Flashcards in SLAC - Scaphoid lunate adavanced collapse Deck (11):
what is scaphoid lunate advanced collapse?
A condition of progressive instability causing ADVANCED arthritis of radiocarpal and midcarpal joints
What is the pathology?
CHRONIC Scaphoidlunate Ligament injury->DISI deformity of scaphoid- dorsal intercalated segemental insatablity
SCAPHOID FLEXES and LUNATE EXTENDS as scapholunate ligament no longer restrains this articulation= scapholunate angle >70
This position of the scpahoid and lunate-> abnormal disruption of forces across midcarpus and radio carpal joints
initially effects the radioscaphoid joint then progresses to capitolunate joint
What is the classification system for SLAC?
Can you describe the watson classification?
Stage 1 - arthritis between scaphoid and radial styloid
Stage 2- arthritis between scaphoid and ENTIRE facet of the radius
Stage 3- Arthritis between CAPITATE and LUNATE
What joint is spared?
RADIOLUNATE joint unlike other forms of arhtirits
What does the pt describe?
difficulty in Wb across wrist
PT Localises pain across SL interval
Progressive weakness of affected hand
What do yo find on examination?
Tenderness directly over scapholunate ligament dorsally
decreased wrist rom
weakness of grip strength
What specific test is useful?
Watson scaphoid shift test
will not be positive in adv stages as scaphoid stabilised
firm pressure over scaphoid , wrist is moved from ulna to radial deviation
pressure removed scaphoid relocates back into scaphoid fossa with snapping/clicking
what is seen on x ray?
stage 1- radial styloid beaking, sclerosis sand joint space narrowing between scaphoid and radial styloid
stage 2- sclerosis and joint space narrowing between scaphoid and entire scaphoid fossa of distal radius
satge 3- sclerosis and joint space narrowing between lunate and capitate- capitate will eventually migrate proximally itnoe space created by scapholunate dissociation
LATERAL= DISI deformity- flexion scaphoid and lunate extended
What are the non surgical tx options?
NSAID , splinting and possible cortical injections- mild disease