Proximal Row Carpectomy Info Consent

Why this operation has been suggested

This page reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. We reach patients through GP or physiotherapist referral. A clinic assessment establishes your diagnosis. For long-standing wear-and-tear, we usually try non-operative care first. This includes activity changes, hand therapy, splinting, and injections. We consider surgery when these have not given enough improvement.

Proximal row carpectomy is a wrist procedure where your surgeon removes the three small bones in the top row of your wrist. This creates a new joint between the remaining large bone and your forearm bone. We offer this to patients with specific damage, such as Kienböck’s disease or advanced arthritis, where motion-preserving options are needed. It is a reliable way to relieve pain while keeping your wrist moving. Evidence shows it provides durable pain relief and function for up to 10 years. Your surgeon will discuss if this shared decision fits your specific wrist condition.

Before the operation

Your surgeon will arrange X-rays, MRI scans, or blood tests to check your wrist and overall health before surgery. You must fast for six hours before your procedure. Stop taking blood-thinning medications only after your surgeon gives you specific instructions. Bring a list of all current medicines to your appointment. Wear comfortable, loose clothing to your visit. You need someone to drive you home after the anaesthesia wears off. We will review these steps with you to ensure you are ready.

On the day

You will arrive at the hospital for your scheduled time. Our team will guide you to a preparation room. You will meet your anaesthetist to review your health history and answer any questions you have about the procedure. This operation is done under general anaesthetic. A regional nerve block is sometimes added for post-operative pain relief — the anaesthetist will discuss this with you on the day.

Once you are ready, you will be moved to the operating theatre. You will fall asleep before anything begins. When you wake up, you will be in the recovery area. Our nurses will monitor your comfort and vital signs closely. You will stay there until you are fully alert and stable. Your surgeon will visit you to share initial updates. You may feel groggy or have a sore throat from the breathing tube. This is normal. We will provide clear instructions for your next steps before you leave.

What the operation involves

Your surgeon removes the three small bones in the top row of your wrist joint. This procedure is known as a proximal row carpectomy. By taking out these bones, your surgeon creates a new, smoother joint surface between the remaining wrist bones and your forearm bone. This helps to reduce pain while keeping your wrist flexible.

The operation can be done in two ways. Your surgeon may make a single cut on the palm side of your wrist. This approach allows for early movement and better recovery of motion. Alternatively, your surgeon may use keyhole surgery. This involves small cuts and special cameras. This method allows for rapid mobilization of the wrist compared to the open procedure.

After removing the bones, your surgeon closes the cut with stitches or glue. You will have a dressing over the area. You do not need to wear a cast or splint after the operation. Your surgeon will guide you on how to start moving your wrist soon after the surgery. This helps you regain strength and range of motion quickly.

After the operation

You will wake up in the recovery ward. We manage your pain with standard medication. Your wrist will be in a dressing and a sling. We do not use a rigid cast, so you can begin gentle movement soon. Most patients stay one night in hospital after this operation, though some are able to go home the same day. Please arrange for someone to stay with you for the first 24 hours to help with basic tasks. Keep your arm elevated to reduce swelling. We will guide you through safe exercises to protect your wrist while it heals.

Recovery

You will notice swelling and stiffness in your wrist right after surgery. This is normal. Your surgeon may suggest keeping your hand elevated to help the swelling go down. You do not need a cast or heavy immobilisation after this procedure. This allows you to start moving your wrist early, which helps you regain motion faster.

We work with Ruby Doolan at Extend Rehabilitation for your hand therapy. She will guide you through gentle exercises to restore movement and strength. You will begin these activities as soon as your surgeon clears you. Early movement is key to getting your wrist back on track.

At home, you will use your arm for light tasks as comfort allows. Avoid heavy lifting or forceful gripping until your grip strength returns. Sleep with your hand propped up on pillows to reduce throbbing. You may feel some ache when you first try to bend or straighten your wrist. This usually eases as your tissues heal and movement improves.

Your timeline may differ from others. Your surgeon and physiotherapist will adjust your plan based on how you feel. You will know you are progressing when daily tasks become easier and pain decreases. Once your surgeon clears you to drive, you can return to the road. Please review our guide on driving after upper-limb surgery for specific safety rules.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

You might notice that your wrist feels stiff and weaker than before. This is common when the procedure is done for a torn ligament between two small bones in the wrist. The joint structure changes, which can make the wrist feel less flexible.

Sometimes, the bones in the middle of your wrist may shift or collapse over time. This can happen even if you do not feel pain. You might not notice this change until a later check-up. We keep an eye on this during your recovery visits to ensure your wrist stays stable.

You may experience persistent pain on the side of your wrist near the little finger. This can be caused by a small bone in your wrist pressing against other structures. If you feel a deep ache or sharp pain in this area that does not go away, tell us. We can check if this bone is causing the irritation.

Your wrist might feel different when you put weight on it. Removing part of the wrist bone changes how force moves through your hand. This can put extra stress on the remaining joints. You may feel a sense of instability or discomfort when pushing up from a chair or doing heavy lifting.

There is a risk that your wrist may not regain full strength or range of motion compared to other surgical options. For example, some patients find their grip strength or ability to move the wrist side-to-side is limited compared to what it was before surgery. You might also notice that your wrist does not bend or straighten as fully as your other hand.

If you notice sudden swelling, redness, or severe pain that does not ease with rest, contact the clinic immediately. For ongoing stiffness or pain, bring it up at your next review. We can adjust your therapy or investigate further.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or inability to move your hand. We want to catch any complications early. Your recovery is our priority. Please do not wait if these symptoms appear. Contact our clinic immediately for advice.