Skip to content

PRC – An Explanation

PRC – proximal row carpectomy is a surgical procedure that removes a row of small bones in the wrist. In reality, the surgeons change a complex joint in the wrist to a simple yet workable hinge. One good part about a PRC as compared to other wrist surgeries is that it has the least amount of recovery time. I have created a small video that explains the procedure as I understand it to be. There are many reasons why a PRC is performed and I am certain that everyone is unique. In my case my lunate bone had not received blood circulation for a very long time and had cracked while I was changing a spark plug on my Vespa GTV 300. There is no other option but a PRC or a complete wrist fusion. Have you had a PRC? If yes, please take 10-seconds and complete our survey so others may know the statistical outcome. (Click Here).

 

 

X-Rays:

 

 

CT Scan – 4 Months After Surgery:

 

Video 1 of 2

 

Video 2 of 2
 

 

 

More to Come…

62 Comments
  1. Josh Huffman permalink

    I’m 33 I work on a drilling rig and I’m about to have that surgery next week I’m scared to death that I won’t b able to work anymore after I have it …same problem as u artery was damaged to the lunate and it’s collapsing …how’s the strength in ur wrist ? Can u tell any difference ? Please any input would help me thank u

    • I can do most of the things I did before but I am a computer guy and I ride a motorcycle. I think shocks like a hammer or chain saw would irritate it. But it is not yet a year. I will be posting an update shortly with a video of things I can do. Am I happy about the surgery? Heck no. Is there worse things in life? Heck yes. I think the lifting would be an issue.

    • Tracy permalink

      I am not certain you will be able to do your same job as gripping strength and flexion are reduced. I am only 6+ weeks post surgery so this is only a limited observation.

    • Joe permalink

      My name is Joe, 34 yrs old. I had the PRC done back in 2007. Initially a had broken my Scaphoid and they did a bone graft to it. 2 yrs later they found that the graft didn’t fuse and was systic and disintegrating.
      Recently I injured the same wrist. They found that my radial and ulnar tips and wrist bones were severely compacted and eroding. The surgeon I spoke with told me to GET ANOTHER JOB.(I do manual labor and work out) He also said that PRC is not meant for people who do laborious work.
      With regard to strength it’ll never be as strong as it was because your hand will be shorter than your ligaments. But managed to get pretty close, although it’ll take some time.
      You’ll be able to do your job but you’ll end up like me. If you decide to continue with your job ALWAYS wear a brace…they didn’t tell me that part.
      I still have some yrs left on it before I have to get a full fusion. How long depends on what I do.

  2. Harold woods permalink

    I had the PRC done in June of 2011 @ kutch and Kleinert here in Lou key was in a cast for 6 weeks but was using my fingers and thumb after only a couple days only off work a week but was back on light duty . After having the cast removed I didn’t do very much PT and went back to full duty. Has been great. Before surgery every time I hit my hand on anything the pain was terrible I was getting cortisone shots every 3 mo. For almost 2 years . Very glad I finally did it it’s changed my life . I’m 56 and mine was from osteoarthritis

  3. Paul permalink

    I too am awaiting my decision to do the PRC. Much of what I read says it’s not all that special in the lo0ng term.
    Glad to find this update post. Each day the pain is worse, but I’m not sold yet. I’m a real active 68 and don’t do well when sedentary.

  4. George Eversole permalink

    Had the procedure done on my left wrist about 9 months ago by a plastic surgeon whose specialty is hands. One of the bones was badly deteriorated from arthritis. I was in constant and extreme pain; and if I hit my hand on something, the pain would go through the roof. Now, only occasional pain if I happen to twist the wrist in some not-every-day way, and even then the pain is momentary and much, much less and more dull. I have equal range of motion with my right wrist; although strength is not quite what it used to be, it’s been less than a year and I have seen constant improvement since the operation. I was very skeptical, wondering how I’d get along without those 3 bones, but I couldn’t be more satisfied. I had no physical therapy, and was instructed to not purposely exercise the hand/wrist, but just use it naturally. GHE, Phoenix, 2-27-14

    • Paul permalink

      Geroge Eversole, I’m at the stage described in the first 4 lines of you post. I’ve read so many follow ups and this thread that I real hesitant to do It. I’ve been buildong a new home for the past year & a half and think it’s better to work in pain than not finish the project. I’m 68 and can’t understand why this should happen to such a young guy.
      I’ve read some long term studies, like 10 years , that say no improvement!. Then I follow this thread and wonder if it’s the answer?

