IS Case 240: Scapholunate advanced collapse

David Tuttle, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-26

History

A 71-year-old man presented with left wrist pain.

Diagnosis

Scapholunate advanced collapse

Discussion

Scapholunate advanced collapse (SLAC) is a characteristic degeneration pattern of the wrist. Watson and colleagues [4] described it in the 1980s as a common pattern of osteoarthritis of the wrist, occurring spontaneously or after trauma to the radial side of the wrist. It is characterized by narrowing of he radioscaphoid and capitolunate joint spaces, compromised scapholunate ligaments with subsequent rotary subluxation of the scaphoid and scapholunate dissociation, with eventual proximal migration of the capitate between the scaphoid and the lunate. SLAC is found in posttraumatic scapholunate rupture, rheumatoid arthritis, and neuropathic diseases. Some investigators report SLAC associated with calcium pyrophosphate dehydrate crystal deposition disease.

Scapholunate degeneration may be classified into three stages. Stage I is characterized by joint space narrowing and subchondral sclerosis of the radial styloid process. In stage II there is progression of degeneration of the mediocarpal joint and joint space narrowing between the capitate and lunate. During stage III, the capitate migrates proximally and approaches the distal radius. Stage III is also known as SLAC-wrist. The mechanism for the development of SLAC begins with scapholunate and radioscapholunate ligamentous insufficiency. The scaphoid undergoes rotary subluxation, with eventual radiocarpal joint arthropathy.

The appropriate surgical treatment of SLAC is controversial. Proximal row carpectomy and midcarpal arthrodesis are two commonly used options.

References

  1. Stäbler A, Heuck A, Reiser M. Imaging of the hand: degeneration, impingement and overuse. Eur J Radiol. 1997 Sep;25(2):118-28. [PMID: 9283840]
  2. Chen C, Chandnani VP, Kang HS, Resnick D, Sartoris DJ, Haller J. Scapholunate advanced collapse: a common wrist abnormality in calcium pyrophosphate dihydrate crystal deposition disease. Radiology. 1990 Nov;177(2):459-61. [PMID: 2217785]
  3. 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. 2008 Oct;61(10):1210-8. [PMID: 17951122]
  4. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg [Am]. 1984 May;9(3):358-65. [PMID: 6725894]

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