When Does Wrist Arthritis Need Surgery?

Our surgeon, Dr. Fillip Findling, may recommend surgery if non-surgical treatments fail to control severe pain that limits your daily activities or work. He may also recommend surgery if advanced joint arthritis or deformity increases the risk of tendon damage. In such cases, surgery can relieve pain and restore better wrist function.

Before surgery, Dr. Fillip Findling carefully evaluates your symptoms, joint damage, and overall wrist movement to confirm that the procedure is appropriate for you. He then selects the surgical approach that best addresses the damaged joint and supports better function. After surgery, he monitors your recovery and adjusts your care as your wrist heals. Call 855-321-6784 to schedule your appointment today at Total Orthopedics and Sports Medicine in Massapequa.

Who Is An Ideal Candidate For Wrist Arthritis Surgery?

You may qualify for surgery if you experience constant pain and loss of function despite non-surgical treatments. Your surgeon may also recommend surgery if arthritis significantly reduces your grip strength, hand stability, or wrist motion. These problems can limit your ability to work, complete daily activities, and use your hand comfortably.

In addition, the following warning signs can also signal the need for a medical evaluation and possible orthopedic surgery:

• Weakness and instability: Reduced grip strength can cause the wrist to buckle or give out during normal hand use.
• Grinding or catching: A grating, crunching, or catching sensation during movement can indicate bone-on-bone friction.
• Structural changes: Your wrist develops visible shifting or crookedness, or an X-ray shows major cartilage loss.
• Rapid Joint Damage: Imaging tests showing rapid joint destruction may indicate the need for surgery.

In such cases, surgery can provide significant relief when advanced arthritis limits hand and wrist use. In fact, a study published in the Archives of Orthopaedic and Trauma Surgery found that wrist arthrodesis (surgical fusion) reduced pain scores by 54%. Functional scores improved by 36% after surgery. The study also reported that 87% of patients were very satisfied with their wrist arthrodesis.

Another study published in The Bone & Joint Journal evaluated 75 patients who underwent total wrist replacement for rheumatoid arthritis. The study found that average grip strength increased from 4.8 kg before surgery to 10 kg at follow-up. Pain scores also decreased from 8.1 to 5.4, while disability scores improved after surgery.

What Causes Arthritis To Develop In The Wrist?

Wrist arthritis develops when the smooth articular cartilage that cushions the joint wears down, becomes damaged, or breaks down due to chronic immune system inflammation. As this protective layer deteriorates, the bones lose the smooth surface that allows wrist movement. Then the damaged joint surfaces rub against each other, which can reduce the wrist range of motion.

Here are the main types of wrist arthritis and the factors that contribute to joint damage:

1. Osteoarthritis

Osteoarthritis develops as the protective cartilage inside the wrist gradually wears down over time. Age, genetic factors, and years of repetitive stress can increase this cartilage loss. As the cartilage wears down, the bones experience greater friction during wrist movement. Over time, this wear can cause pain, stiffness, and reduced joint motion.

2. Post-Traumatic Arthritis

A previous wrist injury can trigger arthritis months or even years after the tissue heals. The damage can alter joint alignment and change the way force moves through the wrist. This change places extra stress on the cartilage during daily hand use. Over time, cartilage damage can increase pain, stiffness, and loss of wrist motion.

3. Rheumatoid Arthritis

If your immune system mistakenly attacks the tissues inside your joints, rheumatoid arthritis can develop in the wrist. This abnormal immune response triggers chronic inflammation in the joint lining and nearby tissues. Over time, persistent inflammation can damage the cartilage, bones, and nearby tendons. This damage can increase the risk of tendon ruptures as the disease progresses.

4. Psoriatic Arthritis

Psoriatic arthritis is an inflammatory joint disease associated with the skin condition psoriasis. In this condition, an abnormal immune response causes inflammation within and around the wrist joint. Persistent inflammation can gradually affect cartilage, joint tissues, and normal wrist movement. As a result, the wrist can become painful, stiff, and difficult to move.

5. Gout And Septic Arthritis

Certain medical conditions can cause sudden inflammation and damage within the wrist joint. For example, gout occurs when uric acid crystals build up in the joint and cause intense inflammation. In contrast, septic arthritis develops when an infection enters the joint and damages nearby tissues. Both conditions can damage joint tissues and require prompt medical evaluation.

What Are SLAC And SNAC Wrist Patterns?

SLAC (Scapholunate Advanced Collapse) and SNAC (Scaphoid Nonunion Advanced Collapse) are two common patterns of wrist arthritis that can develop after an injury. In fact, research published in Tomography found that SLAC and SNAC account for about 55% of wrist osteoarthritis cases. Both conditions change normal movement between the carpal bones and gradually damage the cartilage.

Over time, this damage can cause wrist pain, limited range of motion, and reduced grip strength. The arthritis can also spread to other parts of the wrist as the condition progresses. For this reason, your surgeon checks the stage of joint damage before selecting a treatment.

