SLAC Wrist and the 3 Stages

[sixdeep357]

Hello,

About a year ago I injured my wrist playing softball. The pain wasn't very severe, but it never really went away. It started to worsen over the past few months so I finally went in to see an orthopedic surgeon. The doctor ordered x-rays and came to the conclusion that I have SLAC wrist. I'm 34 years old with a very high activity level. The orthopedic surgeon thought that I was too young and active for wrist surgery. He said over time arthritis in my wrist will worsen and sometime down the road I could consider surgery. He never said which stage I have but I'm guessing stage 1 since the injury is fairly recent and the pain is minimal.

My question has to do with the stages of SLAC wrist and the types of surgeries. From what I've read online, PIN and AIN denervation or radial styloidectomy and scaphoid stabilization procedures may be performed during stage 1. If my condition progresses to stage 2, then proximal row carpectomy or 4 corner fusion could be performed. Finally, wrist fusion for stage 3.

My age aside, I'm afraid that if I wait around, I'll progress to more advanced stages and more complicated surgeries. I'd rather have 4 corner fusion which would save some wrist motion as opposed to a complete wrist fusion and zero mobility.

Is there anyway to know how fast the condition progresses with most people? Has anyone had the surgeries mentioned above? I just learned about my condition yesterday so I'm very unfamiliar with SLAC wrist and I'm trying to learn everything I can. I've had to make lifestyle changes because of pain and so surgery is very tempting - if it will allow me to do the things I enjoy again (softball, basketball, guitar, etc). I guess you could say I was blindsided yesterday and now I'm trying to learn and cope.

Thanks in advance for your help!

Greg

[Coop1963]

Hey six, i broke both distal processes of the forearm bones and tore the SL ligament back in December 2012. Tomorrow i am having surgery due to constant, and ROM pain, because the ligament repair ruptured about 4 months after the first surgery, thus starting the SLAC wrist syndrome. Because the SLL is shot, the plan is to remove the scaphoid bone and fuse the four others in order to preserve some mobility. The doctor seemed confident i would return to activity with much less pain, and more strength and mobility. But, I would opt for the total fusion for maximum strength, and no mobility, and the least amount of pain. I know there are no guarantees,  I just hope I don't have to revisit surgery again in the future. Most of the time SLAC continues to the point that pain will ultimately be the motivator for surgery. I ride dirt bikes, rebuild engines, love mechanics. Should be able to return to what i enjoy, but I may have to go to four wheels, and a roll cage! But i am also a dentist of all things. Quality of life is however the most important thing IMHO. Good luck! have any ? let me know

[Dr. Kokil Mathur]

Hi!
The treatment plan of Scapholunate Advanced Collapse (SLAC) depends on the severity of symptoms. So, if there is no pain and joint restriction, then conservative method is preferred. This is because all surgeries will have their own complications and restrictions. However, progressive arthritis and joint movement restriction is common in SLAC. Hence, most doctors prefer to operate upon a symptomatic SLAC.
Depending on the type of misalignment, following types of surgeries are done: capitolunate arthrodesis, 4-corner arthrodesis, proximal row carpectomy (PRC), complete wrist arthrodesis, denervation, and radial styloidectomy. Please consult your doctor regarding this. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.