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Accuracy is far more important than caliber. A hit with a 22 is more effective than a miss with a 45.

As far as reliability, 22 rimfire is less reliable than centerfire ammo. Having said that, I shoot a lot of 22 and have found its reliability depends a lot on the quality of the ammo and the gun. I have almost no issues with my Browning Buckmark or my S&W M&P 22s. Particularly when I use high quality ammo. I would have no trouble carrying either one with 22s.

If you have been shooting small guns, you might try guns with full grips. I have found that a full grip even on a small gun makes a lot of difference with recoil.

The S&W M&P 22 BTW is a very light relatively small gun. When I was have wrist problems, I seriously thought about carrying that gun.