Do you sometimes feel something strange or painful in your wrist? Maybe this pain started when you fell, lifted something heavy, or played sports. Most of the time, we think, "Oh, it's just a sprain." But sometimes, this can be a condition that requires a little more attention. That's what we're going to talk about today, a condition that occurs in the wrist that requires a little more in-depth examination.
What is this dislocation of the wrist bone? (Scapholunate Dissociation)
Simply put, this `(Scapholunate Dissociation)` is when two small bones in our wrist, the `Scaphoid` bone and the `Lunate` bone, move slightly apart from where they should be, creating a gap, or `gap`, between them. To be precise, these two bones are connected to each other by a very strong ligament, which we call the `Scapholunate Interosseous Ligament (SLIL). In some accident, especially when the hand is twisted and falls, this `ligament` can tear. That's when the connection between the two bones becomes loose, and they start to move around. When you use your wrist, these two bones move away from each other, or `dissociate`.
This is like a knot that has been tied together by two ropes. As long as the knot is tight, the two ropes are together, but as the knot is loosened, the two ropes move apart.
Who is more likely to develop this condition?
In fact, this condition called `(Scapholunate Dissociation)` can occur in anyone, regardless of gender, race, or religion. However, the highest risk is for those who fall on their hands and knees . Imagine, you are walking on the street and suddenly slip, and then we automatically put our hands on the ground to save ourselves. That is when this accident is most likely to happen.
How common is this condition?
As we can see, when we look at other wrist sprains, this `(Scapholunate Dissociation)` condition can be seen in about 5% (`5%`) of cases . Also, some fractures in the wrist area, especially those of the type we call ``distal radius fractures``, that is, when the large bone in the hand breaks close to the wrist, can be seen in about 40% (`40%`) of cases with this `(SL dissociation)` condition . There are some special fractures, like ``chauffeur fractures``, with which this is often seen.
Why is this happening? What are the reasons?
As I mentioned before, the main cause of this is often ``falling on an outstretched hand`` . To be precise, when you fall and put your hand on the ground and put weight on it, the pressure can tear the ``scapholunate interosseous ligament (SLIL)``.
Apart from that, there may be several other reasons:
- Holding the steering wheel tightly during a vehicle accident, such as a car: This ligament can be damaged by the impact on the hand during a sudden collision.
- Some hereditary conditions: For example, conditions like `Hereditary Spastic Paraparesis`.
- Congenital Ligament Laxity: Some people are born with loose ligaments in their joints. This is also more likely to happen to them.
- Rheumatoid Arthritis: This is a disease that causes inflammation of the joints. This disease can also cause the ligaments to weaken, which can lead to this condition.
What are the symptoms of this? How does it feel?
If you have a condition called ``Scapholunate Dissociation'', you will typically experience the following:
- Pain on the back of the wrist, especially when gripping something tightly (`strong gripping motion`) : for example, when opening a bottle cap or gripping a doorknob.
- Weakness in grip strength: An inability to grip things as tightly as before.
- Swelling and tenderness around the wrist: The area around the wrist is swollen and painful to touch.
- Pain when extending your wrist: It hurts when you turn your hand over.
- Sometimes you may hear a "clicking" sound coming from your wrist.
Remember, these symptoms don't occur the same for everyone. Some people experience more pain, some less. So, if you feel anything unusual in your wrist, it's best to see a doctor.
How does a doctor diagnose this?
When you go to see a doctor, they will first ask you about your symptoms. How long have you had the pain, how did it start, and when does it get worse? Then they will examine your wrist to see if there is any pain, swelling, or tenderness.
In addition, a doctor may perform tests such as:
- Scaphoid Shift Test: In this test, the doctor places his or her hand on top of your scaphoid bone and moves your wrist. This test checks the stability of the scaphoid bone.
