The wrist is a complex structure composed of many small bones, ligaments, and tendons that work together to provide a wide range of motion and strength. When issues such as arthritis or injuries affect this intricate joint, daily activities can become challenging and painful. Carpectomy is a surgical option considered for specific wrist problems that aims to alleviate discomfort and improve function.
Understanding Carpectomy
Carpectomy is a surgical procedure that involves the removal of one or more carpal bones from the wrist. The wrist contains eight small carpal bones arranged in two rows, which enable its movement and stability. In a common type of carpectomy, known as proximal row carpectomy (PRC), the three bones in the first row closest to the forearm—the scaphoid, lunate, and triquetrum—are removed. Removing these bones creates a new joint space, allowing the remaining wrist bones to move more freely without painful friction.
When Carpectomy is Performed
Carpectomy is typically considered for individuals experiencing persistent wrist pain due to advanced arthritis or degenerative changes, particularly when less invasive treatments have not provided relief. This procedure is often recommended for conditions like scapholunate advanced collapse (SLAC) wrist and scaphoid nonunion advanced collapse (SNAC) wrist, which result from ligament injuries or unhealed scaphoid fractures leading to progressive arthritis. It is also utilized in later stages of Kienböck’s disease, a condition where the lunate bone loses its blood supply and collapses.
The Carpectomy Procedure
The carpectomy procedure generally takes between one to two hours to complete. Patients typically receive either general anesthesia, which induces a state of unconsciousness, or regional anesthesia, which numbs the entire arm. The surgeon usually makes an incision on the back of the wrist to access the joint. The specific carpal bones are carefully identified and removed while preserving surrounding nerves and tendons. After the bones are excised and the joint is inspected, the incision is closed, and a sterile dressing is applied.
Life After Carpectomy
Following a carpectomy, immediate post-operative care includes pain management and keeping the arm elevated to minimize swelling. The wrist is typically immobilized in a splint or cast for two to six weeks to support healing. After this initial immobilization period, physical or occupational therapy is usually initiated to help restore range of motion, strength, and function. Patients gradually progress through exercises, with typical timelines for returning to daily activities varying, and more strenuous activities like heavy lifting restricted for several months, often between four to six months. While significant pain reduction and improved stability are common outcomes, patients should anticipate that full wrist motion and grip strength may not be completely regained, often achieving around 50-65% of normal range of motion and strength.