  5. Rob permalink

    Guys……. had PRC in both wrists due to Osteoarthitis. Right wrist only 12 weeks ago and doing well. My experience with left wrist is excellent. Have regained much oif my strength and grip and 80 % pain relief. Some aching but well worth the Op

  6. Sharon permalink

    What you all have that involves the lunate bone (only lunate) is called “Kienbock” disease. It is somewhat rare and oftentimes not diagnosed properly since only expert orthopedists catch it. My daughter has it. Hers was caught before the complete death of the lunate and so an amazing hand surgeon in Seattle shortened her radius bone and plated that and then did a “live” bone graft from living bone tissue to what remained of the lunate bone to stop the necrosis. It would not regenerate the lunate but in theory would help keep it from dying completely if the graft worked and the lunate started receiving blood supply again. This condition is often caused by an elongated radius bone. Most of the time it is not caught until it is too late and the lunate is completely dead and crumbling or is almost there. It is usually only on one side but can be bilateral in some people. Just Google “Kienbock” disease or syndrome and you will get some info on it. My daughter was in high school when she was finally diagnosed. At first the pain in her wrist/arm/hand just was thought to be overuse or a sprain/strain since she worked at a job where she did lifting. Not the case though. Her surgery was successful. She is a lot weaker on that wrist/hand and it gets real cold during the cold damp winter months with that metal plate in the wrist but the lunate necrosis has stopped and she won’t have such bad arthritis in her older years because that bone will still be in place. She does not have the aching and pain that she once had. Good luck everyone!!!

  7. Does your hand look different? The xray and video are just like my hand. I’m having the surgery in 10 days.

  8. Chet permalink

    I use to golf a lot then only a few times a year after developed Kienbock in my left wrist from a fall, Haven’t golfed in about 5 years because the pain after a round wasn’t worth it. The golfing was with a neoprene wrist brace and after a few swings pain would develop. It’s my left wrist the power wrist in my swing. As I near retirement I would really like to start golfing again and was wondering if after the PRC surgery would I be able to golf once or twice a week pain free. Thanks

    • If you read the blog there are some golfers who were golfing months after their operation. There are also others that could not. It seems to be that kind of procedure and you never know how your hand reacts to such a surgery until you actually do it.

    • Billy HO permalink

      I am a scratch golfer who had a PRC in my right wrist so yes you will be able to play.
      My shot making is not what it used to be but I believe my short game is better maybe because I hit fewer greens now. I am 57 and play or practice five days a week.

  9. Maria permalink

    I am so glad that i found your blog! I found out that I have Kienböcks disease when I was 21 (I’m now 23). I’ve already had 2 surgeries, but none of them worked. So know my doctor suggested the PRC.
    Can I ask you about the movement in your hand after the surgery, did you get it back (or at least the 50% back)? I was told that you might not even get that much movement back..
    And can you put some weight on it, can you for example do a push up?

    Thanks!

    • Hi, You can get up to 50 % bend of the original. I was not so lucky but I find that I am not that much limited since the body attacks chores from a different angle, your arm and shoulder often compensates. However, you will not be able to do push ups because your hand will not bend that way. You may be able to do them with a closed fist and wrist straight. Depends how heavy you are, I guess and how well your wrist heals. Not something I can do. My goal was to ride a motorcycle again and I am hoping to reach that this summer (as soon as the snow goes).

