4 exercises to treat Scapholunate Wrist Instability

Scapholunate ligament disorders accounts for a high percentage of wrist injuries associated with falls on the outstretched hand. This situation can cause functional limitation, pain or loss of strength, and in some occasions, cause a carpal instability of the scapholunate joint.

In order to manage a wrist instability of such biomechanical complexity, it is important to understand how the wrist works and to know how to select beneficial exercises for this injury.

In this post we have condensed 4 exercises that you should prescribe to your patients with scapholunate ligament injuries and their biomechanical explanation. But first we recommend you to read our Blog about scapholunate instabilities.

We have a COMPLETE article talking the Scapholunate Instability

Which muscles should you focus on to treat a Scapholunate Wrist Instability and Why?

In order to select the exercises that might help to promote the stability lost by the scapholunate, we will focus on the activity and contraction of the following muscles, located in the forearm and connected to the hand:

– Extensor Carpi Radialis Longus (ECRL)
– Extensor Carpi Radialis Brevis (ECRB)
– Abductor Pollicis Longus (APL)
– Flexor Carpi Radialis (FCR)

Focusing on exercising and training those muscles of the hand after a wrist injury is vital, as those specifically enable:

– Supinate and extend the scaphoid.
– Reduce the scaphoid into the scaphoid fossa of the radius.
– Close the scapholunate space

The action of the APL and ECRL coapt the joint. Images from Esplugas M et al 2016

Active rehabilitation is needed to recover carpal ligaments, hand musculature and function. This rehabilitation process could reduce recovery time and promote early improvement. In turn, this type of practice favours the work of the sensorimotor system, allowing the map of the cortical representation of the hand region to be redrawn, which allows optimal recovery and early motor relearning.

Working with the ReHand telerehabilitation system via tablet app, allows the patient to perform exercises adapted to his or her abilities at home, which increases the rehabilitation time and the number of repetitions, allowing the patient to obtain beneficial results and an early motor recovery.

Here are 4 exercises to treat the Scapholunate Instability that the patient can perform with the ReHand app:

Extensor Carpi Radialis Longus & Brevis Exercises

The first two exercises are aimed at exercising and recovering the stabilizer function of the Extensor Carpi Radialis Longus & Brevis.

Extensor Carpi Radialis Longus & Brevis

Exercise 1: Controlled and adapted wrist extension to the patient’s ability and pain.
Exercise 2: Controlled radial wrist deviation to focus work on ECRL and ECRB

The first exercise focuses on muscle extension along the forearm, while the second focuses on radial wrist deviation to neutral.

Exercise 1 Extension exercise with ReHand
Exercise 2 Radial Deviation with ReHand

Flexor Carpi Radialis Exercise

This third exercise is focused on a controlled and tailored wrist flexion. In this case, the exercise focuses on working the FCR in flexion. Of course, attention must be paid to the patient’s symptoms.

Exercise 3 Flexion with ReHand
Flexor Carpi Radialis

Abductor Pollicis Longus Exercise

In this fourth exercise the movement focuses on the fingers, specifically the thumb and index finger. While keeping the index finger steady, we do the exercises with the thumb.

Working with the thumb into an abduction plane, promotes scapholunate stabilisation, thanks to its distribution in the forearm.

Exercise 4 Abductor Pollicis Longus with ReHand
Abductor Pollicis Longus

Do you have patients with wrist instabilities?

Learn how to prescribe Exercise Programmes with ReHand and boost your patient’s recovery!


Esplugas M, Garcia-Elias M, Lluch A, Llusá Pérez M. Role of muscles in the stabilization of ligament-deficient wrists. J Hand Ther [Internet]. 2016;29(2):166–74. Available from: http://dx.doi.org/10.1016/j.jht.2016.03.009

Pablo Rodríguez Sánchez-Laulhé
PhD Candidate | PT, Hand Therapy & eHealth Researcher