Partial ligament tear - scapholunate area

Climbing this summer I injured my wrist. It never really bothered me UNLESS i put it in some weird position under a load OR trying to weight it extended in a push up position. After several months of it not healing, I finally got an MRI and in short, the doc said that it is "partially torn and if it were me I would not have surgery." He also said that sometimes these ligaments never totally heal.
Anyone had any experience with this? I have been splinting it for a 5 weeks now but it is no better, no worse. Any advice as to what I can be doing - actively or passively - to expedite the healing process? Any advice would be greatly appreciated.
Thanks

I've had an injury to that area, but hopefully yours is not as serious as mine. Several years back I completely dislocated my lunate bone. After several surgeries, including installing hardware and a carpal release, I now have limited mobility (about 50% upward and downward).
The pain I had in it, and sometimes still do have, is on point with how you've described yours. I have to do push ups on my knuckles instead of hands to avoid pain. Chimneys and mantles can be awkward. I've started wearing a Wristwidget brand wrist brace, they are a little pricey, but they work amazingly well. I highly recommend getting one.
Only advice I can give from my personal experience is to just slowly feel it out. Don't do whatever causes pain, and stretch thoroughly before climbing.
I would also seek out a good physical therapist, especially one familiar with climbing and some of the awkward movements we do.

Thanks Dan. Just to clarify, after surgery, rehab, etc. you still have pain and limited mobility which causes you pain when in weight bearing loaded positions such as push ups and mantels?
Thanks

Yes, I had pain in it continually for a couple years. Usually just a dull ache, but sometimes shooting pains. I didn't really get to do much therapy, because the final diagnosis of the pain ended up be traumatic osteoarthritis, and the doctor felt continued PT would only exacerbate the pain.

It wasn't until several years later (in retrospect, after my forearms had strengthened from climbing) that I was able to get off all meds, including steroid shots, that I would use for any flare ups.

To answer your question more directly: yes, the limited mobility is permanent. And yes, the only time I have any real pain now is from movements that compress the joint (mantles, push ups, etc, and some awkward hand jams).

To prevent flare ups from doing those kinds of movements, I sometimes use weird beta like chicken winging my arm/ back/ shoulder in a chimney, or mantling on my fingertips. Looks strange/ sketchy, but whatever. You'll find what works for you. Just pay attention to the pain and try not to overdo it.

But I would definitely look into that brace, and physical therapy. Sometimes after these injuries you have a limited rehab window to try to get back to 100%

I have a completely torn SL ligament. It hurt quite badly for the first 3 months. Has gotten much better although I still will have pain with compression at times, instability and clicking. Any of the surgical options involve messing with the natural anatomy of the wrist(removing bones, fusing bones or pulling ligaments from other places) and result in loss of mobility and strength even if they go right. I'm worried about SLAC wrist developing, but there was no guarantee surgery would stop it anyway. One surgeon recommended surgery, the other recomended waiting until better procedures were developed or my wrist deteriorated.

Haven't had surgery and it's been 4 years since the injury, feel like I made the right decision although I guess only time will tell. Boxing and mountain biking are out for me as hobbies though.

In your case if they're telling you that they might be able to actually repair the ligament, might be worth talking to a couple surgeons about beceause a partially torn ligament is more likely to become a fully torn ligament, and there are no good surgical options at that point.

My wrist didn't get better until after stopped using a brace. Although I also wore one for about a month.(I also had an exploratory arthroscopy where they went in to determine whether I had a complete or partial tear and they might have "cleaned" it up(debrided) when they went in.)

I am rehabing three injuries sustained on three different occasions: knee (stepping off a bike while trying to catch a fall), rotator cuff (stupid maneuver at the gym), and wrist from monkeying around on monkey bars with a friend's kid. I have seen a PT, not an orthopedist, for all three and have gotten similar advice: rest from climbing or any other strenuous activity, physical therapy, icing afterwards, anti inflammatory. And that it takes time.

My wrist injury feel exactly like yours. I am sleeping in a brace which helps to avoid awkward positions at night. I don't take anti inflammatory because I don't tolerate them well. I use Thera-band flex bar for PT. It's been getting better slowly, but recovery sped up after I had to stop climbing due to partial tear in rotator cuff. Somehow I feel better about taking a break from climbing because I get 3 for 1, hahaha.

Thank you all. I appreciate the advice and consult
Dan - so NOT wearing the brace seems to help?

I only wear mine (wrist widget) when I climb, and I used to wear the metal bar type brace when I worked with hand tools a lot.

Normajean brought up an excellent point I forgot to mention about sleeping with your wrist in awkward positions. I used to sleep with a brace, but found that it caused me pain (not sure why). Now I just sleep with my arm from my elbow to my fingers laying flat across a pillow. Making sure your wrist isn't tweaked while you sleep is super important. I've also found its equally important to make sure my wrist it warm throughout the night, the cold causes issues too, though that may just be a symptom of my osteoarthritis. One awkward night of sleep can screw your wrist up for WEEKS.

Normajean, I would recommend seeing an ortho for the wrist. If there is a partial tear they can fix it, if it tears all the way there is no good fix. If I had gone to an ortho sooner I might not have a SLAC ticking time bomb on my wrist

I had an accident this year in the gym I work at in SF and it resulted in a torn TFCC, completely torn SL and a ganglion cyst. My orthodontist has worked with climbers before and told me if it had been one of those injuries he would have just let it be. But the severity of the injuries forced surgery. It's been about five months since surgery, my ROM is almost 90% and I'm climbing again! When I started I did wear a brace but now I'm just taping and keeping tabs on pain.

Just keep an eye on your pain levels and do t push it!

Marissa Morales wrote:My orthodontist has worked with climbers before and told me if it had been one of those injuries he would have just let it be.

Any updates Mark? Curious to hear if you had the surgery or not and how it has healed.

I had this surgery 4 months ago for a completely torn SL Ligament. The surgery was early enough that the existing tissue could be used. It was casted for 3 months with wires in. The wrist is still in rehab but it seems things are going as well as can be expected. 

Never had the surgery. It seems to be about 75-80%?  Gets achy after a day of climbing. I have yet to spend a hours climbing SUPER hard on it so that might set it back?

Thanks for asking!

So I totally ruptured the SL ligament and tore the TFCC.

Had multiple scans including MRIs. specialist said that surgery is risky but if I do nothing then the wrist bones separate and grind away the cartilage causing severe arthritis and pain that requires fusing of the wrist. I was told fusing likely within 5-10 years depending on how much I use my wrist.

Had the operation in 2011 , 6 months doing nothing then slow return to climbing. After 2 years 85% strength back and 6 yrs later I can't do push-ups but back to climbing pretty much as normal. 1 major difference when I crack climb I wrap my wrist with thickish protection (a cut down old climbing glove). The doc said that a sharp pebble pressing against the wrong spot could tear the permanent stitches in the ligament.

Before surgery with a bit of manipulation I was able to climb pretty well again making the surgery quite a scary option given the risks.

Most important - get a good doctor as the risks are real.

as an aside - I know 2 climbers with same problem but they did not surgically repair the ligament- 1 has a fused wrist now and the other is delaying the fusing 

David Bruneau wrote:

Any updates Mark? Curious to hear if you had the surgery or not and how it has healed.

I had this surgery 4 months ago for a completely torn SL Ligament. The surgery was early enough that the existing tissue could be used. It was casted for 3 months with wires in. The wrist is still in rehab but it seems things are going as well as can be expected. 

I am back to climbing 9 months after surgery - close to my limit on vertical terrain but still struggling a bit on overhangs and slopers. I have been slacking a bit with the physio. It's far better than it was before the surgery, at 60-80% strength depending on the type of motion. 

done

I came here seeking information & case studies for a fully torn SLL    ...I am a life long surfer traveller completely body aware and now more than a little confused as to the best course of action    I've spoken to two surgeons had X-rays and MRI and both not surprisingly wish to operate ....basically the more information I find and read I am felling less likely to consent to surgery.    I have a great hand therapist & a daily discipline adapted from a lifetimes practice of yoga.    I'm uncomfortable with the prospect of surgery given the unconclusive results ... I'm now 3 months from initial injury and feeling with care and training that my body could do a great job of adaption & survival      But do have reservations as to the negatives in the future   Arthritis etc    ...really appreciate any more thoughts from those of you who've  adapted either way   

Ryan M Moore wrote: I have a completely torn SL ligament. It hurt quite badly for the first 3 months. Has gotten much better although I still will have pain with compression at times, instability and clicking. Any of the surgical options involve messing with the natural anatomy of the wrist(removing bones, fusing bones or pulling ligaments from other places) and result in loss of mobility and strength even if they go right. I'm worried about SLAC wrist developing, but there was no guarantee surgery would stop it anyway. One surgeon recommended surgery, the other recomended waiting until better procedures were developed or my wrist deteriorated. Haven't had surgery and it's been 4 years since the injury, feel like I made the right decision although I guess only time will tell. Boxing and mountain biking are out for me as hobbies though. In your case if they're telling you that they might be able to actually repair the ligament, might be worth talking to a couple surgeons about beceause a partially torn ligament is more likely to become a fully torn ligament, and there are no good surgical options at that point. My wrist didn't get better until after stopped using a brace. Although I also wore one for about a month.(I also had an exploratory arthroscopy where they went in to determine whether I had a complete or partial tear and they might have "cleaned" it up(debrided) when they went in.)

Should not have read this, now I am terrified of hurting my wrist like this...

Ness Erskine wrote:

I came here seeking information & case studies for a fully torn SLL    ...I am a life long surfer traveller completely body aware and now more than a little confused as to the best course of action    I've spoken to two surgeons had X-rays and MRI and both not surprisingly wish to operate ....basically the more information I find and read I am felling less likely to consent to surgery.    I have a great hand therapist & a daily discipline adapted from a lifetimes practice of yoga.    I'm uncomfortable with the prospect of surgery given the unconclusive results ... I'm now 3 months from initial injury and feeling with care and training that my body could do a great job of adaption & survival      But do have reservations as to the negatives in the future   Arthritis etc    ...really appreciate any more thoughts from those of you who've  adapted either way   

I had a fully ruptured SLL too. Good manipulation by an excellent osteopath gave me zero pain and almost full functionality. The risks for surgery are real and very scary particularly complex regional pain syndrome. So it is a big call to have the surgery. However in 5 -10 years arthritis will be so bad that the only pain relief is fusion. This is not a maybe but a certainty ( per 3 different surgeons I consulted). I now have 2 friends with fused wrists. (Ther other one just had the surgery).

So can you live with a fused wrist in the future?

On the flip side, post surgery I have had an excellent result and very happy I made the decision. But pick the hand best surgeon as the results are dependant on who does the surgery. My surgery cost a fortune but was worth every cent. I researched surgeons, consulted the best 3 and picked the best.

Ps this was 7 years ago and knowledge and techniques may have moved on (although I don't think stem cell or prp will help with a complete rupture. I just ruptured my distal bicep tendon and am 1 month post surgery. as my surgeon said - with some problems the best we can do is sow it up and use the drill. In 50 years that will seem barbaric but it is the best we can do today.)

Interesting thread. Here's a quick version of my story which might be helpful to some.  About 4 years ago I suffered a partial SLL tear, and then maybe 6 months later a complete SLL tear.  I saw 4 different hand surgeons, who told me that essentially climbing or hard climbing was over.  Several were keen to operate.  I researched the plethora of surgical repair options, which frankly tend to have not-so-great outcomes. Some kind folks on MP shared their experiences with me.  I spent a lot of time on PubMed, and talking with surgeons, hand therapists, and others.  After much work in PT to try to rehab the wrist, and not great outcomes, I found a surgeon in San Francisco who had just come up with a new alternative surgical repair.  I met with her, and was one of her very earlier surgeries.  Essentially, it mimics ACL repair, but done in the wrist with smaller cannulated screws.  I've now got 2 pieces of cadaver tendon going from the scaphoid, to the lunate and the triquetrum.  Much PT followed surgery.

The wrist is stable, painfree, and I have almost complete range of motion.  I'm training, hangboarding, campusing, and climbing a lot.  I'm back to where I was pre-injury I'd say in terms of climbing performance (occasionally flashing 12d and redpointing to 13+, and falling off easy boulder problems). So I'm certainly stressing my wrist on a regular basis, and have been back going hard for about 2 years now. YMMV, but I think her surgery (which is still quite new) is definitely a better option than what was previously available.  I'm happy to share the surgeon's contact info if you send me a message, or a poster she put together at an early stage where she had done some cadaver tests with her surgery vs. other more common options.  I think quite a few handsurgeons are now using her technique, but I'm definitely not up on that.  SLAC is out of the picture, and I don't feel limited ever by my wrist.  Before the surgery, I really thought I was done with climbing, which was quite a bummer.  Now I've got my life back.