      I wish you luck with your procedure and please keep us informed about how it goes and send us some updates :)

      • Maria permalink

        Thanks for your answer!

        It makes me really sad that there is no better answer to these problems, and that you loose so much movement in your hand. Are you worried about not be able to ride your motorcycle again, your wrist is not fully healed yet? I hope you will succeed in that! :)

        I am having my surgery in maybe 6 months or so (in Finland you have to queue up to 6 months to get your surgery) so I still have time to consider whether to really do this surgery now, or just wait a few years until my wrist gets unbearable and do this surgery later. I don’t like the idea of loosing so much movement..

      • Dave permalink

        I am concerned with the extreme pain in the base of my thumb. Dr says the pain will go away after prc, any advise

      • Maria permalink

        Dave, may I ask, what kind of pain do you have in your thumb? I have recently been experiencing momentarily some sharp pain in the base of my thumb. I thought i was just something else. Can you try to describe your pain?

    • The real problem with a PRC is that it is part science and part luck. Once the surgeons do their best to remove the bones, the body and how you use your hands will decides where the remaining bones settle in place. Often they do not settle in a totally pain free way such as with me. I have an issue with a fragment that is rubbing against the base of my thumb. This causes me a stiffness and sometimes soreness but it is not sore that I have to take painkillers. More like it goes from loose to stiff. I have rode 8,000 Km this summer so far. Being able to ride was one of my goals. I do get sore at times but it goes away quickly without any painkillers.

      Now I have to decide with the doctor if I want to have him grind down the bone in the thumb that is rubbing. Again there is no guarantee. After he fixes that, the bones could settle in a good, same or worse way.

      • Dave permalink

        Maria/Peter, I had my scaphoid and lunate replaced from bone out of my hip 31 years ago. I had a pin going through the base of my thumb by my wrist. The base of my thumb has a dull acke that just won’t go away. After my surgery (31 yrs ago) I lost most movement in my wrist. I have not been back to an Orthopedic surgeon since my surgery and have been putting up with the pain. I had my first visit in June 2014 and the surgeon recommended PRC, because he said the bones have been dead and the surgery probably never actually successful because the bones were dead with no blood flow. At times, I cannot remove a plastic screw cap off a gallon of milk. Thanks

  10. lori permalink

    My husband had this surgery 9 months ago due to the screw in his wrist bone backing out. He is still in a great amount of pain and we are going back to the doctor later this month. He did have physical therapy after and did all the heat and cold treatments. He is a cabinet maker by trade and we have had to close our business after 25 years. He says he has some strength back but very painful to write, brush teeth and push lumber thru his saw. Anyone have any information on their pain level and how long it took to disapate

  11. Barb L permalink

    My lunate was just diagnosed and it is stage IV, completely dead. Would this PRC work on my, right now they are saying I have no option except surgery to remove the dead bone and then fuse the entire wrist so I would have no movement in it at all.

  12. Christina S permalink

    I am grateful to find your blog, as I was diagnosed today. I have systemic schlerderma ( an autoimmune disorder). My immune system thinks it needs to make new skin cells (that I don’t need) so it has attacked my left wrist and dissolved the cartilage to get enough collegan to make these skin cells. So all my small bones are floating around in my wrist with no cartilage to hold them into place and the pain is over the top, when one of puppies hits or pinches a nerve. This surgery is my only option. I’m hopeful my bounce back from this surgery is as easy as some you. I’m quite nervous, so thx for listening.

    • Wow, that is an unusual reason to have this surgery. I wish you luck and keep us informed. Can they stop the immune system from further attacks to cartilage?

      • Christina S permalink

        No, they can’t stop this auto immune response, they can only treat the symptoms. However, I am told that it can go into remission and it5 will never show it’s ugly face again. They have some new “biologics” but they are real chancy and cause all kinds of other problems, like heart attack and stroke. I already have new hip and new knee and now this. I’ll be the bionic women by the all this done. No more making jewelry, Surgery is scheduled for 4/28. hx for the support.

