Dynamic scapholunate instability: results of operative treatment with dorsal capsulodesis

Nineteen patients underwent 20 dorsal capsulodesis for dynamic scapholunate instability. Seventeen patients (18 wrists) were evaluated by a questionnaire and physical examination after a mean postoperative follow-up period of 34 months (range, 12-65). The diagnosis was based on a combination of characteristic symptoms of scapholunate instability and physical findings consisting of dorsal wrist tenderness at the scapholunate interval and a positive scaphoid shift test. Following surgery, a significant decrease was noted in symptoms of pain and clunking. Functional status was improved postoperatively; the most significant gains were seen in opening jars, sweeping, shoveling, and throwing. Fifteen of 17 patients returned to their original occupations, although 7 of those who returned to their original occupations did so with some restrictions. Objective evaluation by physical examination revealed a significant improvement in wrist stability as determined by the scaphoid shift test, and an average loss of 12 degrees of flexion. Fifteen of 17 patients (16 of 18 wrists) stated that they would undergo the surgery again if faced with the same choice. Our data demonstrate that dorsal radioscaphoid capsulodesis of the wrist in patients with dynamic scapholunate instability provides substantial improvement over preoperative status.