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This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• The ulnar nerve is the most frequently involved nerve in revision total elbow arthroplasty [1].
• Radial nerve injury accounts for a substantial proportion of nerve injuries in revision total elbow arthroplasty [1].
• Anatomical anterior and posterior reconstruction for scapholunate dissociation resulted in no patients requiring secondary surgery or treatment related to carpal stabilization [2].
• A negative MRI result is unable to rule out clinically relevant injury to the triangular fibrocartilage complex (TFCC) of the wrist [4].
• A negative MRI result is unable to rule out clinically relevant injury to the scapholunate (SL) ligament of the wrist [4].
• A negative MRI result is unable to rule out clinically relevant injury to the lunotriquetral (LT) ligament of the wrist [4].
• Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears showed encouraging preliminary results in a series of 36 patients [5].
• Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears provided pain relief [5].
• Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears allowed recovery of grip strength [5].
• Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears had a low incidence of postoperative wrist stiffness [5].
• All professional athletes in the series of 36 patients returned to preinjury sports levels following arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears [5].
• Radioscapholunate arthrodesis with compression screws and local autograft is an effective method for appropriately selected patients with a preserved midcarpal joint [7].
• Radioscapholunate arthrodesis with compression screws and local autograft achieved a 100% union rate at a mean follow-up of 12 months [7].
• Radioscapholunate arthrodesis with compression screws and local autograft had no complications in the reported series [7].
• There is a lack of consensus in carpal tunnel management for patients with perilunate dislocations [9].
• The lack of consensus in carpal tunnel management for perilunate dislocations is due to few studies with small sample sizes and inconsistent follow-up [9].
• Both wrist arthrodesis and revision total wrist arthroplasty (TWA) are technically demanding procedures [10].
• Revision wrist arthroplasty strategies should be performed with multidisciplinary team input, preferably in a specialist centre [10].

Anatomy & Pathophysiology¶

• A negative MRI result cannot rule out clinically relevant injuries to the triangular fibrocartilage complex (TFCC), scapholunate (SL) ligament, or lunotriquetral (LT) ligament [4].
• Four-dimensional computed tomography (4DCT) is a non-invasive and affordable method to assess and quantify wrist kinematics by incorporating the temporal dimension [3].
• An individualized, multimodal approach combining clinical examination, imaging, and direct arthroscopic evaluation is essential for early diagnosis of scapholunate injuries and prevention of arthritis progression [12].
• Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury without structural instability [14].
• A consistent longitudinal branch of the posterior antebrachial cutaneous nerve (PABCN) courses over the interval between the brachioradialis and the extensor carpi radialis longus in the proximal third of the forearm [15].

Classification¶

• Four-dimensional computed tomography (4DCT) is a method to assess and quantify wrist kinematics by incorporating the temporal dimension [3].
• A negative MRI result cannot rule out clinically relevant injury to the triangular fibrocartilage complex (TFCC), scapholunate (SL) ligament, or lunotriquetral (LT) ligament [4].
• Dorsal extrinsic ligaments demonstrate MRI signal changes suggestive of acute or chronic injury in patients with an SL interval of 2 mm or greater more often than in patients with an SL interval less than 2 mm [8].
• An individualized, multimodal approach combining clinical examination, imaging, and direct arthroscopic evaluation is essential for early diagnosis of SL injuries [12].
• Lunate fracture-subluxations are unstable injuries best managed with fixation of the carpal fractures [18].
• Lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures, and ligament injuries [18].

Clinical Presentation¶

• Ulnar nerve injury is the most frequently involved nerve injury in revision total elbow arthroplasty [1].
• There is a lack of consensus on carpal tunnel management in patients with perilunate dislocations due to few studies with small sample sizes and inconsistent follow-up [9].
• Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury [14].
• Patients with dorsal radiotriquetral ligament snapping wrist syndrome demonstrated complete resolution of symptoms after debridement of thickened scar tissue on the undersurface of the dorsal radiotriquetral ligament [16].
• Lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures, and ligament injuries, and are associated with common complications [18].
• Symptomatic improvement can occur following carpal tunnel release in patients with severe carpal tunnel syndrome [26].

