The Ending of Two Injuries This Site Has Already Warned You About
Most wrist arthritis isn’t the wear-and-tear kind that arrives with age. It’s the consequence of an injury, often one that happened decades earlier and was never treated properly.
Two injuries account for the majority of it, and both have their own articles here because both are catchable.
A torn scapholunate ligament that was called a sprain.
And a scaphoid fracture that never healed because the first X-ray looked clean.
Both let the carpal bones move in ways they were never designed to, and both wear the wrist out along a route that hand and even orthopedic surgeons can predict years in advance.
Why the pattern is predictable
When the scaphoid and lunate come apart, or the scaphoid breaks and heals in two pieces, the load stops passing through the wrist evenly.
Instead of a broad surface carrying weight across a wide area, contact narrows onto an edge. Cartilage designed for spread-out pressure gets a concentrated load in one spot, and it wears through there first.
From that corner it spreads across the wrist in a known sequence over years.
One joint survives longest: the one between the radius and the lunate, because the lunate keeps sitting square under the radius even while everything around it degrades.
That detail isn’t trivia.
It’s the entire reason the salvage operations work, because they’re built around a joint that’s still healthy.
This is one of the few conditions in medicine where someone can look at a 25-year-old’s X-ray and describe, roughly, what their wrist will look like at 45.
What it feels like
- Aching with load rather than at rest, at least early on. Pressing up out of a chair, push-ups, carrying, opening jars.
- Grip strength dropping, often quite noticeably compared with the other side.
- Loss of movement, especially bending the wrist backwards.
- Swelling or a firm fullness on the back of the wrist.
- Clunking or grinding with certain movements.
- Somewhere in the history, a fall in their twenties that was “just a sprain”.
Treatment, and the trade everyone is actually making
Start with the non-surgical options, because they buy real time:
- a supportive wrist splint for heavy tasks,
- changing how you load the wrist,
- tool and technique adaptation, and
- a steroid injection into the joint for flares
Plenty of people manage well for years like this.
When that stops working, every surgical option involves the same trade in different proportions: you give up movement to get rid of pain.
The question is how much of each.
- Wrist denervation. Small nerve branches carrying pain signals from the joint are cut. Movement is fully preserved and the arthritis is untouched, so this reduces pain without changing the underlying problem. A reasonable option for someone who needs their range.
- Proximal row carpectomy. The whole first row of carpal bones is removed and the hand articulates directly on the radius. Keeps a useful amount of movement, gives up some grip strength, and is a smaller operation than it sounds.
- Partial fusion. The worn-out scaphoid is removed and the remaining bones fused into one block. Keeps roughly half your range and generally more strength than the option above.
- Total wrist fusion. The wrist is fused solid in one functional position. Reliable pain relief, strong, and no movement at all. For heavy manual workers this is sometimes the right answer rather than the last resort.
- Wrist replacement. Keeps movement, doesn’t tolerate heavy load, and is generally reserved for lower-demand hands.
There is no universally best choice here, and that’s the honest answer.
It depends on what your hand has to do. A plumber and a pianist with identical X-rays should probably have different operations.
Recovery
Denervation is quick: a few weeks, then normal use.
The bone operations are longer. Expect a period in a cast, then progressive therapy, with the finished result somewhere between 6 and 12 months. Fusions take longer to feel like your own hand, and adapting to a wrist that doesn’t bend takes a few months of relearning tasks rather than a few weeks.
Grip strength usually improves substantially after any of these, because pain has been limiting it as much as anything mechanical.
The short version
Wrist arthritis in someone under 60 usually has an old injury behind it, and the two usual culprits are a missed scapholunate tear and a scaphoid that never healed.
If that’s you, the useful conversation is about which trade suits your hand, not whether surgery is needed yet.
And if you’re reading this because you had a fall last month and the X-ray was normal, read the two articles linked at the top instead. This one is what those two turn into.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Tens of thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Surgical choices here should be made with a hand surgeon who knows what your hand does all day.