This handout explains the follow-up care after the surgery to repair your scapholunate ligament (SLL). The SLL is a complex ligament (Fig 1). When it ruptures, the wrist collapses (Fig 2). The ligament repair depends on the type of injury, but the goal is to reconstruct the biomechanics of the original ligament (Fig 3). This ligament is very difficult to repair and is analogous to the ACL of the knee. The splint is there for your protection. It is important to move your fingers to avoid stiffness, but please do not lift anything with the operable hand. It is important to protect the repair for approximately 3 months after surgery.

We placed a drain to remove excess fluid and to minimize the risk of infection. While the drain is in place, please make sure to take the antibiotics that were prescribed to you. Please coordinate with our office so that you have an appointment 2 days after surgery, to remove the drain. Alternatively, you may remove the drain at home with instructions for the postoperative nurses in the surgery center. Please see the pain medication form for more detailed information about the postoperative medications to avoid pain, nausea and constipation. If the incision is red or if there is drainage coming out of it, please call us right away. The phone number is listed on the bottom of the page. Go to the emergency room if this occurs at a night or on a weekend.

Wound Care:

  • After surgery, your hand and wrist will be placed into a splint that includes your thumb, forearm, and elbow. The splint helps to protect the surgical repair and lessen the swelling.
  • Elevate your hand as much as possible after the surgery to lessen the swelling. A fair amount of swelling after this surgery is normal.
  • When you shower, cover the splint with a plastic bag to keep it clean and dry.
  • Partial tears can be repaired arthroscopically with a small incision on the thumb side of the wrist. Larger and complete tears require incisions on the back of the hand or the front or both.

Pain Management:

  • You will receive a prescription for narcotic pain medication. Take this with your medication as directed. It is important to “stay ahead” of your pain medication and avoid having to play “catch up” for significant increases in pain. Medication for nausea will also be provided. Please make sure to take this as directed.
  • Please make sure to check with the postoperative nurses and the office staff at Bellevue Bone & Joint Physicians about how to manage your pain medication. To best manage your pain, you must take the pain medication the way it was prescribed. Taking the correct dose at the right time is very important.
  • If you have uncomfortable side effects from the pain medication, please call us at 425-462-9800.
  • Please see “medications after surgery” information form for more instructions.
  • It is normal to have some pain off and on for approximately one year after surgery, particularly in cold weather.

Driving:

  • Do not drive if you are taking narcotic medications, as it is not safe and against Washington state law. Taking medication can make you sleepy and delay your reaction time.
  • Once you are no longer taking narcotic medication, you may drive as soon as you can comfortably grip the steering wheel with both hands.

Activity:

  • Please begin gently exercising your fingers after surgery by bending and straightening your fingers as often as possible to prevent joint stiffness.
  • Exercise your shoulder by raising your arm overhead several times a day to prevent stiffness, because you will not be using your hand and arm for everyday activities.
  • Do not lift anything heavier than a full soda can (about 1 pound or 0.45 kg) until you have been recommended to increase your lifting activities by your physician or therapist.
  • Avoid activities that can make you strain or sweat. Do not return to contact sports for six to nine months after surgery.

Follow-Up:

  • Your sutures will be removed 10 to 14 days after surgery. Your arm will be placed into a cast or brace that includes a thumb, wrist, and hand. If needed, you will be referred to a physical therapist to review exercises for your fingers and to control swelling.
  • Six weeks after surgery, a removable brace can be used to protect the hand and wrist. Even with this brace, do not lift weights any heavier than that of a soda can (1 pound or 0.45 kg).

Surgery To Remove Surgical Implants:

  • In large and unstable ligament tears, a screw is used to repair the scaphoid and lunate bones together with a reconstruction of the ligament. This helps to protect the ligament while it is healing. The screw stays in for three to five months. You may need a minor outpatient surgery to remove this as a secondary procedure.
  • Once the screw is removed, we can increase your hand therapy to include wrist motion and gentle strengthening exercises.

Results:

Most patients with scapholunate ligament repair will recover excellent function with improved strength. However, there is some loss of wrist motion due to scar formation that occurs as the ligament heals.


Thomas E. Trumble, M.D.

*Figures courtesy of Principles of Hand Surgery and Therapy by Thomas E. Trumble, MD, Ghazi M. Rayan, MD, Mark E. Baratz, MD and Jeffrey E. Budoff, MD