  13. I overextended my dominant hand causing a scapholunate dislocation. This was missed on the initial x ray and after a few months someone finally noticed. My first surgery was a bone graft to replace the torn ligament between my scaphoid and lunate from my middle finger joint which was screwed into place. A few months into physio the pain increased and x rays showed one of the screws was loosening so it was decided I would have a second surgery to remove both screws. After not taking any post op x rays I noticed a lot of pain and still restricted movement that was assumed to be the fault of the screws. After physio and acupuncture my surgeon realised that we did not have post op x rays and when they were taken it shows the removal of the screws had dislodged the bone graft causing it be reabsorbed. So I am back to my dislocated wrist. Now I’m told I need surgery again and having seen another surgeon, between the two of them my options are: If the surfaces aren’t too damaged a PRC (which to me at the time seemed drastic), otherwise a wrist fusion with some nerve cutting, or possibly a wrist joint replacement. My question to any of you post op is has anyone had this for quite a while now? or been told just how long this surgery will last them? Because my doctor said it would only last so long then I would have to try one of the alternatives anyway. I am 24 and all that happened was an accident that barely hurt at the time. How long were you in cast? And what % movement did you gain back? What’s the pain like? And I guess the big question, now you’ve had it, if you could go back and make that decision again would you still pick it? Was it worth it?

  14. Patricia permalink

    I fail in Sept and fructure my Scalpniod bone in my right wrist. I had abone graft done in February, but the graft did not take, and the pain is increasing each day. I am having a P.R.C. on Monday morning. What I will have left in my wrist once surgery is completed, is the removal of the scalpnoid and the two joining bones removed and the 4 left will be screwed together to support the wrist function. I have been told that I will still have movement in the wrist. Has anyone out there experienced this and what was your outcome.

  15. my husband had surgery about 10 months ago he had broke wrist 12 years ago and had graft and screw the screw started backing out and froze his wrist in pain unfortunatly his pain and use of wrist is worse than before he is in construction and uses his hands for everything and now can not work more than 3 hrs or so before wrist is useless he can only hold a glasss for about 20 seconds we are told pain is from bone on bone by two doctors and choice is live with it or fuse it. we do not want to fuse going to go for a 3rd opinion not a sucessfull surgery in our eyes very stressed about working husband is only 52

    • Kathy Tirado permalink

      Im supposed to have a prc done in July. Im 66 years old and am thinking maybe I’ll just skip the surgery and just use the splint. However I don’t want anything to get worse. I broke my scaffoid bone which is necrotic so they recommend this procedure. Any opinions?

      • Find the best hand surgeon around and have it done. I will be posting an article on some natural products that I have discovered helped tremendously. I am in the middle of moving and have lifted heavy boxes etc… Yes, my fingers get a bit swollen but no pain. I just got my computer and office together so I hope to publish a blog article shortly.

      • Christina S permalink

        Kathy,
        I’m a 65 yr old and I nursed my wrist along for years and all I did was make it worse. The brace helped but daily life got in the way making my wrist sore ALL the time, instead of most of the time. I had my surg May 28th and am still in cast. However, I had a reaction to the anestesea (spelled wrong) and landed in the cardiac unit with congestive heart failure for 7 days.
        .
        Cast comes off next week. I have to say that the pain and discomfort was doable for me and I did hit the pain pills when necessary. I have pain free movement of 4 fingers, the only thing that hurts is the base of the thumb, which has me worried.

        Please ask a lot of questions about the anestersea and possible drug interactions with the meds you are taking.
        Good luck to you

      • Kathy Tirado permalink

        Thanks for your response. I have spoken to my cardiologist, primary care doc, and liver doc. I have to change some meds over time so it looks like July will be the surgery. I’m worried as I live alone and am unsure about dressing myself and things like that. How much are you able to do? I’m moving apartments on July 1st so I’ll have to quick unpack!

      • I was able to more than I thought. My worst part was removing the brace after the cast was removed to wash my hand daily. That lasted for a week or so. No button shirts and loose fitting jogging pants are best (zipper and button on jeans).

  16. LeAnn permalink

    I developed Keinboch’s disease in my right dominant wrist in 2009 & had a PRC done in 2011. Being a nurse it left me unable to do CPR anymore so I had to find a desk job. I was fortunate to find a desk job but, all the typing, writing, carrying, pushing, pulling on a constant basis throughout the day leaves me in severe pain by the end of the day. All the veins will stick out my hand & wrist & won’t go down until I get home & soak my hand/wrist. Thinking I may need to go back to my hand/wrist specialist.

  17. Jan permalink

    The first week of Aug. I’m due to have what I think to be this same surgery you had. I’m really having 2nd thoughts about having it done. My hand surgeon will also be cutting the nerve to stop the future pain & I’m very concerned about that. Did they do that when you had your surgery?

    • No nerve cutting on my procedure.

      • Jan permalink

        Thank you for your quick response. I’ve been searching for any info I can get on this type of surgery & I don’t see anywhere else where they cut the nerve. I’m hoping to get a second opinion, because cutting the nerve really isn’t sitting well with me.

    • I had the denervation done to help with the pain. In some aspects it has but, I still take pain medication on a daily basis. I have developed arthritis in my wrist & some of my finger joints. I find wearing a Tommie Copper hand glove while I’m working helps.

  18. Paul permalink

    I have now postponed the PRC long enough that the hand surgeon wants to do a 4 corner fusion. Says the lunate is too badly damaged. Never heard or read anything about cutting and nerves, that must be some other proceedure than a PRC.
    The doctor says the fusion will eliminate the pain along woth the cart bad cartliiage. He also say the wrist will be stronger than the PRC wrist. Any thoughts on this approach?

    • Jan permalink

      She will also be removing the same 3 bones as described in the feed as well as cut the nerve. So I guess waiting isn’t a good either. She said that fusion is an alternative, but she usually only does that type of procedure on construction workers because they need to lift a lot of weight. I still want to have the mobility/dexterity of my wrist.

      • A PRC is generally a step before total fusion. When I had my PRC done my doctor told me that I would eventually need a fusion. I also had the denervation done to help with the pain. Which it did. I’m a nurse & my doctor hoped the PRC lasted until after I retired. Good days & bad days. Good luck with your situation.

      • Jennifer permalink

        I have had 10 surgeries between my two hands over the years trying to find relief to all my pain. I am bone on bone in both wrists and have severe arthritis. I have had partial fusions on both wrists 15 years ago. But I’m now back to the point I have to do something again and it’s going to be major what ever it may be. My options are PRC or full fusions. Being only 42 I am wanting to postpone losing my motion as long as possible. My doctor suggested cutting my nerves a while back to help ease the pain. It wasn’t a fix to my problem but would help living with it. I did the surgery a year and a half ago and it did make a difference. I think if you are doing a procedure that stops the progression of your arthritis and hopefully removing some of the issues having the nerve cut is worth it. If it’s the same as mine, you don’t notice it except the decrease in pain. The nerves that are cut have nothing to do with the outside of your hand. The doctor could cut it and not tell you and you would never know it except for hopefully you’re not in as much pain.
        Good luck!

  19. I too have a tough situation with my wrists. I ruptured the scapholunate ligament many years ago now, but it was misdiagnosed. Now I have arthritis in both, and as a result surgeons are telling me I only have the option of a PRC or 4CF. However, I’ve read about a Dr. Tang doing cartilage grafting in the wrist http://nyp.org/news/hospital/surgical-wrist-arthritis.html and also about a study in which rib cartilage was transplanted in the wrist with long-term success in a number of patients http://www.ncbi.nlm.nih.gov/pubmed/24436822. Does anyone here know more about these procedures?

