Proximal Row Carpectomy — (Wrist Salvage)

UW Health · UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Weight-Bearing

NWB surgical UE

Key Restrictions

No lifting/pushing/pulling >5 lbs; no WB through involved UE; wrist cock-up orthosis at all times except hygiene; wrist becomes hinged joint — flexion/extension only after PRC; PROM cautious — do not exceed expected AROM; Dr. Salyapongse immobilizes wrist until 4 weeks; no restrictions at 8 weeks

Timeline & Phases

Phase I (7-14 days): custom wrist cock-up orthosis, AROM wrist/forearm/digits, edema/scar management; Phase II (3 weeks): continue AROM, Dart Thrower's motion, wrist isometrics, proprioceptive retraining; Phase III (4 weeks): gentle PROM wrist/forearm, proprioceptive retraining, light activities without orthosis, wean orthosis; Phase IV (5 weeks): progress PROM with prolonged low-load stretches, gradual isotonic without weights; Phase V (6 weeks): progressive strengthening (putty/exerciser/weights/bands), dynamic orthosis if AROM gains poor; Phase VI (8 weeks): continue strengthening, work/heavy task specific

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with Four-Corner Fusion protocol; PRC removes scaphoid, lunate, triquetrum; wrist becomes hinged joint (flexion/extension only); expected AROM per Saltzman 2015: extension 43°, flexion 36°; expected grip 67% contralateral; prioritize wrist extensor strengthening over flexors (biomechanical moment arm advantage); Dart Thrower's motion maintained — ulnar flexion decreased to 87%; do not exceed expected AROM with PROM; maximum recovery at 12 months; published May 24, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-05-24