Saturday, April 13, 2024

Types Of Wrist Surgery For Arthritis

How Do The Hands And Wrists Work

Hand & Wrist Surgery: Arthritis of the Hand

The movement and power of your hand and wrist are controlled by muscles and tendons:

  • The flexor group, on the inside or front of the arm, control bending of your fingers and wrist these pass over the front of your wrist and are held in place by a strong fibrous band called the flexor retinaculum, or carpal tunnel ligament.
  • The extensors on the outside or back of your forearm allow the hand to open up.
  • Small muscles in your hand allow fine movement.

The tendons in your hand are covered by a layer of synovium, the same tissue that lines your joints. The tendon and synovium are covered by a tendon sheath, which is a bit like the protective covering on the brake cable of a bicycle.

The sense of touch in your hand is supplied by two main nerves:

  • Your median or carpal tunnel nerve passes under your carpal tunnel ligament and gives feeling to most of your hand . It also provides power to muscles at the base of your thumb.
  • Your ulnar or ‘funny bone’ nerve gives feeling to your little finger and half your ring finger, and it powers all of the other small muscles in your hand.

There are also two arteries that supply blood to your hand. You can feel these on the palm-side of your wrist. The radial artery is often felt to take your pulse. The ulnar artery on the opposite side of your wrist is much more difficult to feel.

Ligament Reconstruction And Tendon Interposition

An LRTI is the most common type of thumb arthritis surgery and involves removing damaged joint surfaces and creating a cushion of other tissues to keep the bones separate.

This procedure involves a trapeziectomy or removal of the trapezium bone. This bone is one of the smaller bones in the wrist and forms the CMC joint with the metacarpal bone in the thumb. Arthritis often causes damage to the trapezium.

The padding is usually part of a nearby tendon, which the surgeon removes, rolls up, and places between the bones of the CMC joint. This procedure is helpful for those with moderate to severe thumb arthritis, especially if they struggle to pinch or grip.

This option can greatly improve certain symptoms, such as pain and reduced mobility. However, it usually requires a long and painful recovery period. It may also decrease pinch strength and result in a noticeably shorter thumb.

Disadvantages Of Hand And Wristsurgery

Whilst there are undeniably, advantagesto undergoing surgery for arthritis, there are also some disadvantagesas well.

These include:

  • Artificial joints are notas hard wearing or long lasting as natural joints.
  • An artificial joint suchas a wrist replacement joint is subject to normal wear and tear.
  • There is a risk of the artificialjoint becoming dislocated or loosening over time.
  • Revision surgery will berequired once the artificial joint has reached the end of its lifespan.This surgery may be required more than once with diminishing resultseach time.

Most people are pleased with the resultsbut there are a small number of people who are dissatisfied with theoutcome. However this may due to unrealistic expectations.

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What Is Arthritis Of The Hand

Arthritis is a disease that attacks the tissues of your joints. A joint is where two bones meet. Arthritis can attack the lining of your joint or the cartilage, the smooth covering at the ends of bones. Eventually the cartilage breaks down, the ends of your bones become exposed, rub against each other and wear away. You have many joints in your hand, therefore its a common site for arthritis to happen.

Arthritis of the hand causes pain and swelling, stiffness and deformity. As arthritis progresses, you cant use your hands to manage everyday tasks as you once could.

Whats The Difference Between Wrist Replacement And Wrist Fusion

Fusion of the wrist in rheumatoid arthritis

Joint fusion is surgery that permanently connects the bones that form a joint. It helps stabilize your joint and reduce pain.

After wrist fusion, you arent able to move your joint at all. But with wrist arthroplasty, you can still move your joint after surgery. Fusions generally provide excellent lifelong pain relief, without any restriction on lifting or grasping, or impact on types of activities .