    Does anyone here know of a good way to find the wrist surgeons in the country? I’ve obviously tried googling, and I found some lists, but with uncertain methodology. If I do have to get one of these fairly complicated and tricky procedures done, that I’ll have to live with day-in-day-out the rest of my life, I want to try to find the best and most experienced surgeon out there. thanks

    • I like Dr. Keramati, orthopedic surgeon Northwest, Seattle. He is done one complicated but successful surgery on my right hand. Now we will do the second one, remove three bones from the wrist. Herd good feedbacks about him from other people too. if there is a chance that they can use bone grafting- I am sure he would let you know all detailed.

    • My Surgeon (See Toronto Hand Clinic on top) works with a partner in the United States and together they did a complete wrist replacement. I would call their office and ask for his USA Partner. I believe they are in the Kentucky Hand Clinic.

      • wixona13 permalink

        Thanks for the suggestions Mila and Peter!

  20. wixona13 permalink

    Can anyone recommend a good wrist brace? Thank you in advance.

    • Paul permalink

      I’ve used the FUTURO Sport Wrist support for almost two years while avoiding the PRC. It’s a wrap that adjusts to your size. It helps keep the hand bones from hitting the arm bones, which is the source of the pain. It’s a 3M product and comes in skin & black. Mine are # 46378 and I bought them in the Internet.
      Paul

  21. Dave permalink

    Ha anyone had the PRC with prior aching pain in the base of the thumb, and the pain completely gone After the PRC?

  22. scott permalink

    I had the prc done in July on the right and will be having the left one done after that heals. So far, not sure how I feel about the surgery but the hand is feeling more “normal” daily. The best way I can described what it felt like for me was a “blob”. It felt dead but being 2 months out now, it does feel a lot better. Don’t like that I have to have these surgeries since I’m only 44 but it is what it is.

    My hands were injured at work from all the stress put on them from yrs of concrete work. Dr says I will never be able to do this work again. Also will never play guitar again and am pretty bitter.

    All I can say to ppl who need this surgery is that for me, it wasn’t noticed right away because I wasn’t in extreme pain except when I worked but since I tried working and ignoring the dull ache, it cost me some wrist movement. The prc is a salvage procedure and for some ppl, the longer they wait, the less movement they will have.

    Glad I found this site and will keep checking back, answer any questions if I can and appreciate all the ppl sharing their experience going through the same journey

    • Paul permalink

      Scott, My problem also came as an after effect from an old injury, but got worse when I decided to build s a house at 67. I postponed the PRC surgery and now I’m going for the 4 point fusion instead.
      Thiey say this will give me some use of my newly stiffend right wrist,, they say pain free.
      Had I done the PRC a year ago I would’t have finished my house and still been on light duty for the rest of my life. Couldn’t handle that,and now will have a longer recovery period and hope I won’t regret waiting.

  23. I’m just over a year post surgery and I can tell you it was NOT a short recovery. The surgeon says I have better results than expected, but still about half of the mobility I once had. I too had an old injury that I never had checked out and my surgery was a direct result of stupidity. If you have pain in your wrist (even only sometimes), get it checked out! My grip strength is still very minimal, but would probably be better if I worked it out more. I would say it took almost a full year to get to where my wrist really felt fully healed. The pain is gone, but you’ll always have that feeling of it not being quite right. I also get aches before storms.

    • Dave permalink

      Scott, did you have severe pain in your wrist as well as in the base of your thumb? My dr claims I will be relieved of all the aches and pains after PRC
      Thanks

      • scott permalink

        Hey Dave,
        The pain in my wrist really wasn’t severe. It would start to ache if I used it a lot. It always seemed like it was healing and then it would end up slowly coming back. It wasn’t until the other wrist started hurting that I decided I better get them looked at. I was floored when the Dr told me how screwed up my wrists were. I was expecting mild carnal tunnel or tendonitous

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 41 other followers

%d bloggers like this: