Question about wrist arthritis

[mtomaino]

This week I received this question through the "Contact me" section of www.drtomaino.com:

Dr. Tomaino, I was told yesterday by a VA hand surgeon I have slack wrist. He told me I might need my whole wrist fused if he went in and saw that the lessor fusions were not an option. Looking at your site I see other options. My ligament is torn and I have a cyst and other symptoms that show my wrist is not in good shape. Why can\'t the xrays and MRI give a definitive course of treatment before going in? I appreciate any advice you could give. Thank you for your time.

In most cases, we can decide based on the plain radiograph whether there is an option of a more limited wrist fusion, as opposed to a full wrist fusion. In cases of so called "SLAC arthritis" the joint between the radius and lunate is preserved. This allows preservation of some functional flexion and extension. Why then would anyone recommend a full fusion for a SLAC wrist? Well, the main reason may lie with functional expecations. With a limited fusion, heavy demands may still result in some wrist pain; a complete fusion may result in "more complete" pain-relief---but negates flexion or extension. Also--there may be some situations where the surgeon, based part on experience and part on "intuition" believes that a full fusion may be better for a given patient because of a number of factors, including the liklihood of obtaining a "satisfactory" outcome.

MMT