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Scapholunate advanced collapse (SLAC) wrist

Scapholunate advanced collapse (SLAC) refers to a specific pattern of osteoarthritis and subluxation which most commonly results from untreated chronic scapholunate dissociation (scapholunate ligament injury) or from scaphoid non-union (Scaphoid nonunion advanced collapse (SNAC).
It is caracterized by radioscaphoid joint narrowing, sclerosis, osteophytes, cysts, scapholunate dislocation, and carpal collapse. SLAC is more common in the dominant wrist. It occurs more commonly in men than in women and more commonly in persons who perform manual labor.

AP and Oblique views
AP and Oblique views

lateral view
lateral view

Cor T1
Cor T1

Cor GRE
Cor GRE

Sag T1
Sag T1

42 yo with wrist pain and swelling

Scapholunate advanced collapse (SLAC) refers to a specific pattern of osteoarthritis and subluxation which results from untreated chronic scapholunate dissociation (scapholunate ligament injury) or from scaphoid non-union (Scaphoid nonunion advanced collapse (SNAC). Other etiologies include Preiser disease (avascular necrosis of the scaphoid), midcarpal instability, intra-articular fractures involving the radioscaphoid or capitate-lunate joints, Kienböck disease, capitolunate degeneration, and inflammatory arthritis, such as seen in the crystalline deposition disorders of gout and calcium pyrophosphate dihydrate deposition disease (CPPD). The radiographic findings of arthropathy in SLAC wrist are nearly identical to those occurring in CPPD.
Wrist radiographs reveal radioscaphoid joint narrowing, sclerosis, osteophytes, cysts, scapholunate dislocation, and carpal collapse. 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).

Staging:

Stage 1 A: Narrowing of the radioscaphoid joint first begins at the radial styloid aspect
Stage 1 B: The rest of the radioscaphoid joint is narrowed (the entire scaphoid fossa is involved).
Stage 2: The capitolunate joint is additionally narrowed and sclerotic. This results in a radial or dorsal radial position of the capitate (midcarpal SLAC).

SLAC is more common in the dominant wrist. It occurs more commonly in men than in women and more commonly in persons who perform manual labor.

Suggested reading:

1. Resnik D, eds. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, PA: Saunders, 2002.
2. http://www.wheelessonline.com/ortho/scapholunate_advanced_collapse_slac
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