ago, the problem suddenly got worse. I saw a specialist who performed a debridement of the S/L after a tear was indicated on MRI in June 2008.

Today, I am no better off, unable to continue to playing squash, which I'd dearly love to do. I saw another specialist who repeated the MRI and found that the ligament is mostly absent due to repeated tear. However, there is no bone (scaphoid/lunate) dissociation. It is also painful on extension -- not so much with flexion.

Therefore, the question of whether or not to proceed with surgical reconstruction (tendon graft) is a tough call. The surgeon has left this decision with me after explaining I'd lose some ROM, mostly flexion (which is not such a big deal as extension). I'd truly love to play squash and if I was confident that this procedure would give me a good chance of doing so, I'd go for it.

Can anyone help with advice on this matter? Thanks for any tips.

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[jackjack]

HI!

I had this operation done about 6 months ago, I was a keen weight lifter, had trouble 3 years ago, not alot of pain but it did hurt, I was told it was tendonitis and put in a splint for 2 weeks, it got better, but kept coming back, eventually after 2 1/2 years of pain I got referred to a specialist who said it was a S-L tear and I needed a reconstruction.

The pain is much reduced, but you need to be aware the reconstruction many stretch over time and therefore not be as useful as it was in the beginning, the next step is another operation, i think my surgeon said it would be a partial wrist fusion which would stop any sort of weigh lifting for me.

At the moment I have 60-70% flexion and 5% extension, the surgeon thinks the extension will increase more over time as everything is still bonded VERY tightly right now, so I can possibly expect 50% extension max, flexion should get to around 80% when things are fully mobile again.

With this op, I was told, it's a big op so if you can manage without it then deal with the pain, however as my job is a fire fighter I needed to be able to use my hands without pain, so I took the chance and it seems to be doing OK, i start back on full duties in 2 weeks!!!!

Think hard before having the op mate and you should protect your new wrist as much as possible when using it, remember the wrist you have today is the one you will have for the rest of your life!!

[dibblego]

Thanks jackjack. Shit mate, 6 months before full duties sounds a bit rough. How do you think you'd go at a racket sport like squash?

[jackjack]

My problem at the moment is excessive scar tissue, everything has repaired very well, but the down side of that there are alot of adhesions inside where he did the op and everything he cut has bonbed very tightly. Most people get scar tissue that restricts slight movement, some more than others! He has many other patients who have had the same op that have full or almost full range of movement well before the 6 month mark, it's totally a personal thing, cannot really be predicted unless you have had issues in the past with previous scar tissue.

As for racket sport for me personally i'd say, yes I could play, just. I don't play squash or tennis but i'd say my main issue would be putting top or bottom spin (I hope thats the right phrase hehe) on a ball as I cannot (at the moment) flick my wrist into flexion enough. I could do basic shots, but any other shot would need some sort of adaption from me as a person.

I cannot move my hand back enough to do a press up, which obviously has consequences with opening doors ect, but you adapt, I now do everything with a fist or a fist with my thumb out, I crawl with my hands in a fist position rather than palm down, etc.

But please don't be put off by my experience, most people don't end up with the amount of scar tissue I have and therefore have ALOT more motion.

I'm still glad I had it done, i'd sooner loose some motion (alot in my case) to get rid of the pain.

[dibblego]

Thanks mate for the tip. I just got back from the squash court and my wrist is completely hosed. I think I have to go for it regardless. Got any more tips? Spending 8 weeks in a cast with a pinned joint sounds a bit inconvenient -- how did you do it?

[jackjack]

I was 6 weeks in a cast and then had another 6 weeks out of cast before I could go back to work, sick note was 12 weeks. I didn't have the joint pinned, it was done without all that, so can't really comment on having it pinned, sorry.

When I was in a cast I didn't have many issues, itching wasn't that bad either, I used a hair dryer (on cold ) to blow down the cast which helped abit. Sometimes when your arm or hand twitches, or if someone makes you jump, it can hurt alittle hehe, things like this only seemed to hurt for the first few weeks. Make sure to keeps moving your fingers to avoid them becoming stiff aswell!

All I'd say is, when your out of cast, take it slow, it will still hurt to do things as the joint regains it's mobility, massage the scar tissue to unteather it from the scar tissue underneath. Just be ready for a very weak hand and arm when you are out of the case, you will literally be able to see the difference.

Honestly, good luck with it mate! Any idea when they are talking about doing it?

[dibblego]

Going to see the doctor next week to give the go ahead, so probably a week or so after that. I'm planning to take one week from work (I do lots of maths at a desk).

[dibblego]

Hey mate, I am booked for surgery 21 July.

[dibblego]

Correction to the previous post: Surgery is 12 July.

[worshiper]

Chronic scapholunate ligament instability remains an unsolved problem. A variety of approaches have been described, including bone procedures, such as limited intercarpal fusions and proximal row carpectomy, as well as soft tissue procedures of ligament reconstruction such as direct repair, capsulodesis, tendon graft, and bone-ligament-bone graft. None are entirely satisfactory because of the common outcome of late failure. These cases demonstrate an unpublished soft tissue technique, employing a strip of extensor retinaculum attached to the dorsal triquetrum, inserted into the distal dorsal scaphoid to construct a dorsal intercarpal support along the path of the normal scaphotriquetral ligament.

[marlon]

its been 6 yrs how are you doing right now? tnx

[jackjack]

Great stuff mate, not long now! Let us know how it goes, hope it goes good for you!

Jack

[Damo]

Great Thread, enjoyed all the comments!

[clumsygirl]

Hey there, I'm a new member and I saw this thread. I fell and broke my scaphoid last april and didnt realise, so it was untreated for 12 weeks. Then I fell again in february this year on the ice and ended up in a cast (though luckily it turned out not to be broke again). After 2 MRIs and a op to have a look inside the wrist, Ive been given the option to have a further one to graft tendon over, which sounds very similar to the one being discussed in this thread.

The reason why i'm posting, is that my job is a boom operator for tv. Its quite a physical, and whilst doing my job, my wrist gets bent back (like when you do a pressup). The pole that I hold gets heavy after a few takes, and I still have to maintain mobility to adjust it. What do people think I can expect from the op? Will I be able to do my job again? I noticed a loss of mobility was mentioned. (currently not doing that part of my job, as my physio told me if I carried on with the amount of work I do, I'd get arthritis in my wrist early). Would it be worth me having the op?

I'm still getting pain in my wrist, but not that often (think its due to me avoiding things that i know will hurt)

Any advice would be greatly appreciated!

thanks

[jackjack]

Hey!

Just for your info, i'm a fire fighter so like you I need my hands to do my job.

Currently, I cannot do a press up with my hand bent back, it simply doesn't go back enough to do one comfortably. When i've tried my arm isn't as vertical as my other arm due to the loss of backward motion of the hand. However, my hand does go back to around 2/3rd's of full motion, so when I lift heavy objects above my head, for instance ladders, my hand is not as bent back as it used to be, which makes it slightly harder to lift things, but as the hand is as far back as it will go you adapt to it.

What i'm trying to say is, normally your natural hand position for your job will be fully bent back, after the op you may not have as much as you had before, but what you are left with will be your NEW natural motion and you will get used to it and adapt how you do things slightly.

Not everyone loses motion, some keep the same motion or lose just a little, some on the other hand lose alot... (i'm the latter hehe )

Jack

[clumsygirl]

cheers

i'm off to see a consultant later on this month, i just hope something can get sorted, as its possibly altering my whole career.

Ands