Wrist treatments & procedures
Fractures of the distal radius
A fracture of the distal radius occurs when the area of the radius (the largest forearm bone) near the wrist breaks. Sometimes, the position of the bone is so far out of place that it cannot be corrected using a cast.
This has the potential to restrict effective movement in the arm. In this case, surgery may be required.
It may be possible to re-align the fracture without surgery. In some cases, it will be necessary to operate in order to access the broken bones to improve the alignment outcome.
Depending on the nature of the injury, there are several options for setting the bone in the correct position. These include casts, metal pins, a plate and screws, an external fixing or a combination of these techniques.
Scaphoid fractures and non-union
The scaphoid bone is located on the thumb side of the wrist, in the area where the wrist bends. It can be easily identified if the thumb is held in a "hitch-hiking" position. The scaphoid is at the base of the hollow made by the thumb tendons.
Pain / tenderness in this region can be a sign that the scaphoid is damaged.
If your scaphoid is broken surgery may be required. During surgery, metal implants can be used to hold the scaphoid bone in place until it is fully healed. The incision may be made on the front or the back of the wrist.
Sometimes, the screw or wire can be sited with a small incision.
In other cases, a larger incision is required. In cases where the fracture results in more than two pieces, a bone graft may be needed to assist healing. In this procedure, new bone is placed around the broken bone to stimulate healing. It promotes bone growth and aids healing.
Wrist arthritis
A large number of people suffer from arthritis in their wrists, which makes it difficult to perform simple everyday activities.
Most wrist cases are caused by two variants: Osteoarthritis - a progressive condition that destroys the smooth articular cartilage covering the ends of bones. Unprotected bones then rub against each other, resulting in friction and ultimately pain, stiffness, and weakness.
Osteoarthritis can develop due to normal 'wear-and-tear' on the wrist - or as a side effect of any traumatic injury to the forearm, wrist, or ligaments.
Rheumatoid arthritis is an inflammatory disease that affects the joint linings and destroys bones, tissues, and joints. Rheumatoid arthritis often starts in smaller joints such as the wrist. It often affects the same joint on both sides of the body.
When initial treatments are ineffective, or if hand function is compromised, surgery is an option. The goal of surgery is to relieve pain. Depending on the type of surgery, joint function may also be impeded.
Surgical options include:
Removal of the arthritic bones
Joint fusion (making the joint solid and preventing movement of the wrist)
Joint replacement
You and your GP can discuss these options and select the one that is most appropriate.
Wrist ligament injuries (Sprains)
Ligaments are strong bands of connective tissue that connect bones together. Wrist sprains are very common. There are many ligaments in the wrist that can be stretched or torn, resulting in a sprain. This occurs when the wrist is bent forcefully, such as in a fall onto an outstretched hand. These can be very prevalent in winter as a result of slipping on snow or ice.
A severe sprain occurs when the ligament is completely detached from the bone. These can often require surgical treatment. If the ligament tears from the bone, it may also take a small chip of bone with it – this is known as an avulsion fracture.
Severe sprains may require surgery to reconnect the ligament to the bone. Surgery is followed by a period of rehabilitation and physiotherapy. The ligament can be expected to heal in around 2 months. Full recovery of motion and strength can take several months, dependent on the nature of the initial injury.
Wrist arthroscopy
Arthroscopy is a surgical procedure which helps diagnose and treat problems inside a joint. The wrist is a complex area with eight tiny bones and many more connecting ligaments.
Arthroscopy enables the surgeon to examine the wrist and its movements without major surgery.
An arthroscope is used for two reasons: to make accurate diagnoses and potentially to correct any problems with the wrist.
Arthroscopic surgery is an invaluable diagnostic and treatment tool. Because it needs fewer and smaller incisions patients generally enjoy a more rapid recovery than is seen with regular surgery. Because it is usually an outpatient procedure, most patients return home several hours after the procedure.