Investigations¶

• Four-dimensional computed tomography (4DCT) is a promising, non-invasive, and affordable method to assess and quantify wrist kinematics, extending conventional CT by incorporating the temporal dimension [3].
• A negative result from MRI is unable to rule out the possibility of a clinically relevant injury to the TFCC, SL ligament, or LT ligament of the wrist [4].
• Dorsal extrinsic ligaments demonstrate MRI signal change suggestive of acute or chronic injury in patients with an SL interval 2 mm or greater more often than in patients with an SL interval less than 2 mm [8].
• The sensitivity and specificity of MRI are influenced by the anatomic location of the lesion and technical conditions [35].
• There is no evidence for the superiority of 3 Tesla Magnetic Resonance Imaging over 1.5 Tesla Magnetic Resonance Imaging for diagnosing wrist ligamentous lesions [35].
• An individualized, multimodal approach that combines clinical examination, imaging, and, when appropriate, direct arthroscopic evaluation is essential for early diagnosis of SL injuries and prevention of arthritis progression [12].

Treatment¶

• Arthroscopic dorsal capsuloligamentous repair in chronic scapholunate ligament tears showed encouraging preliminary results including pain relief, recovery of grip strength, low incidence of postoperative wrist stiffness, and all professional athletes returning to preinjury sports levels [5].
• Radioscapholunate arthrodesis with compression screws and local autograft is an effective method for appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications [7].
• Surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy showed lasting symptom relief and improved patient-reported outcomes in 7 patients at an average of 34 months after surgery [13].
• Staged reduction of neglected transscaphoid perilunate fracture dislocation results in good functional pain-free range of motion if properly executed [17].
• Lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures, and ligament injuries, with common complications [18].
• Proximal migration of the thumb metacarpal does not appear to influence functional outcome in ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis [6].
• Four-corner fusion versus proximal row carpectomy for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists shows that proximal row carpectomy results in better outcomes and a lower complication rate compared to four-corner fusion [28].

Complications¶

• Nerve injury is a complication of revision total elbow arthroplasty, with the ulnar nerve being the most frequently involved and the radial nerve accounting for a substantial proportion of cases [1].
• No patient required secondary surgery or treatment related to carpal stabilization in a series of ten patients undergoing anatomical anterior and posterior reconstruction for scapholunate dissociation [2].
• Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears is associated with a low incidence of postoperative wrist stiffness [5].
• Radioscapholunate arthrodesis with compression screws and local autograft achieved a 100% union rate with no complications in appropriately selected patients with a preserved midcarpal joint [7].
• Closed surgical techniques for acute perilunate injuries may result in a smaller postoperative scapholunate gap and better wrist flexion–extension angle and MMW scores compared to open surgery, although the causal relationship is uncertain due to potential differences in injury severity between cohorts [11].
• Surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy showed lasting symptom relief and improved patient-reported outcomes in a series of 7 patients at an average of 34 months after surgery [13].
• Quadriceps tendon autograft with or without bone block have comparable complications for ACL reconstruction [19].
• Ulnar collateral ligament reconstruction (UCLR) demonstrates low complication and revision rates at minimum 48-month mean follow-up [21].
• There is an association between longer follow-up and higher revision rate in rotator cuff repair study designs [24].
• Shoulder arthroplasties are generally designed to last 10-15 years, but revisions are being performed at a mean of 3.9 years from the primary procedure [34].

Recovery¶

• No patient required secondary surgery or treatment related to carpal stabilization following anatomical anterior and posterior reconstruction for scapholunate dissociation [2].
• Arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears resulted in pain relief, recovery of grip strength, and a low incidence of postoperative wrist stiffness [5].
• All professional athletes in the series of arthroscopic dorsal capsuloligamentous repair for chronic scapholunate ligament tears returned to preinjury sports levels [5].
• Debridement of thickened scar tissue on the undersurface of the dorsal radiotriquetral ligament resulted in complete resolution of symptoms in patients with dorsal radiotriquetral ligament snapping wrist syndrome [16].
• Surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy showed lasting symptom relief and improved patient-reported outcomes at an average of 34 months after surgery [13].
• Ulnar collateral ligament reconstruction provides excellent patient-reported and clinical outcomes at medium-term follow-up with low complication and revision rates [21].

