Wrist Arthritis

 What wrist arthritis is

Arthritis of the wrist means wear of the joint surfaces inside it. The wrist is not one joint but a cluster of eight small bones and the joints between them, plus the joint where they meet the two forearm bones. Arthritis can affect any part of that cluster, and which part is affected makes a real difference to what can be done about it.

Typical symptoms are pain, stiffness, swelling, a grinding or grating sensation, and a weaker grip. Pain is often worst with loaded movements — pushing up out of a chair, turning a stiff tap, carrying a bag.

What causes it

The wrist differs from the hip or knee in one important way: most wrist arthritis is the late consequence of an injury, often one from decades earlier.

An old scaphoid fracture that never united. The scaphoid has a precarious blood supply, and a fracture that fails to heal changes how the wrist bones move against each other. Over years this produces a predictable pattern of wear, known as SNAC.

An old scapholunate ligament injury. This ligament holds two of the small wrist bones together. When it tears and is not repaired, the bones separate and the wrist gradually wears in a pattern known as SLAC. The original injury is often dismissed at the time as a sprain.

A distal radius fracture that healed out of line. If the joint surface was left irregular, or the wrist healed at an angle, the joint wears faster.

Kienböck's disease, in which the blood supply to the lunate bone fails and the bone collapses.

Inflammatory arthritis, such as rheumatoid arthritis, which damages the joint lining rather than wearing the surfaces mechanically.

And sometimes no cause is found at all.

Diagnosis is made from your history, examination and X-rays. Sometimes a CT or MRI scan is needed, and occasionally a wrist arthroscopy — a keyhole look inside the joint.

What to try first

Surgery is rarely the first step. Most people get useful relief from some combination of:

- Changing the activities that provoke it

- A wrist splint, which is particularly useful for flare-ups and for specific tasks

- Painkillers or anti-inflammatory medication

- Hand therapy, to keep movement and build the strength around the joint

- A steroid injection into the joint, done under ultrasound guidance where the target is small

Doing nothing is a legitimate choice too. Wrist arthritis is not dangerous, pain fluctuates, and many people manage for years. The trade-off is continuing pain and the limits it places on what you do.

How the surgical choice is made

There is no single operation for wrist arthritis, and that is not evasiveness — it is the nature of the problem. The choice turns on two questions.

Which part of the wrist is worn? Many of these operations work by removing or fusing only the damaged part and leaving the healthy part to do the moving. That is only possible if some of the wrist is still healthy, which is why the pattern on your X-ray, and sometimes on a scan or at arthroscopy, drives the decision.

What do you need most — movement, or strength? These trade against each other. The operations that preserve the most movement give up some strength and durability. The one that gives the most reliable strength gives up movement entirely. There is no option that is best on both counts, and where you sit between them is a personal judgement rather than a clinical one.

The five options below are set out roughly in order of how much they take away.

 Wrist denervation (neurectomy)

What it does. It treats the pain rather than the joint. Two small nerves carry pain signals from the wrist — the posterior interosseous nerve (PIN) and the anterior interosseous nerve (AIN). By the time they reach the wrist both are purely sensory to the joint: they do not move any muscles and they do not supply feeling to the skin of your hand. Dividing them removes a proportion of the pain without weakening the hand and without leaving any numb patch on the skin. Miss Edwards divides both together.

The test that comes first. Before offering this operation, local anaesthetic is injected around the AIN and PIN in the forearm, and you test the wrist over the next few hours. If your pain improves substantially, these nerves are carrying a meaningful part of it and the operation is likely to help. If the pain is unchanged, surgery would not be worthwhile. One caveat is worth knowing: the block tends to give a better result than the operation does. It is a good test of whether to operate, but an optimistic guide to how much relief you will end up with.

What it gives you. It is a small operation on the forearm rather than on the wrist joint, with a short recovery. In published series around 80% of patients report less pain and around 85% are satisfied at an average of two and a half years afterwards, with around 90% saying they would have the operation again. Grip strength improved in around 45% of patients — presumably because the wrist was less painful to use — and range of movement was similar before and after (Weinstein and Berger, 2002; Sgromolo et al., 2018).

