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Wrist Arthritis Surgery

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Updated April 23, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Wrist Arthritis:

The wrist joint is the junction of the two forearm bones (the radius and ulna), and the group of 8 small bones at the base of the hand (the carpal bones). Like other joints in the body, the wrist can develop arthritis, causing joint pain and swelling. Different types of arthritis can affect the wrist joint, including osteoarthritis and rheumatoid arthritis.

Treatment of wrist arthritis most often begins with simple treatments, and when these fail to provide relief, there may be surgical options. Fortunately, unlike the hips and knees, we don't walk on our hands, so many people learn to adequately manage their symptoms of wrist arthritis without major surgery. In some patients, however, arthritis symptoms become disabling, and ultimately surgery may become necessary.

Non-Surgical Treatments:

Treatment of arthritis almost always begins with some simple steps. For people with wrist arthritis, common treatments include ice or heat application, oral medications, and cortisone injections. Wrist splints and braces are often very helpful for treatment of wrist arthritis; physical therapy may also provide relief of painful symptoms.

Wrist Fusion Surgery:

A wrist fusion is a common option for treatment of severe arthritis of the wrist. In some cases, where the arthritis is limited to a small area of the joint, there may be the possibility of performing a fusion between just a few of the small bones of the wrist, called a "limited fusion." For example, a "four-corner fusion" is a surgical procedure performed when arthritis is limited to the small bones of the wrist, usually resulting from an old fracture or trauma to the joint.

In people with more widespread arthritis of the wrist — especially when the arthritis involves the ends of the forearm bones — the option becomes a total wrist fusion. In this case, a large plate and metal screws are inserted across the wrist joint. The wrist will never bend again, but in people with severe arthritis, the primary goal is pain relief. A wrist fusion usually provides a strong and pain-free joint to allow resumption of most activities.

Wrist Replacement Surgery:

A wrist joint can be replaced, similar to how a knee replacement or hip replacement is performed: the joint is replaced with metal and plastic implants that allow movement of the joint between the hand and forearm.

The advantage of a wrist replacement is that, unlike a fusion, patients who have a joint replaced will have movement of the wrist. The disadvantage is that this is generally not a good procedure for active and younger patients, as the implants are not designed to withstand significant forces. Furthermore, wrist replacement surgery is relatively uncommon, so unlike hip and knee replacements, there are few surgeons performing this complex procedure.

Carpectomy:

A carpectomy is a surgical procedure to remove the small bones of the wrist joint. The most common type of carpectomy is removal of the small bone at the base of the thumb, called the trapezium, for people with arthritis of the base of the thumb.

When the arthritis is more widespread in the wrist, a surgery called a proximal row carpectomy (or PRC) removes three of the small wrist bones to remove the worn out joints of the wrist. The proximal row carpectomy may be an option in people who need mobility of the wrist and therefore don't want a fusion, yet are too active to have a replacement. In addition, a carpectomy may be a better option for people who are not good candidates for fusion, such as smokers who have a high chance of complications, such as nonunion, with fusion surgery.

Results After Surgery:

The results of treatment of wrist arthritis with surgery is mostly dependent on matching up the best surgical treatment for each patient. Not each of these surgical options is appropriate for everyone with wrist arthritis, so it's important to be evaluated by a physician experienced with each of these techniques.

In patients who undergo surgery for wrist arthritis, most will find relief of some or all of their pain. While function is not normal after wrist arthritis surgery, it is most often better than the patient experienced before surgery. Mobility of the wrist is variable, depending on which surgical option was chosen.

Sources:

Weiss AC, et al. "Total Wrist Arthroplasty" J Am Acad Orthop Surg March 2013 vol. 21 no. 3 140-148

Wyrick JD. "Proximal Row Carpectomy and Intercarpal Arthrodesis for the Management of Wrist Arthritis" J Am Acad Orthop Surg July/August 2003; 11:277-281.

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