Choose Wrist Procedure for Optimal Outcome
Simple procedures to treat mild to moderate wrist conditions often start with reducing pain and swelling before moving ahead to more active orthopedic treatments. Sometimes wrist treatments involve training the patient to use their wrist differently for high-impact activities like throwing a ball or swinging a hammer.
Orthopedic specialists at Baylor Scott & White Orthopedic and Spine Hospital – Arlington may recommend many types of nonsurgical wrist treatments, including:
- Heat and ice
- Anti-inflammatory medication
- Splint, brace or cast
- Hand therapy rehabilitation
- Steroid injections
The type of wrist procedure chosen depends on the specifics of each patient and each wrist condition. Initially, putting heat and ice on a wrist injury proves helpful for reducing swelling, irritation, and stiffness. Heat speeds up the blood flow to reduce stiffness. Cold packs slow down molecules circulating within tissue for improved mobility.
Another noninvasive wrist care procedure, therapeutic ultrasound, stimulates deep tissue for improved range of motion. Contrast baths alternate heat and cold. Paraffin or warm wax treatments use a machine to apply a warm wax mixture to the affected wrist.
Scar management is a therapy recommended in some case after the injury or orthopedic surgery is healed. To reduce sensitivity and loosen deeper structures in the body, your orthopedic wrist specialist may suggest limited exercise, silicone gel on skin, massage to desensitize scars, then finally injections and surgical options after a year or more when the scar is considered “mature.”
Orthopedic Surgery Repairs Severe Wrist Disorders
More complex wrist procedures may be needed when the wrist has suffered damage such as broken bones, torn ligaments, ripped tendons, or injured nerves. In these cases of wrist pain, recommended wrist procedures may include:
- Surgical fusion
- Joint reconstruction with tendon graft
- Stabilization with metal implants
- Ligament surgery
- Tendon transfer
- Minimally invasive wrist arthroscopy
For example, a broken wrist (also called Colles fracture or distal radial fracture) may require orthopedic surgery. There are many types of wrist fractures, such as intra-articular factures that extend into the wrist joint.
Some broken wrists can be surgically repaired using wrist arthroscopy, an effective diagnostic tool and minimally invasive surgical technique. Arthroscopic surgery can be used to diagnose and treat a number of conditions of the wrist, including chronic wrist pain, wrist fractures, ganglion cysts, and ligament tears.
An open fracture tears through the skin, and a comminuted fracture involves the wrist breaking into more than one piece. A complex wrist fracture may mean the wrist is dislocated or pushed out of alignment. Sometimes the ulna bone of the forearm is fractured along with the scaphoid and/or radial bone.
In addition to applying a wrist splint once swelling goes down, an orthopedic wrist surgeon may recommend realignment (reduction) for broken bone fragments. Following reduction, the splint may be replaced with a plaster cast in a few days. As healing continues, additional diagnostic imaging confirms whether or not the wrist bones are correctly aligned. The cast can be replaced as swelling goes down, finally staying on to stabilize the broken wrist for several weeks.
If the wrist bone has been severely misaligned, open reduction surgery is needed. An orthopedic surgeon sets the broken wrist bones, and then stabilizes them for optimal healing using metal pins, a plate held with screws or wires, or an external fixator frame.
For open fractures, wrist surgery may be done immediately. Exposed bone and soft tissue are cleaned and treated with antibiotics to prevent infection. External fixation may be replaced with internal plates and screws later. A scaphoid (navicular) fracture can call for a cast and/or surgery, depending on the severity and location of the broken bone.
One complication of a scaphoid fracture is reduced blood flow, so the healing process must be monitored closely by your orthopedic hand and wrist specialist. Some patients assume they have a sprained wrist, only to discover that the scaphoid bone was fractured. Accurate diagnosis is a key reason to consult an orthopedic doctor about hand and wrist pain.
Some wrist specialists recommend the use of a bone stimulator. This device sends low-intensity ultrasonic or pulsed electromagnetic waves to stimulate healing in the wrist. It may be helpful in cases such as Kienbock’s disease, where damaged tissue interrupts the blood supply to the lunate bone.
In other cases, a fractured wrist requires stabilization with a bone graft. New bone material is placed around the fractured area, with or without internal fixation hardware. Grafted bone can come from the patient’s own forearm or hip area (autograft). Others use graft material such as allograft cadaver bone.
Pressure on the nerves running through the wrist can also create a need for orthopedic surgery. Disorders such as carpal tunnel syndrome or ulnar tunnel syndrome can be treated with hand therapy, medication or splints. If those options are not successful, surgery may be recommended. The procedure aims to widen the corridor where swollen synovial tissue is squeezing flexor tendons and the median nerve.
To reduce pressure within the wrist, an orthopedic wrist surgeon splits the transverse carpal ligament, removes cysts, clears out old scar tissue, or cuts tendons to open up the irritated wrist passageway. Sometimes orthopedic surgeons employ minimally invasive surgical techniques and tools proven to reduce recovery time.
Find Relief for Arthritic Wrist
There is no cure for arthritis in all its various forms, making it the number one cause of disability in the United States. Before performing surgery, procedures to relieve arthritic wrist pain may include activity changes, splints, nonsteroidal anti-inflammatory medications, physical therapy, and steroid injections.
If these treatments fail, orthopedic surgeons may recommend surgical solutions, such as:
- Proximal row carpectomy to remove three carpal bones
- Partial wrist fusion
- Total wrist fusion (carpal bones and radius)
- Total wrist joint replacement (arthroplasty)
In wrist arthroplasty, damaged wrist bones are replaced with artificial prosthesis made of metal or plastic components. Unlike fusion, wrist arthroplasty allows the wrist to move.
Consult an Orthopedic Wrist Specialist
The first step in stopping wrist pain is to correctly diagnose the cause of the problem. An orthopedic wrist specialist understands the wide ranging number of wrist conditions that factor into your medical condition, whether it’s related to disease or injury.
Consulting with orthopedic doctors and wrist surgeons at Baylor Scott & White – Arlington gives patient’s access to physicians with extensive training, the latest in diagnostic imaging techniques, and well- equipped orthopedic surgical suites to accommodate every type of procedure. Call 855-41-ORTHO to set up an appointment with a wrist specialist today.