Question
A 62 year old carpenter has a stiff, painful dominant wrist. He recalls a fall onto the hand many years ago.
- Describe the radiograph and give the likely diagnosis.
- Describe the staging and why the radiolunate joint is spared.
- Outline the surgical options.
Answer
Findings
- Scapholunate widening with proximal migration of the capitate
- Radioscaphoid joint narrowing with sclerosis and osteophytes
- Preserved radiolunate joint
- Diagnosis is scapholunate advanced collapse (SLAC) after chronic scapholunate ligament injury
Watson staging
| Stage | Arthritis |
|---|---|
| I | Radial styloid and distal scaphoid |
| II | Whole radioscaphoid joint |
| III | Capitolunate joint |
| IV | Pancarpal, radiolunate spared |
- Radiolunate joint is spherical and congruent, so load stays even through it
- Rotary subluxation of the scaphoid loads the elliptical radioscaphoid fossa eccentrically
Management
- Splint, activity change and steroid injection first
- Radial styloidectomy for stage I
- Proximal row carpectomy for stage II with a healthy capitate head
- Scaphoid excision and four corner fusion for stage II or III
- Total wrist fusion for stage IV or failed salvage
- Wrist denervation (AIN and PIN neurectomy) as an adjunct
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.