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Andrew Murphy ◉ and Dr Yuranga Weerakkody ◉ et al.

Scapholunate advanced collapse (SLAC), commonly known as SLAC wrist, refers to a pattern of wrist malalignment that has been attributed to post-traumatic or spontaneous osteoarthritis of the wrist. It is a complication that can occur with undiagnosed or untreated scapholunate dissociation. It is essentially the same sequela of wrist injury causing scaphoid nonunion as seen in scaphoid nonunion advanced collapse (SNAC).

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Pathology

SLAC is most commonly a consequence of undiagnosed or untreated scapholunate ligament injury and rotatory subluxation of the scaphoid bone resulting in radioscaphoid malalignment, progressive chondromalacia, and osteoarthritis.

Its features, however, also have been observed in patients with idiopathic calcium pyrophosphate dihydrate (CPPD) crystal deposition disease.

Radiographic features

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The pattern is that of progressive osteoarthritis affecting initially the articulation between the radial styloid and the scaphoid. In later stages of the disease, osteoarthritis affects the whole radioscaphoid articulation, then the articulation between lunate and capitate. Finally, it may involve other intercarpal joints. In addition, there is scapholunate interval widening as well as proximal migration of the scaphoid and the capitate 3.

Classification

Watson staging is often used by hand surgeons 8:

  • I: osteoarthritis of the articulation between the radial styloid and the scaphoid
  • II: osteoarthritis involving the whole radioscaphoid articulation
  • III: osteoarthritis of the radioscaphoid and capitolunate articulations
  • IV: osteoarthritis of the radiocarpal and intercarpal articulations +/- distal radioulnar joint (DRUJ)

Note that the radiolunate joint is almost preserved until the very last stages of the disease. It is also worth noting that the scaphoid fossa in the radius may be deep/preserved in cases of CPPD in contrast to post-traumatic SLAC wrist.

Plain radiograph

Key assessing parameters include 9

  • scapholunate diastasis (PA radiograph)
  • rotatory subluxation of the scaphoid (lateral radiograph)
  • features associated with dorsal intercalated segment instability (DISI) (lateral radiograph)

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CT

Sagittal reformatted images from multidetector CT arthrographic data are particularly useful in demonstrating abnormal angulations of the scaphoid and lunate bones (increased scapholunate angle and dorsal or volar intercalated segment instability deformity), radioscaphoid incongruity, cartilage loss, and subchondral bone degenerative changes.

Treatment and prognosis

Surgical treatment for SLAC wrist includes four-corner arthrodesis, capitolunate arthrodesis, complete wrist arthrodesis, scaphoidectomy, proximal row carpectomy (PRC), denervation, and radial styloidectomy 2, 5-6.

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  • 1. Moser T, Dosch JC, Moussaoui A et-al. Multidetector CT arthrography of the wrist joint: how to do it. Radiographics. 28 (3): 787-800. doi:10.1148/rg.283075087 - Pubmed citation
  • 2. Strauch RJ. Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis--update on evaluation and treatment. J Hand Surg Am. 2011;36 (4): 729-35. doi:10.1016/j.jhsa.2011.01.018 - Pubmed citation
  • 3. Chen C, Chandnani VP, Kang HS et-al. Scapholunate advanced collapse: a common wrist abnormality in calcium pyrophosphate dihydrate crystal deposition disease. Radiology. 1990;177 (2): 459-61. Radiology (abstract) - Pubmed citation
  • 4. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9 (3): 358-65. - Pubmed citation
  • 5. Tomaino MM, Miller RJ, Cole I et-al. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision? J Hand Surg Am. 1994;19 (1): 134-42. doi:10.1016/0363-5023(94)90237-2 - Pubmed citation
  • 6. 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;20 (6): 965-70. doi:10.1016/S0363-5023(05)80144-3 - Pubmed citation
  • 7. Merrell GA, McDermott EM, Weiss AP. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg Am. 2008;33 (5): 635-42. doi:10.1016/j.jhsa.2008.02.001 - Pubmed citation
  • 8. Weiss KE, Rodner CM. Osteoarthritis of the wrist. J Hand Surgery. 2007;32A: 725-746 http://nemsi.uchc.edu/clinical_services/orthopaedic/handwrist/pdfs/article_osteoarthritis.pdf
  • 9. Brian T. Tischler, Luis E. Diaz, Akira M. Murakami, Frank W. Roemer, Ajay R. Goud, William F. Arndt, Ali Guermazi. Scapholunate advanced collapse: a pictorial review. (2014) Insights into Imaging. 5 (4): 407. doi:10.1007/s13244-014-0337-1 - Pubmed
  • 10. Andersson JK. Treatment of scapholunate ligament injury: Current concepts. (2017) EFORT open reviews. 2 (9): 382-393. doi:10.1302/2058-5241.2.170016 - Pubmed
  • 11. Michel D. Crema, Joachim Zentner, Ali Guermazi, Nabil Jomaah, Monica D. Marra, Frank W. Roemer. Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse: MDCT Arthrography Features. (2012) American Journal of Roentgenology. 199 (2): W202-7. doi:10.2214/AJR.11.7574 - Pubmed

Related Radiopaedia articles

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Wrist pathology
  • alignment
    • ulnar variance
  • wrist fractures and dislocations
    • distal radial fracture
      • distal ulnar fracture
    • pediatric
    • carpal bones
      • scaphoid fracture
        • scaphoid non-union
      • lunate fracture
      • hamate fracture[–]
  • carpal instability
    • scapholunate interval widening
  • osteonecrosis
  • ulnar-sided wrist impaction and impingement syndromes
  • soft tissue and tendons
  • arthritides

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