eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Scapholunate Advanced Collapse: Workup

Author: Dimitrios Danikas, MD, Attending Plastic Surgeon, Bayhealth Medical Center
Coauthor(s): Steve Lee, MD, Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC; Michael Neumeister, MD, FRCSC, Professor & Chairman - FACS - Director Hand/Microsurgery Fellowship - Division of Plastic Surgery, Southern Illinois University School of Medicine; Richard Brown, MD, FACS, Clinical Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Sep 2, 2008

Workup

Imaging Studies

  • Plain wrist radiographs (posteroanterior [PA], lateral, and oblique) are usually sufficient to make the diagnosis of scapholunate advanced collapse (SLAC) and permit staging. They can reveal joint narrowing, sclerosis, osteophytes, cysts, scapholunate dislocation, and carpal collapse.
    • Early changes at the radioscaphoid articulation can appear as an elongated radial styloid process. The scaphoid may assume a vertical position with a cortical ring sign. In SLAC secondary to scapholunate dissociation, increased distance between the scaphoid and lunate, as well as lunate ulnar translocation, will be obvious. A lateral view can show an increase in the scapholunate angle with a dorsiflexion of the lunate (dorsal intercalated segment instability [DISI] deformity).
    • As the disease progresses, the whole radioscaphoid joint becomes narrowed. In subtle cases, PA and lateral wrist computed tomography can reveal these joint changes.
  • For imaging of the skeletal morphology or occult fracture, computed tomography is most useful. If avascularity is a concern, then magnetic resonance imaging is the best imaging modality.

Diagnostic Procedures

  • Nagle recommends staging wrist arthroscopy for articular surface evaluation since lunate fossa changes may be present in advanced cases of scapholunate advanced collapse (SLAC) wrist but may not be appreciated on plain radiographs.9 Since scaphoid resection and ulnar column fusion in the presence of lunate fossa degenerative changes is contraindicated, an accurate assessment of the radiolunate joint is critical for correct surgical planning. When necessary, staging arthroscopy is performed as part of the definitive procedure.

Staging

See Pathophysiology.

More on Scapholunate Advanced Collapse

Overview: Scapholunate Advanced Collapse
Workup: Scapholunate Advanced Collapse
Treatment: Scapholunate Advanced Collapse
Follow-up: Scapholunate Advanced Collapse
Multimedia: Scapholunate Advanced Collapse
References
Further Reading
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References

  1. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg [Am]. May 1984;9(3):358-65. [Medline].

  2. Sauerbier M, Bickert B, Trankle M, et al. [Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)]. Unfallchirurg. Jul 2000;103(7):564-71. [Medline].

  3. Schmitt R, Heinze A, Fellner F, et al. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol. Sep 1997;25(2):92-103. [Medline].

  4. Gong X, Lu LJ. What is the implication of scaphoid ring sign in advanced Kienböck's disease? Is it a sign of advanced carpal collapse or rotary scaphoid subluxation?. J Plast Reconstr Aesthet Surg. 2006;59(7):726-9. [Medline].

  5. Bednar MS, Light TR. Degenerative arthritis. In: Russell RC, ed. Hand Surgery. Vol 4. St Louis, Mo: Mosby; 2000.

  6. Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop. Jan 1986;(202):57-67. [Medline].

  7. Chen C, Chandnani VP, Kang HS, et al. Scapholunate advanced collapse: a common wrist abnormality in calcium pyrophosphate dihydrate crystal deposition disease. Radiology. Nov 1990;177(2):459-61. [Medline].

  8. Taniguchi Y, Yoshida M, Tamaki T. X-ray characteristics of wrists in calcium pyrophosphate crystal deposition disease. Is pseudogout a major cause of scapholunate advanced collapse?. J Hand Surg [Br]. Oct 1997;22(5):659-61. [Medline].

  9. Nagle DJ. Artroscopy. In: Russell RC, ed. Hand Surgery. Vol 4. St Louis, Mo: Mosby; 2000.

  10. Fassler PR, Stern PJ, Kiefhaber TR. Asymptomatic SLAC wrist: does it exist?. J Hand Surg [Am]. Jul 1993;18(4):682-6. [Medline].

  11. Pilný J, Kubes J, Hoza P, Sprláková A, Hart R. [Consequennce of nontreatment scapholunate instability of the wrist]. Rozhl Chir. Dec 2006;85(12):637-40. [Medline].

  12. Kadji O, Duteille F, Dautel G, Merle M. [Four bone versus capito-lunate limited carpal fusion. Report of 40 cases]. Chir Main. Jan 2002;21(1):5-12. [Medline].

  13. Garcia-Lopez A, Perez-Ubeda MJ, Marco F, et al. A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist). J Hand Surg [Br]. Aug 2001;26(4):352-4. [Medline].

  14. Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?. J Hand Surg [Am]. Jan 1994;19(1):134-42. [Medline].

  15. Welby F, Alnot JY. [Resection of the first row of carpal bones: post-traumatic wrist and Kienbock''s disease]. Chir Main. Jun 2003;22(3):148-53. [Medline].