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When Is Surgery Recommended

If you have finger, wrist, or elbow pain or instability that fails to respond to conservative measures such as rest, over-the-counter-medications, cortisone injections or physical therapy, fusion may be the answer. The procedure is not for everyone, however, so its important to consult a hand and upper extremity specialist to assess your condition and determine the appropriate treatment.

Diagnosis Of Arthritis In The Wrist

Arthritis in the wrist is diagnosed in a physical exam by your orthopedic physician. The physician will test your joint strength, range of motion and evaluate your pain level.

The physician will also order an x-ray or blood test. The x-ray will show exactly where the arthritis is located and how severe it is.

In addition, the physician will be able to distinguish which type of arthritis the patient has. The blood tests will be able to help determine which type of arthritis the patient has as well. Rheumatoid arthritis can be confirmed through a blood test, while osteoarthritis cant.

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The Anatomy Of The Wrist

The wrist is a complex joint with two intricate rows of bones at the base of the hand. There are a total of eight small wrist bones and five longer metacarpal bones, which support the fingers and thumb bones . The ulna and the radius are the two long bones that form the forearm and these attach to the first row of the carpals. Each bone end is covered with cartilage, an elastic tissue that creates a cushioned smooth surface that allow the bones to glide smoothly against each other.

What Outcome Can I Expect If I Have Arthritis In My Hands

Hand & Wrist Surgery: Arthritis of the Hand

There is no cure for arthritis. However, you can usually manage mild to moderate symptoms with a combination of medication and non-medication approaches. Surgery may be an option if other treatments fail or the arthritis in your hands is severe. Your healthcare provider will explain what outcome you can expect for your type and severity of arthritis, your age, other existing medical conditions and other factors.

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What Is A Wrist Replacement

Wrist replacement is surgery to remove a damaged wrist joint and replace it with an artificial joint. The replacement part, called a prosthesis, is typically made of metal, with a polyethylene spacer. Its manufactured to work like a normal, healthy wrist. Arthroplasty is the medical term for joint replacement.

Your wrist is a complex joint containing many small bones. It connects your hand and forearm . Your wrist joint is also called your radiocarpal joint.

Your wrist joint helps you bend, straighten and rotate your hand. It moves during many everyday activities, such as waving, washing your hair, typing or picking something up. If your joint is severely damaged or stiff, many daily tasks can be painful.

Are Glucosamine And Chondroitin Supplements Helpful For Treating Osteoarthritis Of The Hand

Supplements are not reviewed or approved by the Food and Drug Administration . They are not required to undergo the same rigorous clinical trial methods that medications must undergo in the U.S. Some clinical trials show benefits with pain relief however, there is no proof that these supplements slow the progression of osteoarthritis. If you plan to try these, always check with your healthcare provider before using supplements. These products may interfere with medications you currently take.

A note from Cleveland Clinic

Dull or burning joint pain, morning stiffness, swollen joints in your hand are all symptoms of arthritis. Many types of arthritis could affect your hands. Many treatment options are available depending on your exact arthritis type. Medications can reduce joint pain and swelling. Researchers are still working on ways to slow the progression of osteoarthritis. See your healthcare provider if you think you have arthritis in your hands. They will perform a complete exam and offer you a complete treatment plan, which includes hand exercises, use of hot and cold packs, other lifestyle tips and traditional treatments including medications, braces/splints, steroid injections and surgery.

Last reviewed by a Cleveland Clinic medical professional on 07/06/2021.

References

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The Decision Is Yours

Joint surgery is not for everybody. Even if your doctor and surgeon determine your condition would be improved by surgery, the decision to have the operation is up to you. You need to weigh your options and understand what the surgery will involve–before, during, and after surgery, and over the months of physical therapy. It will require patience and the willingness to follow through with physical therapy. Your commitment is the key ingredient in the success of joint surgery. If you’re not sure about having surgery, ask for a second opinion from another doctor. Ask your doctor to suggest a surgeon with arthritis experience. Sign a release form and ask that your medical records and X-rays be sen to the consulting physician. Consider the advice of all your doctors carefully. Doctors, nurses, physical and occupational therapists, and social workers are part of the team that will work to make the surgery a success. Your family and friends are also members of the team. Look to them for emotional support and for assistance during your recovery. But the most important team member is you.

