If you’ve had wrist pain since a fall, or your wrist just doesn’t feel right when pushing, lifting, or using tools, there’s a chance you’ve injured a key stabilising structure in your wrist — the scapholunate ligament.

It’s an injury that’s often missed, but if left untreated, it can lead to long-term issues like weakness, clunking, and even early arthritis.

🧱 What Is the Scapholunate Ligament?

Your wrist is made up of many small bones. Two of these — the scaphoid and lunate — are held together by the scapholunate ligament.

This ligament acts like a keystone in an arch, quietly holding things together. You don’t notice it when it’s working, but if it tears or becomes unstable, your wrist may feel weak, painful, or unreliable — especially during pushing or weight-bearing tasks.

🤕 How Does This Injury Happen?

The most common cause is a fall onto an outstretched hand, especially when the wrist is bent backwards and angled slightly toward the pinky side. This position puts a lot of stress on the ligament and can cause it to stretch or tear.

But you don’t always need a fall to injure it.

⚠️ Other Causes of Scapholunate Ligament Injury

There are three main ways this ligament can be injured:

Cause	How it Happens	Common in…
Traumatic	A sudden force through the wrist (e.g. fall on an outstretched hand, drill kickback)	Tradies, athletes, climbers
Degenerative	Wear and tear over time due to repetitive use or ageing	Manual workers, middle-aged adults
Inflammatory	Ongoing joint inflammation (like in rheumatoid arthritis) weakens the ligament over time	People with RA, lupus, or autoimmune arthritis

🛠️ Examples of Each:

• Trauma: Tripping and landing on your hand, or using a power drill that suddenly jerks back — a known “wrist breaker” injury.
• Degeneration: Years of using your wrist heavily — lifting, twisting, gripping — slowly breaks down the ligament without you even realising.
• Inflammation: Conditions like rheumatoid arthritis cause the joint lining to become inflamed, which eats away at nearby ligaments over time.

In all three cases, the end result can be the same: wrist pain, instability, and loss of function.

🧩 Signs and Symptoms to Look Out For

• Pain in the middle or thumb-side of the wrist
• Discomfort when pushing (e.g. getting off the floor, doing push-ups)
• Clicking or clunking during movement
• Weak grip or wrist fatigue
• A feeling that your wrist “gives out” or isn’t trustworthy

🖼️ Why It’s Often Missed

Scapholunate injuries don’t always show up on a normal wrist X-ray. Early or partial tears may look fine — even though the ligament is damaged.

That’s why special tests may be needed:

• Clenched fist X-rays (taken while making a fist)
• MRI or MR arthrogram to look at soft tissue
• Wrist arthroscopy (camera inside the joint) to confirm the diagnosis

🧰 What Can You Do About It?

✅ Milder or Early-Stage Injuries

With partial tears or early changes, many people can avoid surgery and recover with:

• Wrist support (splint or tape)
• Reducing painful activities
• Specific exercises to restore wrist stability and control
• Close monitoring over time

🕒 Recovery takes time — often 3 to 6 months — but many return to full function with guided rehab.

⚠️ More Severe or Long-Standing Injuries

If the ligament is fully torn or the bones are no longer aligned, you may:

• Need referral to a hand specialist
• Consider imaging to rule out instability or early arthritis
• In some cases, surgery is considered (especially if instability affects daily function)

🔥 Inflammatory Causes: What’s Different?

If the cause is inflammation (like rheumatoid arthritis), treatment may also include:

• Referral to a rheumatologist for disease-modifying medications
• Wrist protection during flare-ups
• Modified rehab that accounts for joint sensitivity
• In some cases, early ligament or joint preservation surgery if instability worsens

🧠 Important: Inflammatory joint conditions can cause ligament damage silently — so if you have RA and your wrist feels unstable, don’t ignore it.

🧠 Recovery Tips from a Hand Physio

• 🔒 Don’t rush back to load — build control first
• 🖐️ Train your wrist in neutral before adding push or grip movements
• ⚖️ Use wobble boards, laser pointers, or bodyweight shifts to retrain coordination
• 🧗 Climbers: Avoid palm presses and mantles early on. Use neutral hangs if needed.
• 🛠️ Tradies: Be cautious with drills and power tools. Use both hands where possible and keep your wrist neutral.

🚩 When to Get It Checked

• Pain that’s not improving after 4–6 weeks
• Clicking, catching, or a clunking sensation
• Weakness, loss of grip, or a sense of instability
• You’ve had a fall or power tool injury
• You have rheumatoid arthritis and your wrist feels “off”

👋 We Can Help

At Crux Physio & Hand Therapy, we’re experts in managing hand and wrist injuries — especially those that are often missed or misunderstood.

Whether your injury came from a fall, your tools, or a chronic condition, we’ll give you:

• A clear diagnosis
• Personalised rehab
• Hands-on care and advice to rebuild confidence in your wrist again