  16. Vanhove W, De Vil J, Van Seymortier P, Boone B, Verdonk R. Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist. J Hand Surg Eur Vol. Apr 2008;33(2):118-25. [Medline].

  17. Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr Aesthet Surg. Oct 19 2007;[Medline].

  18. van Riet RP, Bain GI. Three-corner wrist fusion using memory staples. Tech Hand Up Extrem Surg. Dec 2006;10(4):259-64. [Medline].

  19. Sauerbier M, Kania NM, Kluge S, et al. [Initial results of treatment with the new AO wrist joint arthrodesis plate]. Handchir Mikrochir Plast Chir. Jul 1999;31(4):260-5. [Medline].

  20. Kalb K, Ludwig A, Tauscher A, et al. [Treatment outcome after surgical arthrodesis]. Handchir Mikrochir Plast Chir. Jul 1999;31(4):253-9. [Medline].

  21. Ekelund L, Hagberg L, Hörberg L, Jörgsholm P, Gunnarsson M. Imaging of four-corner fusion (SLAC arthrodesis) of the wrist with 64-slice computed tomography. Acta Radiol. Feb 2007;48(1):76-9. [Medline].

  22. Masmejean E, Dutour O, Touam C, Oberlin C. [Bilateral SLAC (scapholunate advanced collapse) wrist: an unusual entity. Apropos of a 7000-year-old prehistoric case]. Ann Chir Main Memb Super. 1997;16(3):207-14. [Medline].

  23. Watson HK, Weinzweig J. Intercarpal arthrodesis. In: Green DP, Hotchkiss RN, Pederson WC, eds. Green's Operative Hand Surgery. Vol 1. Philadelphia, Pa: Churchill Livingstone; 1999.

  24. Brown RE, Erdmann D. Complications of 50 consecutive limited wrist fusions by a single surgeon. Ann Plast Surg. Jul 1995;35(1):46-53. [Medline].

  25. Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg [Am]. Sep 1994;19(5):751-9. [Medline].

  26. Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg [Am]. Nov 1995;20(6):965-70. [Medline].

  27. Imbriglia JE, Broudy AS, Hagberg WC, McKernan D. Proximal row carpectomy: clinical evaluation. J Hand Surg [Am]. May 1990;15(3):426-30. [Medline].

  28. Hastings H 2nd, Weiss AP, Quenzer D, et al. Arthrodesis of the wrist for post-traumatic disorders. J Bone Joint Surg Am. Jun 1996;78(6):897-902. [Medline].

  29. Weiss AC, Wiedeman G Jr, Quenzer D, et al. Upper extremity function after wrist arthrodesis. J Hand Surg [Am]. Sep 1995;20(5):813-7. [Medline].

  30. Dacho A, Grundel J, Holle G, Germann G, Sauerbier M. Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist). Ann Plast Surg. Feb 2006;56(2):139-44. [Medline].

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Further Reading

Forearm, wrist, & hand (acute & chronic), not including carpal tunnel syndrome. Work Loss Data Institute.  2004 (revised 2007 May 16).  80 pages. [NGC Update Pending] NGC:005799
 
Chronic wrist pain.
American College of Radiology.  1998 (revised 2005).  7 pages.  NGC:004619
 
Acute hand and wrist trauma.
American College of Radiology - Medical Specialty Society.  1998 (revised 2005).  8 pages.  NGC:004607

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Keywords

scapholunate advanced collapse, SLAC wrist, degenerative arthritis, scaphoid injury, scapholunate collapse, scapholunate dissociation, wrist pain, carpal tunnel syndrome, carpal ligament instability,  scaphoid fracture, wrist arthritis, arthritis of the wrist, wrist arthrodesis, periscaphoid arthritis, scaphoid nonunion advanced collapse, SNAC, Terry Thomas sign, carpal bone, scaphoid, lunate, hand bone, os lunatum, os scaphoideum, perilunate fracture dislocations, perilunate injuries

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Contributor Information and Disclosures

Author

Dimitrios Danikas, MD, Attending Plastic Surgeon, Bayhealth Medical Center
Dimitrios Danikas, MD is a member of the following medical societies: American Academy of Anti-Aging Medicine, American College of Surgeons, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Steve Lee, MD, Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC
Steve Lee, MD is a member of the following medical societies: American College of Surgeons and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Michael Neumeister, MD, FRCSC, Professor & Chairman - FACS - Director Hand/Microsurgery Fellowship - Division of Plastic Surgery, Southern Illinois University School of Medicine
Michael Neumeister, MD, FRCSC is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association of Academic Chairmen of Plastic Surgery, Canadian Society of Plastic Surgeons, Illinois State Medical Society, Illinois State Medical Society, Ontario Medical Association, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, and Society of University Surgeons
Disclosure: Nothing to disclose.

Richard Brown, MD, FACS, Clinical Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

A Lee Osterman, MD, Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael Yaszemski, MD, PhD, Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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