Diagnosis:  SLAC Wrist

What is SLAC Wrist?

Scapholunate advanced collapse (SLAC) is the most common pattern for degenerative osteoarthritis in the wrist. Non-union of a scaphoid fracture and chronic untreated scapholunate dissociation are two common injuries which may alter the location or position of the scaphoid. Over time, abnormal loading resulting from mal-alignment of a wrist bone causes damage to several joint surfaces. As the condition persists, other wrist bones may experience migration and mal-positioning. End stage SLAC wrist involves collapse of the scapholunate joint as both the scaphoid and lunate bones are rotated out of a normal, functional position.

Signs and Symptoms:

SLAC wrist may not present any symptoms, though some patients notice pain or discomfort following increased activity or overuse of the wrist. Often, this condition is diagnosed when a patient presents a secondary problem such as carpal tunnel syndrome. Swelling, weakness, pain, and decreased wrist motion may indicate SLAC wrist.

Conservative Options:

Conservative options include splinting to reduce wrist motion. Anti-inflammatory medications or steroid injections may temporarily reduce pain and swelling. 

Surgical Options:

If conservative treatment is not effective, surgery may be recommended to alleviate pain and prevent further damage to the wrist. Options may include proximal row carpectomy and wrist fusion, depending on the level of damage to the joint.

Proximal row carpectomy involves excision (removal) of the scaphoid, lunate, and triquetrum bones and allows for better preservation of strength and motion. The wrist will be splinted for 4 weeks, at which point range of motion exercises will be initiated. About 3 months after surgery, strengthening exercises may begin.

Wrist fusion may be more successful at alleviating pain, though motion is limited. Surgery involves placement of an implant, typically a metal plate and screws. A short arm splint is worn until fusion takes place, typically 6-8 weeks after surgery.





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