The diagnosis and treatment of intermediate stage wrist arthritis remains a challenge. In the earliest stages, the goal of treating prearthritic conditions, such as carpal instability caused by ligament injuries or carpal or distal radius fractures, is clear: anatomic reduction and healing of the fracture and correction of the instability to forestall degeneration of the wrist. Similarly, in established arthritis with severe pain and limitation of motion caused by advanced destruction of the articular surface, treatment usually involves some form of arthroplasty or arthrodesis. However, the patient with wrist pain and established but mild, moderate, or localized degenerative changes and good motion remains a treatment dilemma.