SLAC stands for scapholunate advanced collapse, the most common pattern of wrist arthritis. It develops over years after an untreated scapholunate ligament tear changes how the wrist bones move and wears the cartilage in a predictable order. A similar pattern after a scaphoid non-union is called SNAC wrist.

I was told my wrist cannot be fixed. Is that true?

Usually that means the ligament can no longer be reconstructed, not that nothing can be done. Once arthritis is established, salvage procedures reliably relieve pain. The right operation depends on which joint surfaces are still healthy, and several options preserve useful wrist motion.

Will I lose all wrist motion?

Not necessarily. Motion-preserving procedures such as proximal row carpectomy and four-corner fusion keep useful movement while removing the arthritic surfaces. A complete wrist fusion, which trades motion for maximum strength and durability, is reserved for advanced arthritis or heavy-demand patients. The choice is matched to your stage and goals.

How do you decide which salvage procedure I need?

The decision is based on the stage of the arthritis, specifically which cartilage surfaces are still healthy, along with your activity level and goals. Examination, imaging, and sometimes arthroscopy are used to map the wrist. The aim is the least drastic operation that will reliably control your pain.

SLAC Wrist and Salvage Procedures, Steven J. Lee, MD

SLAC stands for ScaphoLunate Advanced Collapse. It is the most common pattern of wrist arthritis, and it follows a known sequence: a chronic scapholunate ligament tear changes how the wrist bones move, the cartilage wears in a predictable order, and over years the wrist becomes arthritic and painful. A similar pattern after a scaphoid non-union is called SNAC wrist (scaphoid non-union advanced collapse).

By the time arthritis is established, the ligament can no longer be repaired or reconstructed. The goal shifts from restoring normal anatomy to relieving pain while preserving as much useful motion and strength as possible. These pain-relieving operations are called salvage procedures, and several reliable options exist.

How SLAC develops

The cartilage damage in SLAC wrist progresses through recognized stages, which guides treatment. Early on, the arthritis is limited to a small area at the tip of the radius, and more of the wrist can be preserved. In later stages the arthritis spreads across the wrist, and the operations that work best change accordingly. Matching the procedure to the stage is the central decision.

Symptoms

Patients with SLAC or SNAC wrist usually describe:

Wrist pain that has built up over months to years
Stiffness and loss of wrist motion
Weak grip and pain with loading the wrist
Swelling on the back of the wrist
A history of a wrist injury that was never fully treated

Dr. Lee's approach

The first task is to confirm the diagnosis and stage the arthritis accurately, because the right salvage procedure depends on which joint surfaces are still healthy. Dr. Lee uses the examination and imaging, and sometimes arthroscopy, to map exactly where the cartilage is preserved.

Dr. Lee favors the least drastic operation that reliably controls pain for a given stage. Many patients keep meaningful wrist motion with a proximal row carpectomy or a four-corner fusion. Dr. Lee developed a technique that cushions a proximal row carpectomy with a dermal allograft, which can preserve motion and often avoid a wrist fusion.

A complete wrist fusion is rarely necessary and reserved for advanced disease or for heavy-demand patients who prioritize a strong, durable wrist over motion. For some patients a limited nerve procedure called denervation can reduce pain while preserving motion. The point is that end-stage wrist arthritis is treatable, and the choice is tailored to the patient's stage, demands, and goals.

Proximal row carpectomy

Removing the proximal row of carpal bones lets the wrist move on a new, healthier surface. It preserves useful motion and has a relatively quick recovery, and it is well suited to stages where the surfaces it relies on are still good.

For patients whose joint surfaces are too worn, Dr. Lee developed a technique that uses a dermal allograft to cushion the bones.

Four-corner fusion

The scaphoid is removed and the four remaining carpal bones are fused together, which eliminates the arthritic joints while keeping motion at the main wrist joint. It is a durable option for more advanced patterns and is chosen based on which surfaces are involved.

Total wrist fusion

For advanced, whole-wrist arthritis or for heavy-labor patients who want maximum strength and durability, fusing the entire wrist reliably eliminates pain at the cost of wrist motion. Many patients however can be treated with Dr. Lee's dermal-allograft technique, preserving motion when others have recommended wrist fusion.

Wrist denervation

Cutting selected small sensory nerves to the wrist can reduce pain while preserving motion. It does not address the arthritis itself, but for the right patient it is a lower-impact way to manage pain, sometimes as a first step. This is routinely done as part of the other above procedures as well.

Recovery timeline

Recovery varies by procedure, and hand therapy is part of all of them:

Weeks 0 to 6
Splint or cast depending on the procedure. Finger, elbow, and shoulder motion encouraged. Pain typically improves steadily.
Weeks 6 to 12
Begin wrist motion for the motion-preserving procedures, or continue protection for a fusion, with progressive strengthening in therapy.
Months 3 to 6
Return to work and most activities. Grip strength continues to improve, and final results settle over several months.

What patients commonly misunderstand

What patients are often surprised to learn:

End-stage wrist arthritis is treatable. Even when the ligament cannot be reconstructed, salvage procedures reliably relieve pain. Being told a wrist cannot be fixed usually means reconstruction is off the table, not that nothing can be done.
You do not always lose all motion. Motion-preserving options like proximal row carpectomy with dermal allograft and four-corner fusion keep useful wrist movement. A complete fusion is only one of several choices, reserved for specific situations.
When others have told you a wrist fusion... The technique Dr. Lee developed can often prevent the need for a total wrist fusion, even if the joint surfaces are worn away, preserving motion and providing good pain relief.

This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.

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SLAC Wrist and Salvage Procedures: treating end-stage wrist arthritis.