You are here

Scapholunate Advanced Collapse M19.039 715.13

SLAC wrist xray

DISI, VISI

SLAC wrist xray

proximal row carpectomy xray

proximal row carpectomy xray

synonyms:SLAC wrist, Scapho-Lunate Advanced Collapse, scapholunate advanced collapse

SLAC ICD-10

SLAC ICD-9

  • 715.13 Osteoarthrosis, localized, primary, idipathic, forearm

SLAC Etiology / Epidemiology / Natural History

  • Primary disorder in the SLAC wrist is that of scapholunate dissociation secondary to scapholunate interosseous ligament rupture . Scapholunate dissociation leads to unopposed volar flexion of the scaphoid and the dorsal intercalated segmental instability (DISI) pattern
  • Scapholunate dissociation is generally from trauma, but may occur from calcium pyrophosphate deposition.
  • Most common cause of wrist arthritis. 57% of degenerative wrist arthritis (Watson HR, Ballet FL. Journal of Hand Surgery 1984;9A, No. 3 May 1984).

SLAC Anatomy

SLAC Clinical Evaluation

  • Variable degrees of wrist pain, swelling and decreased ROM. Advanced disease is associated with night pain.
  • May have remote history of wrist trauma.

SLAC Xray / Diagnositc Tests

  • Degenerative changes progress from the radial styloid and scaphoid along the scaphoradial joint.
  • Lateralradiographs may show the scapholunate angle to be increased beyond 60°, which is felt to be the upper limit of normal.  Normal scapholunate angle=47 range=30-60 degrees.
  • PAradiograph, the scaphoid appears foreshortened, has a “cortical ring” sign(volar flexed scaphoid distal pole seen in cross section) and there is a scapholunate gap of greater than 3 mm
  • PA clenched fistview in ulnar deviation accentuates widenings at the scapholunate interval
  • Carpal height Index= distance between the base of the third metacarpal and the articular surface of the radius divided by the length of the third metacarpal on a neutral P/A xrays. Normal = 0.54 +/- 0.03. Best evaluated by comparing Carpal height index to that of the normal side. (Mann Fa, Radiology 1992;184:15). Can also compare carpal height index using the height of the capitate. Normal using capitate = 1.57 +/- 0.05.

SLAC Classification / Treatment

SLAC Associated Injuries / Differential Diagnosis

SLAC Complications

  • Degenerative changes in the radiocapitate articulation.
  • Stiffness, motion loss.
  • Weakness.
  • CRPS
  • Continued pain.
  • Instability.

SLAC Follow-up Care

  • Post-op: Volar splint in neutral, elevation.
  • 7-10 Days: Wound check, short arm cast.
  • 4 Weeks: Cast removed, xray wrist. Start gentle ROM / strengthening exercises. Functional activities. Cock-up wrist splint prn / for light duty work. No heavy manual labor
  • 3 Months:Full activities, may resume manual labor if adequate strength has been achieved.
  • 6 Months:
  • 1Yr: follow-up xrays, assess outcome

SLAC Review References

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer