Patients › Wrist

Proximal Row Carpectomy

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A wrist salvage operation for an arthritic wrist (SLAC/SNAC) that keeps useful movement — how it works, recovery, and how it compares with fusion.

Updated Aug 2026

X-ray of a wrist after proximal row carpectomy, with the capitate resting against the radius. — After proximal row carpectomy the first row of wrist bones is removed and the capitate articulates directly with the radius, preserving useful movement. Muzichick / Wikimedia Commons, CC BY-SA 4.0

Why this operation has been suggested¶

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For long-standing wear-and-tear arthritis, we usually try non-operative care first. We consider surgery when that has not given enough improvement.

This procedure removes three small wrist bones to let the remaining bones move more freely. It is a reliable motion-preserving option for pain-free function. It compares favorably with total or limited carpal fusions. You can expect good pain relief with preservation of wrist motion. Our goal is to restore your daily function without the stiffness of a fused joint.

Before the operation¶

Please fast for seven hours before your surgery. This allows us to bring you forward if the list runs early. Stop taking certain medications as your surgeon advises. Arrange a lift home and wear comfortable clothing. Bring a list of your current medicines. We use X-rays, MRI, or ultrasound to plan your procedure. Most patients do not need blood tests or an anaesthetic review. You may need them only if you have other medical conditions. Your surgeon will give you specific instructions for your care.

On the day¶

You present to the hospital’s surgical admissions unit. You are checked in and prepared for theatre. You meet the anaesthetist to discuss your care. 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.

You are then taken into the operating theatre, where the operation is performed. You wake up in the recovery area. Nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home. This depends on the procedure and your recovery.

What the operation involves¶

Your surgeon makes a single cut over the back of your wrist. This open approach gives clear access to the small bones in the middle of your wrist. Through this opening, the surgeon carefully removes the proximal row of carpal bones. These are the three small bones that sit closest to your forearm. By removing these specific bones, the surgeon creates space and reduces pressure on the remaining wrist structures.

After the bones are removed, your surgeon closes the cut with stitches. You do not need a cast or heavy immobilisation after the procedure. This allows you to start moving your wrist gently and early. Early movement helps protect your range of motion and supports a smoother recovery. The goal is to preserve the natural movement of your wrist while removing the source of pain and instability.

After the operation¶

You will wake up in the recovery ward with your arm in a soft dressing. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You may have a sling or a temporary splint, but these are not always used. We will manage your pain with standard medication. Please arrange for someone to stay with you for the first 24 hours to help you at home. Keep your arm elevated to reduce swelling. Your hand therapist will make a definitive splint within about a week of surgery.

Recovery¶

Your wrist will be wrapped in a soft dressing after surgery. You may or may not go home with a sling or a temporary support on the front of your forearm. We do not use rigid casts or hinged braces for this procedure. Your hand therapist, Ruby Doolan at Extend Rehabilitation, will make your definitive splint within about a week. She directs your therapy and fits any splint you need. You will not see a hand therapist for your rehabilitation.

In the early days, some pain and swelling is normal. Resting your hand above heart level helps reduce swelling. Gentle movement of your fingers and shoulder is encouraged to keep blood flowing. As the swelling settles, you will begin specific exercises to restore motion. Your hand therapist guides these movements to ensure safe healing. We aim for pain-free function that preserves your wrist movement.

You will notice gradual improvements in strength and flexibility. Milestones are based on how you feel, not just the calendar. You can return to driving once your surgeon clears you and you can safely hold the wheel and react in an emergency. See our guide on driving after upper-limb surgery for universal safety rules. Your timeline may differ; your surgeon and hand therapist will guide you based on your individual progress.

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.

Stiffness and Weakness You might notice that your wrist feels stiff and weaker than before. This is common when the procedure is done for static scapholunate dissociation. You may find it harder to grip objects or push yourself up from a chair. Your surgeon will guide you through exercises to help you regain strength safely.

Progressive Collapse Over time, the bones in your wrist may shift or collapse. This can happen even if you do not feel pain right away. You might notice a change in the shape of your wrist or a gradual loss of movement. Your surgeon will check your wrist during follow-up visits to watch for these changes.

Changes in Load and Pain The way your wrist handles weight may change after surgery. This can put extra stress on the remaining joints. You might feel a deep ache or pain when you use your hand for heavy tasks. If the pain becomes sharp or does not ease with rest, tell your surgeon. They can adjust your activity plan to protect your wrist.

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 redness or discharge from your wrist, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or inability to move your hand. These signs need urgent assessment to keep your recovery on track.

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