Wrist Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Wrist surgery encompasses a range of distinct procedures addressing specific pathologies of the distal forearm, carpal bones, and wrist joint. The most commonly performed wrist operations include carpal tunnel release (CTR) for compression of the median nerve within the carpal tunnel causing carpal tunnel syndrome (CTS); open reduction and internal fixation (ORIF) with a volar locking plate for displaced or unstable distal radius fractures (the most common fracture in adults); triangular fibrocartilage complex (TFCC) repair or debridement for ulnar-sided wrist instability and pain; scaphoid fracture fixation with a headless compression screw for displaced or proximal pole fractures; and wrist arthroscopy — a keyhole inspection and treatment of intraarticular pathology using a 2.7 mm arthroscope through small dorsal portals. More complex procedures include proximal row carpectomy and total wrist arthroplasty or arthrodesis (fusion) for end-stage wrist arthritis, and Darrach procedure or ulnar shortening osteotomy for ulnar impaction syndrome. Treatment is selected by an orthopaedic or hand surgeon based on the specific diagnosis confirmed by clinical examination, plain X-rays, and MRI or CT as required. Arthroscopic techniques have advanced the management of wrist pathology, enabling diagnosis and treatment of triangular fibrocartilage complex (TFCC) tears, ganglion excision, and loose body removal with minimal surgical access and faster recovery compared to open approaches.

Carpal tunnel release is indicated for electrophysiologically confirmed median nerve compression at the wrist (nerve conduction study showing prolonged distal motor and sensory latencies) in patients with persistent or progressive symptoms — nocturnal numbness, tingling, and pain in the thumb, index, and middle fingers — that have failed conservative management with night splinting and corticosteroid injection for 3–6 months, or when there is objective motor weakness or thenar muscle wasting indicating advanced compression. Distal radius ORIF is indicated for unstable or significantly displaced fractures in adults, particularly those failing closed reduction or where the fracture pattern (intraarticular comminution, volar or dorsal angulation exceeding 20 degrees, radial shortening over 5 mm, or ulnar variance changes) predicts malunion and poor functional outcome with conservative plaster treatment alone. TFCC repair is indicated for peripheral TFCC tears causing ulnar wrist pain and instability — particularly in patients with a positive TFCC stress test — that fail 3–6 months of conservative rehabilitation.

Carpal Tunnel Release (CTR): Under wide-awake local anaesthesia (WALANT technique — lidocaine and adrenaline injected into the palm without sedation), or regional wrist block, a 3–4 cm longitudinal skin incision is made in the palm in line with the ring finger. The palmar fascia and transverse carpal ligament are divided under direct vision using a knife or scissors, decompressing the median nerve. Endoscopic CTR uses 1–2 small portals and a camera-guided blade to divide the ligament from within, allowing faster return to work but with slightly higher risk of incomplete release. Distal Radius ORIF: Under regional (Bier block, or plexus block) or general anaesthesia with tourniquet haemostasis, a volar (palmar) approach (Henry approach) exposes the distal radius between the flexor carpi radialis and radial artery. The fracture is reduced anatomically under fluoroscopic guidance and a titanium volar locking plate secured with bicortical locking screws, providing rigid angular-stable fixation permitting early mobilisation. TFCC Repair: Under general or regional anaesthesia, 2.7 mm arthroscope portals are established on the dorsum of the wrist. The TFCC is inspected; peripheral tears (which have vascular supply and healing potential) are repaired with outside-in suture technique under arthroscopic vision; central degenerative tears are debrided with a powered shaver. The procedure typically takes 45–75 minutes.

Carpal tunnel release achieves greater than 90% patient satisfaction with resolution of nocturnal numbness, tingling, and pain typically within days to weeks of surgery. Grip strength and fine motor function recover progressively over 3–6 months, with near-complete functional recovery in most patients who did not have advanced thenar atrophy before surgery. CTR is one of the most cost-effective operations in orthopaedic surgery, with high procedural success and rapid return to work. Volar locking plate ORIF for distal radius fractures achieves good or excellent functional outcomes (DASH and QuickDASH scores) in over 90% of patients by 6 months, restoring near-normal wrist range of motion, grip strength, and radiological alignment in the large majority. Surgical fixation enables immediate wrist mobilisation and finger exercises from day 1, avoiding the joint stiffness associated with prolonged plaster immobilisation. TFCC repair provides pain relief and improved rotational stability in 70–85% of patients, enabling return to manual work and sport in most cases.

Carpal tunnel release complications include injury to the palmar cutaneous branch of the median nerve causing scar hypersensitivity, injury to the recurrent motor branch of the median nerve causing thenar weakness (rare, under 0.5%), pillar pain (discomfort at the hypothenar or thenar eminences for several months), incomplete ligament division requiring revision, and haematoma. Scar tenderness and grip weakness improve progressively over 3–6 months in most patients. Volar locking plate ORIF risks include extensor pollicis longus (EPL) tendon rupture from hardware prominence (requiring plate removal and tendon grafting), complex regional pain syndrome (CRPS) causing disproportionate pain and stiffness (1–5%), wound infection, malunion, and loss of fixation requiring revision. Hardware removal is performed if symptomatic plate prominence causes tendon irritation. TFCC repair risks include wrist stiffness, infection, incomplete pain relief requiring repeat arthroscopy, and failure of the repair requiring open reconstruction. Arthroscopic procedures carry a small risk of neurovascular damage at portal sites.

Carpal tunnel release: The hand is wrapped in a bulky compressive dressing for 48 hours. Finger mobilisation exercises begin immediately. Light hand use for personal care resumes at 1–2 weeks when dressing is removed; writing and keyboard work resume at 2–3 weeks; full activities and return to manual work at 4–6 weeks. Scar desensitisation massage is taught at the wound check visit. Distal radius ORIF: A volar plaster back-slab is applied for comfort for 1–2 weeks. A formal hand therapy assessment is arranged at 2 weeks when the splint is removed; wrist flexion-extension exercises and forearm rotation begin under the therapist's guidance. Grip-strengthening exercises begin at 6–8 weeks. Return to light desk work at 2–3 weeks and heavy manual work at 3–4 months. Radiographic healing at 6–8 weeks. TFCC repair: A below-elbow splint in neutral rotation is worn for 6 weeks followed by gradual mobilisation with a hand therapist. Return to sport or heavy manual work at 3–4 months. Occupational therapy and hand physiotherapy are integral components of rehabilitation after all wrist surgical procedures.