Right SLAC wrist

Case contributed by Dr Wayland Wang

Presentation

Swollen right hand and wrist after minor trauma.

Patient Data

Age: 85 years

X-ray right wrist and hand

Modality: X-ray

There is a widened scapholunate distance with proximal subluxation of the capitate and altered contours of the scaphoid and lunate bones. Additionally, subchondral cystic changes are demonstrated throughout the bones of the carpus and also in the distal ulna. Convexity of the pronator fat-pad suggests a wrist joint effusion, although the soft tissues around the joint are oedematous. Scattered densities through the joint spaces, particularly in the TFCC, and calcific density posterior to the carpus are of uncertain significance and may represent soft tissue/cartilage calcification or remnants of old trauma.

These findings may represent changes after previous trauma (particularly rupture of the scapholunate ligament) or crystal deposition disease (such as pyrophosphate arthropathy). The metacarpals and phalanges are relatively unaffected. Osteoarthritic changes are noted at the first carpometacarpal and several distal interphalangeal joints. No definite acute bony injury is demonstrated.

X-ray left wrist and hand (for comparison to the right)

Modality: X-ray
Study performed as a reference for the right wrist. Bony contours are preserved. Loss of joint space and subchondral sclerosis are demonstrated through the mid carpal joints, in keeping with osteoarthritic change. There is the suggestion of subchondral cysts particularly in the lunate and distal ulna. Joint alignment otherwise is normal.

Case Discussion

This is a case of scapholunate advanced collapse (SLAC) wrist. This can occur in the setting of CPPD deposition or traumatic injury to the scapholunate ligament.

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Case Information

rID: 50766
Case created: 20th Jan 2017
Last edited: 21st Jan 2017
Inclusion in quiz mode: Included

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