How Does A Doctor Diagnose Wrist Joint Damage?

Our surgeon, Dr. Fillip Findling, may perform a detailed physical examination and review your medical history to identify the source of wrist symptoms. He may also order X-rays to assess cartilage loss, joint space, bone alignment, and other signs of arthritis. If he suspects an inflammatory condition such as rheumatoid arthritis, he may order blood tests to look for signs of inflammation.

Moreover, the American Academy of Family Physicians reports that the following tests can identify structures that may contribute to wrist pain:

• Grind Test: Checks for arthritis or instability through gentle joint compression.
• Lunotriquetral Shear Test: Assesses the ligament between two small wrist bones for a possible tear.
• McMurray’s Test: Checks for damage to the TFCC (cartilage and ligaments that support the outer wrist).
• Supination Lift Test: Assesses pain and weakness linked to a TFCC injury.
• Watson’s Test: Checks for instability between the scaphoid and lunate bones.

However, if X-rays and physical tests do not show the full extent of the damage, our surgeon may order an MRI or CT scan. These scans provide detailed images of the bones, cartilage, ligaments, and other wrist structures. Call 855-321-6784 to schedule an evaluation with Dr. Fillip Findling and discuss your wrist treatment options.

Can An Arthritic Wrist Be Treated Without Surgery?

Yes, many cases of wrist arthritis can improve without surgery, especially during the early stages. Non-surgical care focuses on pain relief, reduced swelling, and better wrist function. These treatments cannot repair damaged cartilage, but they can control symptoms and delay surgery for many patients.

Here are the main non-surgical options your doctor may recommend based on the extent of joint damage:

1. Splinting And Bracing

A wrist splint supports the joint and limits painful motion. This support also reduces pressure on damaged areas during daily activities. Your doctor may recommend a brace for tasks that place extra stress on your wrist. However, you should follow the recommended wear schedule to avoid excess stiffness.

2. Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can reduce pain and swelling. Your doctor may recommend an over-the-counter or prescription option based on your symptoms. Topical anti-inflammatory gels can also ease discomfort directly around the wrist. However, your medical history can affect which medication is safe for you.

3. Corticosteroid Injections

In some cases, your doctor may recommend steroid injections to relieve wrist pain and inflammation. During this treatment, your doctor injects the medicine directly into the affected joint. The injection can reduce swelling and provide pain relief for several months. However, repeated injections can affect cartilage and other joint tissues. For this reason, your doctor may limit the number of injections you receive.

4. Hand Therapy

According to the American Academy of Orthopaedic Surgeons, targeted exercises can improve wrist movement and function. Your therapist may use gentle exercises to improve flexibility and strengthen the muscles that support the wrist. Stronger muscles can provide better joint support without placing extra stress on damaged cartilage. Over time, therapy can improve wrist motion and allow easier hand use during daily activities.

What Are The Surgical Options For Wrist Arthritis?

Wrist fusion and wrist replacement can provide long-term pain relief for severe arthritis. If the damage affects only part of the wrist, proximal row carpectomy may remove the damaged bones while preserving some movement. Partial wrist fusion can also stabilize the damaged area and reduce pain.

For selected cases, wrist denervation can reduce pain by blocking small nerve fibers around the joint without changing the bones. Arthroscopic procedures can also address certain areas of joint damage through small incisions. However, your hand surgeon chooses between these procedures based on the extent of arthritis.

Can Removing Damaged Wrist Bones Ease Your Pain?

Yes, removing damaged wrist bones can reduce pain when arthritis affects specific parts of the joint. For example, a proximal row carpectomy (PRC) removes three small carpal bones closest to the forearm. This procedure reduces painful contact between damaged joint surfaces while preserving some wrist movement.

Moreover, an NIH study followed patients younger than 45 who underwent PRC or four-corner arthrodesis (4CA), a type of partial wrist fusion. The study found that both procedures provided similar pain relief. The study also found the following key outcomes over the long-term follow-up period:

Proximal Row Carpectomy (PRC)	Four-Corner Arthrodesis (4CA)
24% revision rate	20% revision rate
11% overall complication rate	30% overall complication rate
Slightly better wrist motion	Slightly better grip strength
30% moderate or severe arthritis at 10 years	29% moderate or severe arthritis at 10 years

When Is Partial Wrist Fusion A Good Option?

Our surgeon, Dr. Fillip Findling, may recommend partial wrist fusion when arthritis or instability affects only a specific area of the wrist. He may also recommend this procedure when the damage remains localized and healthy cartilage can still support wrist movement. This procedure can reduce pain and stabilize the damaged area while preserving some motion.

Partial wrist fusion can also treat several wrist conditions, such as:

• SLAC Wrist: Ligament damage causes arthritis in specific wrist joints.
• SNAC Wrist: An unhealed scaphoid fracture causes progressive joint damage.
• Kienböck’s Disease: Reduced blood supply damages the lunate bone.
• Carpal Instability: Ligament damage causes abnormal movement between wrist bones.