Key Evidence¶

• [L4] The ulnar nerve is most frequently involved, although radial nerve injury accounts for a substantial proportion of cases. [1] (10.1016/j.jse.2026.04.042)
• [L4] No patient required secondary surgery or treatment related to the carpal stabilization. [2] (10.1177/1753193419886536)
• [L5] Four-dimensional computed tomography (4DCT) is a promising, non-invasive, and affordable method to assess and quantify wrist kinematics, extending conventional CT by incorporating the temporal dimension. [3] (10.1177/17531934251326028)
• [L2] A negative result from MRI is unable to rule out the possibility of a clinically relevant injury to the TFCC, SL ligament, or LT ligament of the wrist. [4] (10.1016/j.arthro.2015.04.090)
• [L4] The series of 36 patients shows encouraging preliminary results with pain relief, recovery of grip strength, low incidence of postoperative wrist stiffness, and all professional athletes returning to preinjury sports levels. [5] (10.1016/j.hcl.2011.07.003)
• [L1] Furthermore, proximal migration of the thumb metacarpal does not appear to influence the functional outcome. [6] (10.2106/jbjs.d.02630)
• [L4] This technique is an effective method to perform radioscapholunate arthrodesis in appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications. [7] (10.1016/j.jhsa.2013.01.026)
• [L4] Dorsal extrinsic ligaments demonstrate MRI signal change suggestive of acute or chronic injury in patients with an SL interval 2 mm or greater more often than in patients with an SL interval less than 2 mm. [8] (10.1016/j.jhsa.2019.03.003)
• [L4] There is a lack of consensus in carpal tunnel management in perilunate dislocation patients due to few studies with small sample sizes and inconsistent follow-up. [9] (10.1016/j.jhsg.2025.100797)
• [L5] Both wrist arthrodesis and revision TWA are technically demanding and should be performed with multidisciplinary team input, preferably in a specialist centre. [10] (10.1177/17531934241297843)
• [L1] Closed surgical techniques may result in a smaller postoperative scapholunate gap and better wrist flexion–extension angle and MMW scores compared to open surgery, but these findings may relate to different cohorts in terms of injury severity, making the causal relationship uncertain. [11] (10.1177/17531934221150331)
• [L5] Moving forward, an individualized, multimodal approach that combines clinical examination, imaging, and, when appropriate, direct arthroscopic evaluation will be essential for early diagnosis of SL injuries and prevention of arthritis progression. [12] (10.1016/j.jhsa.2025.11.021)
• [L4] The surgical intervention for palmar midcarpal instability using autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy has shown lasting symptom relief and improved patient-reported outcomes in 7 patients at an average of 34 months after surgery. [13] (10.1016/j.jhsa.2025.02.010)
• [L5] Sensorimotor techniques including proprioceptive retraining may improve pain, neuromuscular control, and functional outcomes in patients with chronic wrist pain due to ligament injury. [14] (10.1016/j.jht.2016.03.008)
• [L5] In addition, in the proximal third of the forearm, a consistent longitudinal branch of the PABCN courses over the interval between the brachioradialis and the extensor carpi radialis longus. [15] (10.1016/j.jhsa.2019.08.011)
• [Case_report] Both patients demonstrated complete resolution of symptoms after debridement of the thickened scar tissue on the undersurface of the dorsal radiotriquetral ligament. [16] (10.1016/j.jhsa.2015.12.029)
• [L4] If properly executed, a good functional pain free range of motion is the usual outcome. [17] (10.1186/1749-799x-7-19)
• [L4] Lunate fracture-subluxations are unstable injuries that are best managed with fixation of the carpal fractures, while lunate fracture-dislocations are complex injuries requiring stabilization of the lunate, associated fractures and ligament injuries with common complications. [18] (10.1177/1753193417740850)
• [L4] Both grafts are safe and viable options for ACL reconstruction with comparable clinical outcomes, complications and revision rates. [19] (10.1007/s00167-022-07281-z)
• [L4] UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. [21] (10.1136/jisakos-2021-000614)
• [L1] There was an association between longer follow-up and higher revision rate. [24] (10.1016/j.asmr.2024.100993)
• [L4] Symptomatic improvement following carpal tunnel release in patients with severe CTS can occur. [26] (10.1016/j.jhsa.2021.11.015)
• [L1] In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. [28] (10.1016/j.jhsa.2024.01.011)
• [L4] Generally, shoulder arthroplasties are designed to last 10-15 years; however, revisions are being performed at a mean 3.9 years from the primary procedure. [34] (10.1016/j.jse.2019.12.015)
• [L1] The sensitivity and specificity of MRI are influenced by the anatomic location of the lesion and technical conditions. [35] (10.1016/j.arthro.2024.04.029)

