SLAC Wrist (Scapholunate Advanced Collapse)

SLAC wrist (Scapholunate Advanced Collapse) is a pattern of wrist arthritis that develops over time following injury to the scapholunate ligament.

This ligament plays an important role in keeping two key wrist bones (the scaphoid and lunate) moving together in a stable way. When the ligament is damaged, the normal mechanics of the wrist are disrupted.

Over time, this leads to abnormal movement between the wrist bones and uneven wear of the joint surfaces. This gradual process results in arthritis, which can cause pain, stiffness and loss of function.

SLAC wrist is one of the most common patterns of wrist arthritis following ligament injury.

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Diagnosis is based on clinical assessment and imaging.

This may include:

• Examination of wrist movement, strength and stability
• X-rays to assess joint alignment and arthritis
• MRI or CT scans in selected cases to assess ligament injury and joint damage

The pattern of joint wear seen on imaging helps confirm the diagnosis.

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Treatment depends on the stage of arthritis and severity of symptoms.

Non-surgical treatment may include:

• Activity modification to reduce strain on the wrist
• Pain relief and anti-inflammatory medication
• Wrist splints for support
• Hand therapy to maintain movement and strength

If symptoms persist or significantly affect function, surgical treatment may be considered. Options include:

• Removal of damaged bones (e.g. proximal row carpectomy)
• Partial wrist fusion to stabilise the joint
• Wrist denervation (in selected cases)
• Total wrist fusion or replacement in more advanced cases

The aim is to reduce pain while preserving as much movement as possible.

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Surgical treatment is tailored to the stage of arthritis and individual patient needs.

Procedures aim to remove damaged joint surfaces, improve stability and reduce pain while maintaining useful movement.

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Recovery depends on the type of procedure performed.

In general, this may include:

• A period of immobilisation in a splint or cast
• Hand therapy to restore movement and strength
• Gradual return to daily activities

Improvement in pain is usually the main goal, although some loss of wrist movement is expected with certain procedures.

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As with any surgical procedure, there are potential risks, although these are uncommon.

Possible complications include:

• Infection (around 1%), usually treated with antibiotics
• Swelling or stiffness, which may take time to settle
• Scar sensitivity
• Nerve irritation or injury (rare)
• Ongoing pain or incomplete symptom relief
• Reduced range of movement following surgery
• Progression of arthritis in remaining joints over time

Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity.

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You should seek medical advice if you have persistent wrist pain, particularly if it follows a previous injury or is associated with weakness or reduced movement.

Early assessment can help identify ligament problems before more advanced arthritis develops.

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