Wrist surgery encompasses various procedures designed to restore function, relieve pain, and stabilize the complex anatomy of the joint. The wrist is formed by the radius and ulna forearm bones and eight small carpal bones, held together by ligaments and tendons. When this structure is compromised by trauma, chronic disease, or nerve compression, surgical intervention may be necessary. The specific type of surgery recommended depends on the underlying problem and the structures requiring repair.
Defining Surgical Approaches
The fundamental method a surgeon uses to access the wrist joint is the first distinction made in surgical categorization. The two primary approaches are open surgery and arthroscopy, and the choice between them influences recovery and scar size.
Open surgery is the traditional method, requiring a larger incision for direct access to the wrist’s internal structures. This technique is often necessary for complex cases, such as repairing severe fractures or advanced arthritis, where extensive manipulation or reconstruction is required. While it provides a wide field of view, it involves a longer recovery time and a more noticeable scar due to greater tissue disruption.
Arthroscopy is a minimally invasive technique utilizing a small camera, called an arthroscope, inserted through tiny incisions. The surgeon views the joint’s interior on a monitor and uses specialized instruments to perform repairs. This approach results in less pain, reduced scarring, and a faster recovery period compared to open procedures, making it ideal for diagnostics, ligament repairs, or removing damaged tissue.
Addressing Nerve and Tendon Procedures
Many common wrist surgeries focus on relieving pressure on nerves or addressing issues within soft tissues, such as tendons. Carpal tunnel release is a frequently performed procedure targeting the median nerve as it passes through the narrow carpal tunnel. During the procedure, the surgeon cuts the transverse carpal ligament, which forms the roof of the tunnel, to decompress the nerve and relieve symptoms like numbness and tingling. This release can be performed using either a traditional open incision or a minimally invasive endoscopic technique.
Other procedures focus on tendons and surrounding tissues. A tenosynovectomy involves the surgical removal of an inflamed tendon sheath. This is often utilized when chronic inflammation persists, creating more space for the tendon to glide freely. Surgeons also perform ganglion excision (ganglionectomy) to remove a common, fluid-filled cyst that arises from a joint capsule or tendon sheath. These cysts are typically located on the back (dorsal) side of the wrist, and excision aims to remove the cyst and its stalk to prevent recurrence.
Repairing Bone Trauma and Instability
When the wrist suffers an acute injury, surgery is often needed to stabilize the bones and ligaments. Open Reduction Internal Fixation (ORIF) is commonly used to treat unstable or displaced fractures, particularly of the distal radius or carpal bones. This involves making an incision to manually reposition the broken bone fragments and then securing them internally with hardware like metal plates, screws, or pins. The internal fixation provides immediate stability, allowing the bone to heal in the correct anatomical alignment.
Ligament reconstruction or repair procedures are performed when the fibrous bands connecting the wrist bones are torn, causing joint instability. A common example is the repair of the scapholunate ligament. Repairing this injury may involve reattaching the torn ligament using suture anchors, often augmented by temporary fixation with Kirschner wires (K-wires) to hold the joint in position while it heals. In cases of trauma or localized arthritis, a surgeon may perform a limited excision to remove a small, damaged bone fragment, alleviating pain and restoring some motion.
Surgeries for Chronic Joint Conditions
For patients with severe, chronic damage, such as from advanced arthritis or long-term instability, the goal of surgery shifts from repair to joint alteration. Arthrodesis, commonly known as fusion, permanently joins two or more bones together. This eliminates motion in the affected joint area, thereby eliminating the pain caused by bone rubbing against bone. Fusion can be partial, involving a few carpal bones, or total, fusing all carpal bones to the radius, resulting in a stable but immobile wrist.
Alternatively, arthroplasty, or joint replacement, involves removing damaged joint surfaces and replacing them with an artificial implant (prosthesis), typically made of metal and plastic. Unlike fusion, arthroplasty relieves pain while preserving motion, though it is usually reserved for low-demand patients due to concerns about implant loosening. Another motion-preserving option is the proximal row carpectomy (PRC), where the three small bones in the proximal row—the scaphoid, lunate, and triquetrum—are surgically removed. This allows the remaining carpal bones to articulate directly with the forearm bone, improving pain and retaining functional movement.