- X-ray: This can show how large the gap is between the scaphoid and lunate bones (scapholunate gap). Usually, this gap is 2 millimeters (2 mm) or less. However, in the case of SL dissociation, this gap can be 5 millimeters (5 mm) or more. Sometimes, you can see something called a "ring sign" on an X-ray. This is a misalignment of the scaphoid bone.
- MRI (Magnetic Resonance Imaging): An MRI can be very helpful in determining whether the scapholunate interosseous ligament (SLIL) is torn. It can provide a good picture of the soft tissues surrounding the bone.
- Arthroscopy: This involves making a very small incision and inserting a camera (scope) through it to look inside the joint. This allows you to see the damage to the ligaments directly. Sometimes, treatment can be done at the same time as the arthroscopy.
How is this treated? (Treatment)
When treating a condition called `Scapholunate Dissociation`, the first things to do are:
- Analgesics: Medicines are given to reduce pain.
- Splinting: A special splint is used to immobilize the wrist and thumb. This helps the damaged ligaments heal.
Then, your doctor will likely refer you to a hand specialist. This condition often requires hand surgery within six weeks of the injury.
During surgery, you will either be given general anesthesia (meaning you will be completely asleep), or regional anesthesia (meaning you will only be numbed). During surgery, the doctor will:
- A small incision is made on the back of the wrist.
- The damaged tissue is removed and cleaned.
- Then, to close the gap between the scaphoid and lunate bones, that is, to bring the two bones back together, you use something like a tendon taken from somewhere else in your own body, a suture, or a metal screw.
- Finally, the incision is sewn back together.
What can I do to reduce this risk?
To reduce the risk of `(Scapholunate Dissociation)`, the most important thing is to take steps to protect yourself from falls. You can do things like:
- Engaging in exercises that improve balance, coordination, and strength.
- Removing trip hazards in the home. For example, check for loose cords, poor lighting, and rugs.
- If necessary, use an assistive device such as a cane or walker.
- Wearing flat, sturdy, good traction shoes.
What can I expect if I have this condition? (Complications)
If you don't get treatment for SL dissociation quickly, complications like these can occur:
- Chronic pain: You may have ongoing wrist pain.
- Inflammatory arthritis: Arthritis can develop with inflammation of the joint.
- Joint instability: The wrist may feel as if it is moving uncontrollably.
- Reduced grip strength: You may not be able to grip things properly.
- Scapholunate Advanced Collapse (SLAC) Ankle: This is a degenerative arthritis condition that causes the wrist joint to wear down. This can be very painful.
How long will it take for me to recover if I have (Scapholunate Dissociation)? (Outlook)
If you have surgery for SL dissociation, you will need to wear a cast for a few weeks afterward. After the doctor removes it, physical therapy will help your wrist regain strength. With proper treatment and physical therapy, you should be able to return to your normal activities within a few months.
How do I take care of myself with Scapholunate Dissociation?
After treatment for SL dissociation, talk to your doctor about what types of activities and exercises you can safely do. There are specific exercise programs that can help you regain strength and range of motion in your wrist. Never go beyond what your doctor tells you to do and do things that are too hard on your wrist.
Take-Home Message
Okay, so the `Scapholunate Dissociation` we talked about is when the two small bones in the wrist, the `Scaphoid` and `Lunate`, move out of place, creating a gap between them. The main cause of this is damage to the `Ligament` that connects these two bones. This often happens when you fall with your arm outstretched.
The main symptoms are wrist pain, swelling, tenderness, and decreased grip strength. A doctor uses tests such as the scaphoid shift test, X-rays, MRIs, and arthroscopy to diagnose this.
Surgery is often the best treatment. With proper treatment and physical therapy, most people can return to their normal activities within a few months. Therefore, if you have persistent pain or discomfort in your wrist, it is important to see a doctor and get advice rather than assuming it is just a sprain.
` Wrist, Wrist Pain, Hand Bones, Ligaments, Scapholunate Dissociation, Fracture, Surgery
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