Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Scapholunate Advanced Collapse Workup

  • Author: Dimitrios Danikas, MD, FACS; Chief Editor: Harris Gellman, MD  more...
 
Updated: Nov 06, 2015
 

Imaging Studies

See the list below:

  • 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.
Next

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.

Previous
 
 
Contributor Information and Disclosures
Author

Dimitrios Danikas, MD, FACS Attending Plastic Surgeon, Pikeville Medical Center

Dimitrios Danikas, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, American Academy of Anti-Aging Medicine, Northeastern Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Neumeister, MD, FRCSC, FACS Chairman, Professor, Division of Plastic Surgery, Director of Hand/Microsurgery Fellowship Program, Chief of Microsurgery and Research, Institute of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine

Michael Neumeister, MD, FRCSC, FACS is a member of the following medical societies: American Association for Hand Surgery, American Burn Association, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, 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, Society of University Surgeons, American Council of Academic Plastic Surgeons

Disclosure: Nothing to disclose.

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, American Society of Plastic 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.

Sotirios Papafragkou, MD Chair, Department of Surgery, Hand and Microvascular Surgery, Northern Maine Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael Yaszemski, MD, PhD Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

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, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern 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, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

The authors and editors gratefully acknowledge the contributions to this topic made by Mark F. Hendrickson, MD.

References
  1. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg [Am]. 1984 May. 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. 2000 Jul. 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. 1997 Sep. 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. 1986 Jan. (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. 1990 Nov. 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]. 1997 Oct. 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]. 1993 Jul. 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. 2006 Dec. 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. 2002 Jan. 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]. 2001 Aug. 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]. 1994 Jan. 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. 2003 Jun. 22(3):148-53. [Medline].

  16. Laulan J, Marteau E, Bacle G. Wrist osteoarthritis. Orthop Traumatol Surg Res. 2015 Feb. 101 (1 Suppl):S1-9. [Medline].

  17. 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. 2008 Apr. 33(2):118-25. [Medline].

  18. 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. 2007 Oct 19. [Medline].

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

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

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

  22. 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. 2007 Feb. 48(1):76-9. [Medline].

  23. 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].

  24. 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.

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

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

  27. 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]. 1995 Nov. 20(6):965-70. [Medline].

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

  29. Mantovani G, Mathoulin C, Fukushima WY, Cho AB, Aita MA, Argintar E. Four corner arthrodesis limited to the centre using a scaphoid one piece graft and a dorsal circular plate. J Hand Surg Eur Vol. 2010 Jan. 35(1):38-42. [Medline].

  30. Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol. 2009 Apr. 34(2):256-63. [Medline].

  31. Gaston RG, Greenberg JA, Baltera RM, Mih A, Hastings H. Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am. 2009 Oct. 34(8):1407-12. [Medline].

  32. Ferreres A, Garcia-Elias M, Plaza R. Long-term results of lunocapitate arthrodesis with scaphoid excision for SLAC and SNAC wrists. J Hand Surg Eur Vol. 2009 Oct. 34(5):603-8. [Medline].

  33. Kiefhaber TR. Management of scapholunate advanced collapse pattern of degenerative arthritis of the wrist. J Hand Surg Am. 2009 Oct. 34(8):1527-30. [Medline].

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

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

  36. 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. 2006 Feb. 56(2):139-44. [Medline].

Previous
Next
 
Stage 2 scapholunate advanced collapse (SLAC) wrist.
Scapholunate advanced collapse (SLAC) wrist from Kienböck disease.
Scapholunate advanced collapse (SLAC) wrist from nonunion of the scaphoid. The patient underwent 4-bone fusion.
Scapholunate advanced collapse (SLAC) wrist from nonunion of the scaphoid. The patient underwent 4-bone fusion.
Scapholunate advanced collapse (SLAC) wrist treated with total wrist fusion.
Scapholunate advanced collapse (SLAC) wrist treated with total wrist fusion.
Stage 2 scapholunate advanced collapse (SLAC) wrist treated with 4-bone fusion.
Stage 2 scapholunate advanced collapse (SLAC) wrist treated with 4-bone fusion.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.