However, Dr. Fillip Findling may avoid partial wrist fusion if you have widespread joint damage, active rheumatoid arthritis, or a wrist infection. In these cases, he may discuss other treatment options that better address your joint damage. He also explains the benefits, limitations, and expected recovery of each option before you choose treatment. Schedule a consultation with Dr. Fillip Findling to discuss the right treatment for your wrist.

When Do Surgeons Recommend Total Wrist Fusion?

A total wrist fusion may be recommended (arthrodesis) for severe, end-stage joint damage when motion-preserving procedures are no longer suitable. They may also recommend this procedure for severe instability, or complex wrist fractures and deformities. In some cases, joint destruction from a local bone tumor may require total wrist fusion.

During this procedure, your surgeon removes damaged cartilage and positions the wrist bones for fusion. He then uses a metal plate and screws to hold the bones securely together as they heal. Once the bones fuse, the wrist gains permanent stability. However, the fused joint limits wrist motion during daily activities. After surgery, most patients do not require plaster immobilization.

Can Joint Replacement Preserve Wrist Motion?

Yes, wrist joint replacement can preserve motion while reducing pain from advanced arthritis. During wrist replacement surgery, the damaged joint surfaces are replaced with metal and plastic components that allow the wrist to bend. These artificial parts support the movement needed for light daily activities.

Unlike fusion, total wrist arthroplasty preserves motion in cases of severe wrist arthritis. However, this procedure has several limitations that can affect long-term results, such as:

• Activity Limits: Heavy lifting can place excess stress on the implant.
• Implant Wear: Artificial parts can wear down or loosen over time.
• Patient Selection: Surgeons often recommend replacement for patients with severe arthritis who do not place heavy demands on the wrist.
• Less Common Surgery: Wrist replacement is less common than hip or knee replacement.

Can Wrist Arthroscopy Treat Joint Damage?

Yes, wrist arthroscopy can treat joint damage through a minimally invasive treatment. During this procedure, your surgeon inserts a small camera and specialized instruments through tiny incisions. These tools allow the surgeon to repair tears, remove damaged tissue, or smooth damaged cartilage inside the joint.

In fact, a study published in the Journal of Hand Surgery Global Online evaluated arthroscopic treatment for SLAC wrist arthritis. Average pain scores decreased from 7 before surgery to 0.18 at five-year follow-up. DASH disability scores also improved from 48 to 3, while patients reported an average satisfaction score of 4.8 out of 5.

How Do You Know Which Wrist Procedure Is Right For You?

To determine the right wrist procedure, the surgeon reviews your diagnosis, the extent of joint damage, and your daily activity needs. They also check your medical history and test wrist stability, tenderness, and range of motion. Beyond this, X-rays, MRI scans, or CT scans can provide a clearer view of bone, cartilage, and soft tissue damage. If these tests do not clearly identify the problem, your surgeon may use wrist arthroscopy to examine the complex joint damage directly.

In addition, the following risk factors can guide your surgeon toward the most appropriate wrist procedure:

• Age: Younger and older adults may have different recovery needs and long-term goals.
• Bone Quality: Strong, healthy bone can support certain surgical options more effectively.
• Activity Level: Daily activities and sports can affect how much wrist motion you need.
• Occupation: Jobs with heavy lifting or repetitive hand use can influence procedure choice.
• Grip Demands: Your surgeon considers the strength required for work and daily tasks.
• Recovery Potential: Overall health can affect healing and surgical eligibility.

What Is Recovery Like After Wrist Joint Surgery?

Recovery after wrist joint surgery usually takes 6 to 12 weeks for early bone or tissue healing. During the first few weeks, you may wear a splint or cast depending on the type of surgery and the extent of repair. Most patients can return to light activities within a few weeks, while full strength and flexibility can take several months.

The recovery timeline also varies between wrist arthroscopy, proximal row carpectomy, fusion, and joint replacement. After total wrist arthroplasty, you should begin rehabilitation exercises to restore wrist movement. During follow-up visits, your surgeon checks the incision, reviews imaging, and gradually allows more hand use.

Consult Dr. Fillip Findling to Find Out If You Need Wrist Arthritis Surgery!

Severe wrist pain from arthritis can limit your hand movement and interfere with daily activities. As symptoms worsen, you may worry about further joint damage and wonder if surgery or non-surgical care is right for you. You may also have concerns about surgical results, possible risks, and the time required for recovery.

At Total Orthopedics and Sports Medicine, our surgeon, Dr. Fillip Findling, may guide both non-surgical and surgical care based on the extent of your wrist damage. He also explains the expected recovery timeline, rehabilitation plan, and activity restrictions to guide your recovery. Moreover, we accept major insurance plans to provide convenient access to your orthopedic care. Call 855-321-6784 or visit our clinic in Massapequa for a personalized treatment plan.

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