Who Gets Arthritis In Their Hands

Wrist Pain &  Wrist Arthritis

You are more likely to get arthritis in your hands if:

  • Youre older. Osteoarthritis is commonly seen after age 50. Rheumatoid arthritis typically first appears between the age of 35 and 50.
  • Youre a woman.
  • Youre overweight.
  • Youve had previous injuries to your hand. If youve dislocated or broken any joints in your hands or fingers, you are more likely to develop arthritis.
  • You’ve inherited genes that cause the development of arthritis.

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Symptoms Of Arthritis In The Wrist

Arthritis is a common disorder and occurs in many different joints in your body. Although its common, it still puts a damper on your everyday activities. Arthritis in your wrist is especially challenging, since you use your hands for just about everything in life. There are a few different causes of this type of arthritis, such as:

  • Cracking or grinding with movement

If youve experienced any of the above symptoms, arthritis may be the root of your problem. This condition can be managed in a variety of ways, and Dr. Osmani discusses all options with you and helps you decide which avenue is best for your life.

Treatments For Arthritis In The Wrist

There is not a cure for arthritis in the wrist, but Mercy Health offers a variety of treatments that will help manage the symptoms of the disease and help patients live active lives.

First-line therapies typically are non-surgical and involve modifying activity, immobilization, medications, exercise and/or steroid injections.

In severe cases where non-surgical treatments have not been able to alleviate the pain from arthritis in the wrist, surgery may be indicated. The goal of surgery is to relieve the pain and preserve motion in the hand and wrist.

Your physician will work with you to determine which treatment option is best for your case.

More advanced arthritis of the wrist treatments include:

  • Arthroscopic debridement

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Splinting And Pain Relief

Nonoperative measures for wrist arthritis are primarily aimed at relieving pain. Rest in the form of splinting with removable thermoplastic splints may be useful during exacerbations, with the wrist maintained in neutral or slight dorsiflexion, its functional position. Overuse of splinting may cause wrist stiffness and weakness. A high-quality systematic review concluded that for people with osteoarthritis of the hand, limited evidence supports use of education and exercise, mixed evidence supports a beneficial effect of splinting on pain, and no evidence supports one splinting design over another.

Nonsteroidal anti-inflammatory drugs are useful in controlling inflammation, thereby reducing synovitis and swelling. They are most useful in inflammatory arthritis. Antirheumatism medications such as systemic steroids, methotrexate, and tumor necrosis factor inhibitors are useful in patients with RA. Allopurinol may be useful in patients with gouty arthritis of the wrist.

What Happens Before Wrist Arthroplasty

Wrist Surgery For Arthritis Video

Wrist replacement should be performed only by an experienced orthopaedic surgeon, preferably one who subspecializes in hand surgery. Before recommending the procedure, the bone and joint specialist will:

  • Ask you about your general health and any medical conditions you have.
  • Ask about your wrist pain, how long its been happening and how it affects your life.
  • Examine your wrist for strength and range of motion.
  • Order X-rays of your wrist to get pictures of the bones involved.
  • Perform other tests to make sure youre healthy enough for surgery .
  • Make sure that other, more conservative treatment options have been tried, and that other surgical options were discussed with you.

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Bleeding And Wound Haematoma

A wound haematoma is when blood collects in a wound. Its normal to have a small amount of blood leak from the wound after any surgery, and usually this stops within a couple of days. But occasionally blood may collect under your skin, causing a swelling. This can cause a larger but temporary leakage from the wound usually a week or so after surgery, or it may require a smaller second operation to remove the blood collection. Drugs like aspirin and antibiotics can increase the risk of haematoma after surgery.

Read more about types of anaesthetic.

