SLAC and SNAC Wrist Info
Last reviewed
SLAC/SNAC wrist – understanding pain from arthritis at the wrist, often after injury.
What you're feeling
You likely feel a deep ache in your wrist that gets worse when you lift things or twist your hand. This pain often flares up after you use your hand for daily tasks like reaching behind your back to fasten a bra or tucking in your shirt. Many patients notice the discomfort is strongest when they wake up in the morning or after a long day of activity.
You might find it hard to sleep on the side of your affected arm because the pressure triggers sharp pain. Simple actions like turning a doorknob or carrying a grocery bag can become difficult or impossible. Your surgeon may explain that this pain comes from wear-and-tear arthritis or instability in the bones of your wrist.
While some treatments aim to preserve motion, others focus on stopping the pain by fusing specific joints. You may experience relief once the unstable bones are joined together, though your range of motion might change slightly. The goal is to give you reliable, resilient results that stay stable over time so you can return to the activities you love.
What's actually happening
In your wrist, small bones called carpal bones move together like a chain. Normally, a strong ligament acts like a rope to keep these bones aligned. When this rope stretches or tears, the bones shift out of place. This shift changes how your wrist moves and puts extra pressure on the smooth coating of cartilage. Over time, this wear-and-tear leads to arthritis, which causes pain and stiffness.
Your surgeon may notice that the top row of wrist bones drives most of the motion. If the connection between these bones breaks, the bottom row cannot move smoothly with it. This misalignment creates a "dart-throwing" motion that feels awkward. While you might still move your wrist in a specific arc, the normal path is lost. The bones rub against each other where they should glide, leading to the grinding sensation and pain you feel.
To fix this, your surgeon might remove a damaged bone or fuse others together. Removing up to 25% of the scaphoid bone does not significantly change how the rest of your wrist moves. However, it can cause a mild tilt in the lunate bone. Fusing four bones together creates a smoother path that mimics normal motion better than other methods. This approach helps stop the arthritis from getting worse and gives you a stable wrist for daily tasks.
What we can do about it
Your journey begins with self-management and guided physiotherapy. Your surgeon may suggest exercises to keep your wrist moving and strengthen the muscles around it. This approach aims to reduce pain and improve how you use your hand in daily life. You should give this non-surgical care a fair chance before considering more invasive steps. While the evidence does not specify a set number of weeks for this trial, consistent effort is key to seeing if your symptoms improve without surgery.
If simple measures are not enough, your surgeon may discuss medical management to control your pain. This often includes anti-inflammatory medicines or cortisone injections to calm swelling and reduce discomfort. Some patients may also consider hyaluronic acid or PRP injections, though the evidence notes these are options for specific scenarios. These treatments can provide relief, but they do not fix the underlying wear-and-tear arthritis. The goal is to manage your symptoms so you can continue with your daily activities for as long as possible.
When conservative care reaches its limit and pain remains severe, surgery may be considered. Your surgeon will look at the specific stage of your arthritis and which joints are affected to choose the right procedure. Options range from removing a small bone to fuse the remaining joints together, or in some cases, using a special implant to replace a damaged surface. The chosen operation aims to relieve pain and restore function while preserving as much movement as possible.
When to see someone
See your GP if you have persistent wrist pain that does not improve with rest. Ask for a specialist review if you feel weakness, instability, or if your wrist locks or gives way. Seek help if symptoms interfere with your sleep or work, or if you notice a sudden worsening of pain. Your surgeon may discuss options like partial wrist fusion or joint replacement if wear-and-tear arthritis has advanced. Some procedures show a 100% union rate at 12 months, while others have higher conversion rates to total wrist fusion. Early assessment helps ensure the best outcome for your wrist function.
