Wrist

• Total Wrist Replacement

• Wrist Arthroscopy

• Wrist Sprain

Total wrist replacement (wrist arthroplasty) is performed when arthritis pain is severe, and has not responded to other treatments. Both rheumatoid and osteoarthritis cause pain, and both can affect finger and hand strength, making it difficult to pinch or grip. The primary candidate for wrist replacement has severe arthritis, but does not place significant stress on the wrist.

Although replacing the wrist reduces pain and restores strength, a synthetic wrist, which is usually made of metal and plastic, will not be as strong as the original.

In a patient with severe arthritis in both wrists, replacing one wrist and fusing the other is recommended. In this way, the replacement wrist offers good range of motion, while the fused wrist provides enough strength to handle stressful activity.

Total Wrist Replacement Procedure

The first step in total wrist replacement is making an incision through the skin on the back of the wrist. Tendons are moved aside, and the joint capsule surrounding the wrist joint is cut into. To make room for the prosthesis (synthetic wrist), some of the wrist's carpal bones are removed. The end of the radius is then shaped to fit the prosthesis. Special rasps bore holes in the hand bones and in the forearm's radius bone to accommodate the metal stems of the prosthesis.

After fitting the stems as tightly as necessary, the prosthesis is put in place and its range of motion checked. If the surgeon is pleased with the result, the metal stems are cemented into place. After the tendons are put back in place, the incision is closed.

Arthroscopy is a minimally invasive surgical procedure that can be used both to diagnose and treat a wide range of conditions that affect joints.

In the wrist, arthroscopy is used to treat ligaments, tendons and other types of tissue that become damaged as a result of degeneration, trauma, or disease.

Wrist pain is a common problem with many possible causes. Sometimes it results from a sprain or fracture due to a fall or other injury, while in other cases it stems from conditions such as arthritis or carpal tunnel syndrome.

It is essential, therefore, to obtain the proper diagnosis in order to treat it correctly and effectively.

The Wrist Arthroscopy Procedure

During the wrist arthroscopy procedure, the wrist is stabilized by being placed on a separate operating table from the one the patient is on. Several tiny incisions are made in the wrist and a thin tube, called an arthroscope, is inserted into the treatment area. The arthroscope is connected to a camera that displays images of the wrist's internal structure on a computer screen, allowing the surgeon to precisely identify and target joint abnormalities.

Depending upon what is found, the surgeon, using special small surgical tools, may be able to treat the condition immediately. Reasons for wrist arthroscopy include removing scarred or inflamed tissue, repairing fractures, removing ganglion cysts, and repairing torn ligaments or tendons.

A sprain is a common type of injury that involves a stretching or tearing of ligaments, the strong bands of tissue that connect bones to one another. A wrist sprain is often caused by falling onto an outstretched hand or by bending the wrist backward.

Although anyone can sprain a wrist, athletes, including gymnasts, baseball and basketball players, skiers, skaters and skateboarders, are particularly susceptible. Protective splints or braces can offer some protection from injury for those at greatest risk.

Treatment of a Wrist Sprain

Many mild wrist sprains can be treated with rest, ice, compression and elevation (RICE). Taking nonsteroidal anti-inflammatory drugs (NSAIDs) can also help. For more serious wrist sprains, immobilization with a splint or cast may be prescribed.

To repair a ligament that is completely torn (a Grade 3 sprain), surgery may be required. When a wrist sprain requires surgery, and sometimes even when it does not, physical rehabilitation may be necessary to restore ease of function, range of motion, and strength to the wrist.

Grades of a Wrist Sprain

Wrist sprains are graded on a scale of one to three based on their severity and the extent of damage to the ligaments.

Grade 1
A grade 1 wrist sprain is mild, involving only a stretching of the ligaments involved. In grade 1 sprains, no tearing of ligaments takes place.

Grade 2
Grade 2 sprains are of moderate severity and involve a partial tearing of the ligaments. Patients with a Grade 2 sprain may suffer some dysfunction.

Grade 3
A grade 3 sprain is a significant injury in which the ligament is completely torn. Grade 3 sprains require immediate medical treatment and/or surgical repair. If, as the ligament tears away from the bone, it takes a chip of bone with it, the injury is known as an avulsion fracture. Treatment may vary widely depending on the grade of the sprain. Some mild sprains may not require any medical intervention, but may heal on their own with home remedies.