Scapholunate Advanced Collapse (SLAC) Clinical Presentation

Updated: Feb 16, 2022
  • Author: Dimitrios Danikas, MD, FACS; Chief Editor: Harris Gellman, MD  more...
  • Print


A history of wrist injury, scaphoid fracture, carpal tunnel decompression, or carpal ganglion excision may be present. Many patients with scapholunate advanced collapse (SLAC) wrist have minimal symptoms and may present because of a secondary problem, such as carpal tunnel syndrome.

Patients may have a variable duration history of wrist pain during activity. They commonly relate their symptoms to increased activity and overuse. Postactivity pain may be present. Patients may have modified their activities, depending on the severity of symptoms. Many patients have used nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.


Physical Examination

Wrist edema may be present, and patients may have pain with motion, especially when loading the wrist in an extended position. Limited wrist range of motion (ROM) is typical, and an average wrist flexion-extension arc of 80-90° has been reported. Direct palpation of the scapholunate joint or radiocarpal joint generally elicits pain. Pain with resistance against active finger extension while the wrist is held in passive flexion is common.

A scaphoid shift test also elicits pain. To perform this maneuver, the examiner places the fingers of the same hand on the dorsum of the distal radius of the wrist being examined (ie, the left hand is used to examine left wrist). The examiner's thumb is placed volarly on the scaphoid tuberosity and pushed dorsally while the other hand passively deviates the patient's wrist radially and ulnarly. This stresses the periscaphoid ligaments and subluxes the scaphoid dorsally, thus eliciting pain if periscaphoid disease is present.