You should have a dental check-up and get any problems dealt with well before your operation. Theres a risk of infection if bacteria from dental problems get into the bloodstream.

You may need to wear splints after the operation, which can make everyday tasks difficult. Its a good idea to make preparations before the operation. Simple things like choosing clothes with wide arms, stocking up your freezer or arranging to have some help in your home will all make it easier to manage one-handed. Its a good idea to arrange help with transport, as youll probably have to attend hospital regularly to see your doctor or therapist. Your occupational therapist will be able to advise you before your operation if you have any concerns about coping at home afterwards.

Why Is Hand And Wrist Arthritis Surgery Performed

Arthritis can cause a number of painful and debilitating problems with the hands and wrists. When nonsurgical options fail to control your pain, surgery may be suggested to improve your pain and function. Some of the most common arthritis-related conditions that can be treated using hand and wrist surgery include:

  • Base of thumb arthritis

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Common Types Of Wrist Surgery

Pain in the hand and wrist may have many causes, including injuries and health conditions. Some of these injuries and conditions, when diagnosed early, may not need invasive surgery. However, this isnt always possible. There are circumstances when wrist surgery is necessary to help bring you relief and restore your mobility.

Here are some common wrist surgeries.

Risk Factors For Arthritis In The Wrist

broken wrist surgery in Raleigh

Risk factors for osteoarthritis in the wrist include:

  • Women develop osteoarthritis in the wrist at an earlier age.
  • 60% of patients over 60 have joint damage.
  • 80% to 90% of patients over 75 have joint damage.

Gender

  • Women develop osteoarthritis in the wrist more often than men

Risk factors for rheumatoid arthritis in the wrist include:

  • Rheumatoid arthritis in the wrist strikes people ages 20 to 40.

Gender

  • Women are three times more likely to develop rheumatoid arthritis than men.

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Hematoma And Distraction Arthroplasty

This procedure may also involve the removal of the trapezium bone, but differs as it uses a wire to temporarily immobilize the thumb. Surgeons will remove the wire 6 weeks later. Without the constant friction in the joint, the body may be able to heal itself.

This option may benefit people with moderate to severe arthritis who want a simpler surgery. Older individuals may also find this procedure useful, alongside those with a failed reconstruction surgery.

However, hematoma and distraction arthroplasty is a controversial surgical option with debatable benefits. While it may help reduce pain, it can impact grip strength and result in thumb shortening.

Exercise For Arthritis In The Wrist

Its important to exercise your wrist joints to promote range of motion, improve flexibility, and prevent additional damage. Your doctor will likely send you for physical therapy so you can do these exercises under supervision and then repeat them at home. Your physical therapist can develop a program thats right for you. The stronger the muscles are around the joint, the better youll feel, says Dr. Hampton. Here are some range-of-motion exercises, including some for your wrist, which you can try at home.

In addition to physical therapy, its a good idea to do regular cardiovascular and strength training exercises that dont put too much pressure on your wrist joints. Swimming and water exercises, for example, places less pressure on the joints since water helps supports the body. Tai chi and yoga involve gentle, flowing movements. Walking is low-impact exercise thats well-suited to people with arthritis. Avoid any exercises with a pushing movement or that put weight on the wrist as that could exacerbate your wrist pain, says Dr. Hampton. You want to stay active, he says. Keep the muscles and tendons around the joint strong. That will help with pain.

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Wrist Surgeon In New York City

Neglecting to address wrist and hand pain often leads to the need of more complicated and extensive treatments. This is why its best to consult with a doctor and get a proper diagnosis as soon as you begin to feel symptoms in your hand or wrist.

Dr. Michele Y. Yoon is a skilled hand specialist who is known for treating a variety of conditions and injuries through non-surgical and surgical treatments. Examples of conditions she commonly treats are arthritis, carpal tunnel syndrome, trigger finger, hand fractures, and hand trauma.

Call our office today at 913-9465 or request an appointment online today.

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