What it does not do. It does not cure anything. The arthritis is untouched and carries on as it would have done; you simply feel less of it. Complete relief is unusual — most people keep some discomfort at a level they find acceptable. And not everyone is helped: where the operation fails, it usually does so within the first year. Around 15% of patients needed a further procedure in the original published series (Weinstein and Berger, 2002), while larger reviews report around 19 to 24% within two years (Kadhum et al., 2020; Smeraglia et al., 2020) and around 40% by five years (Tandrup et al., 2026).

Why it is often worth doing first. It does not burn any bridges. Every operation below remains available afterwards, and denervation may substantially delay the need for one.

Recovery. Day case, general or regional anaesthetic, 45 minutes to an hour. No splint. Stitches out at 10 to 14 days, driving within a few days to a week, desk work at 2 to 3 weeks, manual work as soon as comfort allows.

Distal pole scaphoid excision

Where the wear is confined to the far end of the scaphoid, where it meets the trapezium and trapezoid, removing that worn end is a small operation with a quick recovery and preserved wrist movement. It is covered in full on the STT arthritis page. This procedures is only useful when the arthritis is mainly isolated to the STT joint

Partial wrist fusion (including four-corner fusion)

What it does. Where the wear follows the SLAC or SNAC pattern, the damage is concentrated between certain bones while the joint between the lunate and the radius stays healthy. Partial fusion takes advantage of that: the worn bones are fused together into a single block, and the healthy lunate-radius joint is left to do the moving. In the commonest version, the scaphoid is removed and four remaining bones are fused — hence "four-corner fusion".

The trade-off. You keep a useful arc of wrist movement, though noticeably less than a normal wrist, and you keep a strong wrist because the fused block transmits load well. It is often the choice for someone who needs grip strength and can accept reduced movement.

What to know. The bones have to unite, which takes time in a cast or splint and does not always happen — non-union is the main specific risk, and it usually needs further surgery. [ADD FIGURE: your own or a published non-union rate and expected range of movement would strengthen this section considerably.]

Proximal row carpectomy

What it does. The first row of wrist bones — the scaphoid, lunate and triquetrum — is removed altogether. The head of the capitate then sits in the socket of the radius, forming a new, simpler joint.

The trade-off. It is a simpler operation than a partial fusion with a quicker recovery, because nothing has to knit together and there is no non-union to worry about. Movement is generally good. Grip strength is usually somewhat reduced compared with a partial fusion.

What to know. It depends on the cartilage on the head of the capitate and in the socket of the radius being in reasonable condition. If those surfaces are already worn, it is not an option — which is one of the things the X-rays, and sometimes an arthroscopy, are looking for. 

Total wrist fusion

What it does. The wrist is fused solid, usually with a plate, so that it no longer moves at all. The forearm rotation — turning your palm up and down — is unaffected, because that happens between the two forearm bones rather than at the wrist.

The trade-off. It is the most reliable operation on this page for pain relief and for strength, and it is permanent. The cost is the movement, entirely and irreversibly.

Who it suits. People whose whole wrist is worn, so that nothing partial is possible; people who need a strong wrist for heavy work; and people for whom an earlier operation has not worked. Most people adapt to a fused wrist better than they expect, but it is a decision to make with your eyes open, and it is not one that can be undone.

Total wrist replacement

What it does. The worn joint surfaces are replaced with an artificial joint, preserving movement.

Where it fits. It is a much less established operation at the wrist than at the hip or knee. It preserves movement, but it is an implant, and implants can loosen, wear or need revising. It is generally reserved for people with low physical demands on the wrist — often those with inflammatory arthritis affecting several joints, for whom a fusion on both sides would be disabling. I do not offer total wrist replacement but for those patients in whom I think it would be a surgical option then I can refer on to a surgeon who does.

What all of this means in practice

Three things are worth carrying into your consultation.

The X-ray does most of the choosing. Several of these operations are only possible if a particular part of the wrist is still healthy. Looking at the films together is usually the quickest way to understand why some options are on the table and others are not.

The order matters. Denervation and, where appropriate, distal pole excision are small operations that leave every larger option open. The larger operations do not work in reverse.

The trade-off between movement and strength is yours to make. There is no clinically correct answer to how much wrist movement a person should be willing to give up. It depends on your work, your hobbies and what you already struggle with, and it is the part of the conversation that should take the longest.

 More information

There is a patient information and consent leaflet for wrist neurectomy on this page. The other operations are discussed in detail at consultation.

Written by Miss Alison Edwards, Consultant Hand Surgeon. Published September 2026. Next review September 2028.