References¶

[1] Nerve Injury in Revision Total Elbow Arthroplasty - A Systematic Review and Meta-analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.04.042

[2] Anatomical anterior and posterior reconstruction for scapholunate dissociation: preliminary outcome in ten patients. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419886536

[3] Dynamic wrist imaging: How it works and how to assess kinematic changes in wrists with scapholunate instability. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251326028

[4] Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.04.090

[5] Arthroscopic Dorsal Capsuloligamentous Repair in Chronic Scapholunate Ligament Tears. Hand Clinics. 2011. DOI: 10.1016/j.hcl.2011.07.003

[6] Ligament Reconstruction with or without Tendon Interposition to Treat Primary Thumb Carpometacarpal Osteoarthritis. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.d.02630

[7] Radioscapholunate Arthrodesis With Compression Screws and Local Autograft. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.026

[8] Dorsal Extrinsic Ligament Injury and Static Scapholunate Diastasis on Magnetic Resonance Imaging Scans. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.03.003

[9] A Review of Perilunate Dislocations and Concomitant Acute Carpal Tunnel Syndrome: When Should the Carpal Tunnel be Released?. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100797

[10] Revision wrist arthroplasty strategies. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241297843

[11] Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221150331

[12] Imaging for Scapholunate Ligament Injuries: Techniques, Challenges, and Innovations. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.11.021

[13] Culp Midcarpal Reconstruction to Treat Palmar Midcarpal Instability. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.02.010

[14] Proprioception retraining for a patient with chronic wrist pain secondary to ligament injury with no structural instability. Journal of Hand Therapy. 2016. DOI: 10.1016/j.jht.2016.03.008

[15] Anatomy of the Posterior Antebrachial Cutaneous Nerve, Revisited. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.08.011

[16] Dorsal Radiotriquetral Ligament Snapping Wrist Syndrome – A Novel Presentation and Review of Literature: Case Report. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.12.029

[17] Staged reduction of neglected transscaphoid perilunate fracture dislocation: A report of 16 cases. Journal of Orthopaedic Surgery and Research. 2012. DOI: 10.1186/1749-799x-7-19

[18] Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417740850

[19] Quadriceps tendon autograft with or without bone block have comparable clinical outcomes, complications and revision rate for ACL reconstruction: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2022. DOI: 10.1007/s00167-022-07281-z

[21] Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2021-000614

[24] Rotator Cuff Repair Study Designs Correlate With Revision Shoulder Surgery Rates: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation. 2024. DOI: 10.1016/j.asmr.2024.100993

[26] A Systematic Review of the Outcomes of Carpal Ligament Release in Severe Carpal Tunnel Syndrome. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2021.11.015

[28] Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.01.011

[34] Revision shoulder arthroplasty: a systematic review and comparison of North American vs. European outcomes and complications. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.015

[35] No Evidence for the Superiority of 3 Tesla Magnetic Resonance Imaging Over 1.5 Tesla Magnetic Resonance Imaging for Diagnosing Wrist Ligamentous Lesions: A Systematic Review and Meta‐analysis. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.04.029