Wrist arthritis is very common. Wrist arthritis may occur from ligament injuries, fractures, or from chronic overuse. Wrist arthritis leads to pain, stiffness and often swelling of the wrist.
Regardless of why the wrist arthritis occurred, nonoperative treatment should usually be tried first. Nonoperative treatment consists of splinting, a steroid injection, and limiting activities to within the limits of pain. Non-steroidal anti-inflammatory medications, such as ibuprofen or Naprosyn can also be tried.
If these fail, surgical treatment can be extremely effective. Most cases of wrist arthritis can be treated by fusing only one of the two wrist joints, called the “midcarpal joint”. Bone graft (healthy bone that helps the joint fuse) is taken from the distal radius, the large bone of the wrist, through the same incision. I performed a study that demonstrated that removing the scaphoid bone, which is usually involved in the arthritic process, increases motion following partial wrist fusion.1 This should essentially always be done.
The traditional way to perform a partial wrist fusion is by a “four-corner” fusion, where 4 of the wrist’s bones are fused together using two screws. Please see the “Wrist Arthritis” section of this website for an x-ray and description of the four-corner fusion. However, recently I’ve changed to a lesser surgery, which fuses only two bones, the lunate and the capitate, using a single screw. This seems to generate less pain and heal quicker than the traditional four-corner fusion. Essentially, it’s less surgery for the same result.
Partial wrist fusions are performed as an outpatient surgery. Following surgery, a cast is worn for 4-6 weeks. If a normal wrist had this fusion performed on it (which would obviously never happen), it would lose approximately 35-40% of its motion. However, arthritic wrists are already stiff to some degree, and so less motion is lost in these cases. In some cases, where the arthritis has led to very severe stiffness, a gain in functional motion may actually occur. Hand therapy is often used once the cast is removed to maximize motion.
This is an easy surgery to recommend, as most patients do extremely well and return to work, sports and the other activities that they enjoy, without the pain that used to keep them from being so active.