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Wrist instability

Understanding SLAC-Wrist and its effects

Scapholunate advanced collapse arthropathy (SLAC-Wrist) is a progressive degenerative disease of the wrist. It develops due to chronic instability between the scaphoid and lunate bones, often following an untreated or improperly treated ligament injury. Over time, this instability leads to osteoarthritis, joint wear and tear and a considerable loss of function.

Patients with SLAC-Wrist often suffer from pain, limited mobility and problems with everyday activities that require strength and flexibility in the wrist. The disease progression usually follows a predictable pattern: initially, the scapholunate ligament is overstretched or torn, resulting in abnormal movement. As the disease progresses, osteoarthritis develops in the radiocarpal and metacarpophalangeal joints, further limiting function and increasing discomfort. Without proper treatment, degeneration can significantly impair quality of life and make even simple movements, such as grasping objects or typing on a keyboard, painful and difficult.

Wrist instability
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.
Are you suffering from wrist instability and looking for a specialist?

Causes and symptoms of SLAC-Wrist

The main cause of SLAC-Wrist is a chronic injury to the scapholunate ligament that disrupts the normal biomechanics of the wrist. This ligament is crucial for the stability of the wrist. If it is damaged, there is excessive movement between the scaphoid and lunate bones, which in the long term leads to cartilage wear and eventually to osteoarthritis.

Typical symptoms of SLAC-Wrist

Treatment options for SLAC-Wrist

Conservative therapy

In the early stages of the disease, conservative measures can help to alleviate symptoms and delay surgery. These treatments include

However, these measures do not treat the underlying cause of the condition and often only provide temporary relief. If the disease progresses, surgical treatment is required to restore function and relieve pain.

Konservative Therapie

Surgical treatment options

Depending on the severity of the disease and the functional needs of the patient, various surgical procedures are available. The two main categories are arthrodesis (joint fusion) and reconstructive surgery.

Arthrodesis (joint fusion)

Arthrodesis is a definitive procedure in which the affected bones are fused together to eliminate all movement in the joint. This procedure is usually recommended for patients with advanced osteoarthritis who have severe pain and significant functional limitations.

Advantages of arthrodesis

Disadvantages of arthrodesis

Reconstructive procedures

For patients who wish to retain a certain degree of mobility, joint-preserving reconstructive procedures can be an alternative to fusion.

Proximal row carpectomy (PRC)

In this procedure, the first three carpal bones (scaphoid, lunate and triquetrum) are removed in order to reduce pain and maintain mobility.

Advantages

Disadvantages

Rekonstruktive Verfahren

Partial arthrodesis (limited wrist fusion)

Only certain joint areas are stabilized, while others retain a certain degree of mobility.

Advantages

Disadvantages

Wrist prosthesis (arthroplasty)

In some cases, a wrist prosthesis may be an option. This involves replacing damaged joint surfaces with an artificial implant to maintain mobility and reduce pain.

Advantages

Disadvantages

Comparison between arthrodesis and reconstructive procedures

The choice between arthrodesis and reconstructive surgery depends on several factors:

Success rates and patient outcomes

Studies show that both arthrodesis and reconstructive procedures can significantly improve symptoms.

Are you suffering from wrist instability and looking for a specialist?

Frequently asked questions

SLAC-Wrist is a degenerative disease of the wrist caused by chronic instability between the scaphoid and lunate bones.

Early signs are pain, weakness and reduced grip strength. Stiffness and restricted movement occur over time.

Treatment ranges from conservative measures such as physiotherapy and medication to surgical interventions such as arthrodesis or reconstructive procedures.

For patients with severe osteoarthritis, arthrodesis can provide a permanent solution to pain, but at the expense of mobility.

Contact and further information

Please contact me for further information or a consultation at my practice in Vienna.