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Wrist Instability (SLAC)

Wrist Instability
(SLAC)

Understanding SLAC Wrist and Its Impact

Scapholunate advanced collapse (SLAC) is a progressive degenerative condition affecting the wrist. It develops due to chronic instability between the scaphoid and lunate bones, often following an untreated or mismanaged ligament injury. Over time, this instability leads to arthritis, joint wear, and a significant loss of function. Patients with SLAC wrist commonly experience pain, decreased range of motion, and difficulty performing everyday activities requiring wrist strength and flexibility.

The progression of SLAC wrist typically follows a predictable pattern, moving from mild degenerative changes to severe joint destruction. Initially, the scapholunate ligament becomes stretched or torn, leading to abnormal wrist mechanics. As the condition progresses, arthritis sets in at the radiocarpal and midcarpal joints, further reducing function and increasing discomfort. Without appropriate treatment, the degeneration can severely impact a patient’s quality of life, making even simple movements, such as gripping objects or typing, painful and difficult.
Ankle instability
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Causes and Symptoms of SLAC Wrist

Causes and Symptoms of SLAC Wrist

The primary cause of SLAC wrist is a chronic injury to the scapholunate ligament, which disrupts the normal biomechanics of the wrist. This ligament is crucial for maintaining the stability of the wrist joint, and once compromised, it leads to excessive motion between the scaphoid and lunate bones. This abnormal motion results in increased wear and tear on the cartilage, ultimately leading to osteoarthritis.

Symptoms of SLAC wrist include persistent wrist pain, particularly on the radial side, weakness, swelling, and a noticeable decrease in grip strength. As arthritis progresses, patients may develop stiffness and a limited range of motion, making daily activities such as lifting objects, turning doorknobs, or writing increasingly difficult. Many patients report a grinding sensation in the wrist due to the joint surfaces rubbing against each other without adequate cartilage protection.

Treatment Options for SLAC Wrist

Treatment Options for SLAC Wrist

OSG instability

Non-Surgical Management

In the early stages of SLAC wrist, conservative treatments may help manage symptoms and delay the need for surgery. These options include wrist splinting to stabilize the joint, nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation, and corticosteroid injections for temporary relief. Physical therapy can also play a role in maintaining mobility and strengthening the surrounding muscles to provide additional support to the weakened ligament.
However, these measures do not address the underlying cause of SLAC wrist and may only offer temporary relief. As the condition progresses, most patients will require surgical intervention to restore function and alleviate pain.

Surgical Treatment Options

Several surgical approaches can be considered for SLAC wrist, depending on the severity of the condition and the patient’s functional needs. The two primary categories of surgical intervention are arthrodesis (wrist fusion) and reconstructive procedures.

Arthrodesis

Arthrodesis, or wrist fusion, is a definitive procedure that eliminates movement in the affected joint by surgically fusing the bones together. This procedure is typically recommended for patients with advanced arthritis who have significant pain and functional limitations. While wrist fusion eliminates pain effectively, it also results in a complete loss of wrist motion. Despite this limitation, many patients adapt well and find they can still perform essential daily tasks using compensatory movements from the elbow and shoulder.

Reconstructive Procedures

For patients seeking to preserve some wrist mobility, reconstructive procedures may be a preferable alternative to fusion. These procedures aim to stabilize the wrist while retaining as much motion as possible. One option is a proximal row carpectomy, which involves removing the proximal row of carpal bones (scaphoid, lunate, and triquetrum) to reduce pain and improve range of motion. Another option is a limited wrist fusion, which stabilizes specific joint areas while allowing partial movement in the remaining structures.
Recent advancements in joint replacement technology have also introduced wrist arthroplasty as an option for select patients. This procedure involves replacing the damaged joint surfaces with a prosthetic implant to preserve movement while reducing pain. However, wrist arthroplasty is less commonly performed than other reconstructive procedures, particularly in younger or more active patients.

Comparing Arthrodesis and Reconstructive Procedures

Choosing between arthrodesis and reconstructive surgery depends on various factors, including the patient’s level of pain, functional demands, and personal preferences. Arthrodesis provides the most predictable pain relief and is particularly beneficial for patients with severe arthritis who require a stable and strong wrist. However, the complete loss of wrist motion can be a drawback for those who rely on wrist flexibility for their profession or daily activities.

On the other hand, reconstructive procedures allow patients to retain some degree of movement, making them an attractive option for those with mild arthritis or specific lifestyle requirements. While these procedures may not completely eliminate pain, they offer a compromise between pain relief and function. The decision should be made in consultation with an experienced hand surgeon who can evaluate the patient’s condition and recommend the most suitable treatment approach.

Ankle instability
Ankle instability

Success Rates and Patient Outcomes

Studies have shown that both arthrodesis and reconstructive procedures can provide significant symptom relief and improved function for patients with SLAC wrist. Complete wrist fusion has high success rates in terms of pain reduction and joint stability, with many patients reporting satisfaction with their ability to adapt to the loss of motion. Reconstructive procedures, such as proximal row carpectomy and limited wrist fusion, have also demonstrated favorable outcomes, particularly in patients with less severe arthritis.
Regardless of the chosen treatment, postoperative rehabilitation is essential for optimizing recovery and ensuring the best possible outcomes. Patients are typically advised to undergo physical therapy to strengthen the surrounding muscles, improve flexibility, and gradually regain function. With appropriate treatment and rehabilitation, many patients with SLAC wrist can return to an active lifestyle with minimal discomfort.
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FAQ - Frequently Asked Questions

What is SLAC wrist?

SLAC wrist is a degenerative condition caused by chronic instability between the scaphoid and lunate bones, leading to progressive arthritis and loss of function.

What are the early signs of SLAC wrist?

Early symptoms include wrist pain, weakness, and reduced grip strength. Over time, stiffness and difficulty performing daily activities may develop.

What are the treatment options for SLAC wrist?

Treatment options range from non-surgical management (splinting, NSAIDs, physical therapy) to surgical procedures such as arthrodesis (wrist fusion) and reconstructive surgeries.

Is wrist fusion the best option for SLAC wrist?

Wrist fusion is highly effective in eliminating pain and stabilizing the joint, but it results in a complete loss of wrist motion. Some patients may prefer reconstructive procedures that preserve partial movement.

Can I regain full wrist function after surgery?

While surgery can significantly reduce pain and improve function, full wrist function is unlikely to be restored. However, most patients adapt well and regain sufficient movement for daily tasks.

For more information about SLAC wrist treatment and to schedule a consultation, contact me in Vienna.

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