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These are similar pictures to wrist arthritis. The former resulting from a deficiency of the ligament between the scaphoid and the lunate. This involves the two bones coming apart and on X-ray one sees the so called Terry Thomas sign, which is the black gap in between the two bones, being similar to the gap between the famous comedian's two front teeth!
The latter (SNAC) is a similar pattern of arthritis but it results from a scaphoid fracture that has not jointed up. In both situations the height of the carpal bones diminishes.
In the case of the SLAC wrist the capitate moves into the gap between the scaphoid and lunate. The distance between the radius and the capitate diminishes thus wear and tear occurs between the lunate and the capitate and the scaphoid and the lunate, and also between the scaphoid and the radius. For some reason that is not known the joint between the radius and the lunate is quite commonly preserved and it is really dependent on this preservation of this joint that treatment depends.
There are four possible options of treatment for this joint.
- Motion preserving operations
- Four corner fusion - this involves moving the scaphoid bone and fusion together four of the remaining bones of the wrist, capitate, lunate, triquetral and hamate.
- Proximal row carpectomy - this involves taking out the scaphoid lunate and triquetrum. Both these procedures rely on the integrity of the area of the radius that the lunate normally articulates. In the four corner fusion the lunate still articulates with that part of the radius. In a proximal row carpectomy the capitate actually articulates with that part of the radius
- Wrist Denervation. There are three main nerves that supply the hand. Each nerve gives off some branches to the wrist joint. Wrist denervation involves cutting these branches thus taking away the pain from an arthritic wrist. This operation has the advantage of being able to test whether it will work by carefully placing local anaesthetic around these nerves of the wrist, Sending the patient away to see if the local anaesthetic helps and if it does help then it is likely that the operation will help to a similar degree.
- Total Wrist Fusion. This essentially immobilises the wrist joint so that one is not able to put the wrist up and down, although you are able to rotate the wrist i.e. put the palm up to the ceiling and then face it down to the floor. This is the ultimate panacea for wrist arthritis and it generally does cure pain but obviously it does restrict movement.
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