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Hand, Finger & Wrist Treatment Options
Treatment options presented by your physician can vary. Medications, Natural Treatments, Physical Therapy or possibly surgery might be discussed.
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Wrist arthroscopy is surgery that uses a tiny camera and surgical tools to examine or repair the tissues inside or around your wrist. The camera is called an arthroscope. The procedure allows the doctor to detect problems and make repairs to the wrist without making larger cuts in the skin and tissue.
This procedure involves surgically removing the surfaces of the joints affected by arthritis and joining the bones with plates and screws until they grow together, or fuse. If the entire wrist is not involved, the surgeon may perform a partial fusion, in which the joints that are not damaged are preserved, allowing some movement of the joint. For more extensive arthritis, the surgeon may fuse the entire wrist, which leaves the wrist rigid and immobile, but usually free of pain.
Unlike hip or knee replacement, wrist replacement can be performed on an outpatient basis. To replace a wrist, the surgeon makes an incision on the back of the wrist and cuts away the damaged joint surfaces of the ulna, the radius and in some cases the first row of carpal bones. The surgeon then inserts a metal prosthesis into the center of the radius, which is held in place with cement. Depending on the prosthesis design, the carpal component of the artificial joint may be inserted in the center bone of the hand (the third metacarpal) or screwed into the remaining row of carpal bones. This part of the prosthesis is also cemented in place. A polyethylene spacer is inserted between the two metal components, and the carpal bones may be fused together to hold the prosthesis. Unlike wrist fusion, wrist replacement can allow movement of the wrist; however, it is not appropriate for people who put heavy demands on their wrists.
The basic goal of fracture fixation is to stabilize the fractured bone, to enable fast healing of the injured bone, and to return early mobility and full function of the injured extremity. Fractures can be treated conservatively or with external and internal fixation. Conservative fracture treatment consists of closed reduction to restore the bone alignment. Subsequent stabilization is then achieved with traction or external splinting by slings, splints, or casts. Braces are used to limit range of motion of a joint. External fixators provide fracture fixation based on the principle of splinting. There are three basic types of external fixators: standard uniplanar fixator, ring fixator, and hybrid fixator. The numerous devices used for internal fixation are roughly divided into a few major categories: wires, pins and screws, plates, and intramedullary nails or rods. Staples and clamps are also used occasionally for osteotomy or fracture fixation. Autogenous bone grafts, allografts, and bone graft substitutes are frequently used for the treatment of bone defects of various causes. For infected fractures as well as for treatment of bone infections, antibiotic beads are frequently used.
Finger Joint Fusion3
Similarly, to wrist, certain joints of the fingers can be fused to ease pain and correct deformity. The most commonly fused finger joint is the distal phalangeal joint (DP), the joint closest to the nail.
Finger and Thumb Joint Replacement3
For the proximal and metacarpophalangeal joints (MCPs) where mobility is more important, joint replacement is possible. For pain and deformity in the MCP joints a doctor often uses flexible silicone implants. A doctor may also replace the basal joint, the joint at the base of the thumb.
Carpal Tunnel Release3
In this procedure, the surgeon releases, or cuts free, the carpal ligament from the median nerve to relieve the symptoms of carpal tunnel syndrome. Traditionally this has been done through an open surgical procedure, meaning the wrist was opened. In recent years, surgeons have used two less invasive approaches to carpal tunnel surgery: The mini open approach, which involves a smaller incision, a shorter recovery time and possibly a lower risk of complications than the traditional procedure. The endoscopic approach, which involves making small incisions in the palm and wrist and inserting one or two camera-equipped tubes called endoscopes to view the inside of the wrist on a monitor. Guided by the image on the monitor, the doctor inserts small tools into the tubes and through the incisions to perform the procedure. For some people this approach involves less pain and a shorter recovery time than traditional carpal tunnel release.
What Can You Expect From Replacement Surgery?
If you are considering surgery, discussing treatment options with your doctor is essential to help decide if this is the right choice for you. Treatments for finger and thumb joint replacement pain focus on ways to manage discomfort and improve function. Most successful treatments involve a combination of methods tailored to individual needs, lifestyle, and health.
The potential benefits from replacement4 are:
- Reduce joint pain.
- Restore or maintain joint motion.
- Improve the look and alignment of the joint(s).
- Improve overall hand function.
Potential risks may include:
- incomplete healing
- loss of feeling and dexterity
Among other associated risks.
What Should I Expect After Surgery5?
After the surgery, the hand will be wrapped in a large dressing involving the fingers, hand and wrist. Patients will be asked to keep the hand elevated during the first few post-operative days to prevent swelling. Pain medications will be prescribed and antibiotics if the health care team thinks infection may be a threat. Patients can have finger replacement surgery as an in-patient, where they stay overnight in the hospital, or as an out-patient, where they are able to go home shortly after the procedure. This depends on how many joints need to be replaced in the hand; how long the procedure will take; how long the surgeon estimates the patient may be in pain after the surgery; and other special patient considerations. Patients will need to discuss all these details with their surgeon.