The Orthobullets Podcast CoinFlips | Hand | Progressive Wrist Pain in 70M
Oct 29, 2025
Asif Ilyas, an orthopedic hand surgeon specializing in wrist arthritis, along with experts Jason Nydick and Deana Mercer, dissect the complexities of managing progressive wrist pain in a 70-year-old man. They weigh the benefits of different surgical options like proximal row carpectomy versus four-corner fusion. Nonoperative approaches, denervation strategies, and nuances of wrist arthroplasty are explored. Insights on postoperative care and addressing potential complications like carpal loosening add depth to their engaging discussion.
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SLAC Pattern Narrows Surgical Options
- Advanced wrist arthritis often reflects a SLAC pattern with both radiocarpal and midcarpal involvement limiting motion-sparing options.
- When radiolunate is preserved, surgeons consider motion-preserving procedures but options narrow with midcarpal disease.
Use Cortisone Before Committing To Surgery
- Try corticosteroid injections liberally for elderly patients before surgery to relieve symptoms and delay operations.
- Reserve surgery for persistent disability or when injections and therapy fail to meet activity goals.
Surgeon Switched From Four-Corner To PRC
- Asif abandoned four-corner fusions due to his personal high nonunion and stiffness rates and now favors PRC with dorsal capsular interposition.
- He preserves options so a failed PRC can still be converted to fusion later.