Overview:
The wrist is a complicated joint involving eight carpal bones (the Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, and Hamate), and the two forearm bones (the Radius and Ulna).
Arthritis is a condition in which the cartilage on the ends of bones breaks down, causing pain, swelling, and stiffness in a joint. Arthritis in the wrist follows three general patterns. First, it may occur after a lifetime of normal every-day use of the hand. Second, inflammatory diseases such as rheumatoid arthritis or lupus can cause wrist arthritis.
The third common form of wrist arthritis is called Post Traumatic Arthritis. Generally, this type of arthritis may develop in the months to years following a fracture or other severe injury in the wrist. The patient does not remember the injury event if it occurred years earlier. Improper healing of wrist bone fractures can cause parts of the affected bone to become poorly aligned or even die, which negatively affects the cartilage. This pattern occurs when a Scaphoid fracture does not heal properly, in which case it is called Scaphoid Non-union Advanced Collapse (SNAC) wrist arthritis. Wrist injuries can also result in ligament tears. If a ligament is torn, it may allow a wrist bone to shift out of place, resulting in improper wear and tear of the cartilage. A ligament between the Scaphoid and the Lunate is at risk in a wrist injury. If it tears and causes arthritis, it is called Scapho-Lunate Advanced Collapse (SLAC) wrist arthritis.
Symptoms:
Note: The following symptoms are not meant to diagnose a condition. If you have these or other symptoms, you should be evaluated by a qualified healthcare provider.
- Note: Wrist pain from a recent trauma should be evaluated to rule out an acute fracture or ligament injury that could possibly be treated.
- Pain in the wrist several months to years following a wrist trauma.
- Stiffness in the wrist.
- Swelling in the wrist.
- Redness or heat in the wrist.
- Creaking or crunching sensation with use of wrist.
- Limited and/or painful use of the wrist.
Treatment:
- History and Physical Exam: The doctor or midlevel provider will obtain a history of the problem and perform an appropriate physical exam to find the area of concern.
- Imaging: Usually, imaging of the wrist begins with x-rays. If more information is needed, the doctor or midlevel provider may order a CT Scan or an MRI.
- Non-surgical Management:The goal of treatment is to decrease pain in the wrist joint. Symptomatic treatment is an option, including the use of splints, ice, moist heat, and over the counter pain medicines (as allowed by the patient’s primary care provider). The use of chronic pain medicine is avoided.Another non-surgical option is a steroid injection into the joint. The steroid is an agent that decreases inflammation in the joint, and thus helps with pain. It is important to understand that steroids do not fix the joint, and the pain relieving effect may be temporary. Steroids can cause tissue breakdown, so there is a limit on the number of injections that can be given.
- Surgical Management: The primary goal of surgery for Post Traumatic Wrist Arthritis is pain relief. There are several options for surgery. It is important to understand that each of the surgeries results in postoperative wrist stiffness to some degree. A surgery called a Proximal Row Carpectomy involves the removal of a row of wrist bones, forming a new wrist joint surface. A partial fusion of the wrist is another option, in which several of the carpal bones are fused together, yet allows for a small amount of wrist motion in most patients. A total wrist fusion is the yet another option, which takes away all of the motion of the wrist. Other surgeries may be performed for Post Traumatic Wrist Arthritis as well, depending on surgeon preference and experience.
Pre-operative Care:
- Recovery is variable depending on the patient’s medical history and the surgery performed. Generally, the patient is immobilized in a cast or splint for several weeks to months, with restrictions on use of the hand during the postoperative care period.
- After surgery, you will be placed in a post-operative dressing/splint which you must wear until your first post-operative visit with one of our providers. You must keep the dressing CLEAN and DRY to avoid risk of infection and other wound healing complications.
- Someone should be with you for the first 24 hours after surgery.
- You will be given a prescription for post-operative pain medicine. Do not take it with other pain medicines unless directed by your doctor. Do not drive, drink alcohol, or make important decisions while taking the pain medicine.
- Do not smoke, use smokeless tobacco, nicotine gum, or nicotine patches. Nicotine is a vasoconstrictor, and can impede healing by limiting blood flow to the surgical site(s).
- You must remain non-weight bearing (no use) with the surgical hand and arm until cleared by one of our providers. This may be several weeks to months, depending on your healing and the surgery performed. Your doctor will provide you with specific restrictions.
- At the first post-operative visit, your stitches will be removed. You will likely be placed into a forearm-based cast. You will remain in a cast for a number of weeks to months (depending on your healing), until transitioned to a removable splint. If your cast becomes wet or soiled, you should come into the office for a new cast.
- To evaluate bone healing at your follow-up appointments, the doctor will order imaging such as x-rays or a CT scan.
- After several weeks to months of immobilization, you will likely be stiff and weak in your hand. Often, patients are sent to an Occupational Therapist, with the goal of regaining functional use of the operative hand. Remember, you are an active participant in your care, and part of your recovery depends on your desire to participate in therapy.