From the Guidelines
Scapholunate Advanced Collapse (SLAC) wrist is a progressive wrist condition resulting from untreated scapholunate ligament injury, leading to predictable arthritic changes. This condition occurs because scapholunate ligament disruption causes abnormal carpal bone mechanics, leading to cartilage wear between the radius, scaphoid, and capitate bones.
Key Characteristics of SLAC Wrist
- Progressive wrist condition
- Resulting from untreated scapholunate ligament injury
- Leading to predictable arthritic changes
Diagnosis and Treatment
Treatment depends on the stage of degeneration, with early stages (1-2) potentially managed with wrist splinting, NSAIDs, and physical therapy, while advanced stages (3-4) may require surgical options such as proximal row carpectomy, four-corner fusion, or total wrist fusion 1.
Importance of Early Diagnosis
Early diagnosis through physical examination and imaging (X-rays, MRI) is crucial for optimal management and preventing further deterioration. Although ultrasound (US) can be used to identify various wrist pathologies, including synovitis, joint effusion, and tendon injury, an interdisciplinary group of hand surgeons and radiologists has recommended against the inclusion of US in the standard evaluation of scapholunate instability 1. Without proper treatment, SLAC wrist progresses through predictable stages of arthritis, eventually affecting the entire wrist. The use of musculoskeletal US in patients without definitive diagnosis presenting with pain, swelling, or mechanical symptoms of the wrist may be reasonable to evaluate tendon and soft tissue pathology, but it is not recommended for scapholunate instability evaluation 1.
From the Research
Definition and Overview of Scapholunate Advanced Collapse (SLAC) Wrist
- Scapholunate advanced collapse (SLAC) wrist is a common type of wrist osteoarthritis (OA) 2, 3, 4, 5, 6
- It is characterized by degenerative arthritis in the wrist, specifically affecting the radioscaphoid joint 3
- SLAC wrist can result in debilitating wrist pain and limited mobility 4
Treatment Options for SLAC Wrist
- Non-operative treatment consists of pain medication, splinting, and avoiding activities that induce pain 2
- Operative treatment options include four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) 2, 3, 6
- Other treatment options include wrist denervation, arthroscopic wrist debridement, and radial styloidectomy 4, 5
- The choice of treatment depends on the stage and severity of the disease, as well as the patient's individual needs and preferences 2, 3, 4, 5, 6
Outcomes and Comparisons of Treatment Options
- Studies have compared the outcomes of FCA and PRC, with some showing similar results and others showing slight advantages of one over the other 2, 3
- A systematic literature review and meta-analysis found that PRC resulted in statistically significantly increased flexion/extension range of motion, grip strength, and reduced level of pain compared to FCA 3
- However, the differences were small and may not be clinically significant 3
- Other studies have reported good functional outcomes and pain relief with arthroscopic wrist debridement and radial styloidectomy 5 and wrist denervation 4