History

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.

Differential Diagnoses

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Media Gallery

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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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)

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.

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.

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.

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 of 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, Florida Medical Association, Florida Orthopaedic 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.

Sections Scapholunate Advanced Collapse (SLAC)
Overview
Presentation
DDx
Workup
Treatment
Media Gallery
References

Scapholunate Advanced Collapse (SLAC) Clinical Presentation

History

Physical Examination

References

Tables

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