Scapholunate Advanced Collapse Workup

  • Author: Dimitrios Danikas, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: May 22, 2012
 

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.
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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.

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Staging

See Pathophysiology.

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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, American Society of Plastic Surgeons, and Northeastern 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, 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, FRCSC, FACS 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.

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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

Disclosure: Nothing to disclose.

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

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

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.

Additional Contributors

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

References

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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.
 
 
 
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