© 2019 by Orthopaedic Research Clinic Alaska

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The American Board of Orthopaedic Surgery

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Wrist & Hand

Wrist & Hand Procedures

Our hands are a vital part of our everyday life: for communicating, touching feeling, holding, manipulating, caressing and more. The forearm is connected to the hand by the wrist, involving many joints and muscles to allow your hand and fingers to move and rotate. Much like the ankle and foot complex, the wrist is a complicated joint where the mobility is influenced by its composing anatomy.

Common injuries include osteoarthritis or inflammatory arthritis affecting the joints, inflammation of the tendon sheaths, and carpal tunnel syndrome. ORCA advocates nonoperative care whenever possible but understand that operation may be the only solution.

 
Wrist Arthroscopy

Arthroscopy refers to a surgical procedure that is used to diagnose and treat issues within the wrist joint. During a wrist arthroscopy, the surgeon will use a small fiberoptic instrument to view within the wrist joint without making big incisions into the tissue and muscle.


The wrist is a joint that consists of eight tiny bones and multiple connecting ligaments. Surgeons and use arthroscopic surgery in order to diagnose and provide treatment for many wrist conditions, such as wrist fractures, ligament tears, chronic wrist pain, and ganglion cysts. Arthroscopic surgery is often performed as a diagnostic procedure when physicians are unsure what is causing pain in the wrist. If nonsurgical treatment fails to provide pain relief after several months, a wrist arthroscopy procedure may help resolve this pain.


During the wrist arthroscopy procedure, the surgeon makes portals through the skin to reach certain locations in and around the joint. These portals are simply small incisions that are smaller than half an inch long. The surgeon inserts the arthroscope, which consists of a camera, a small lens, and a lighting system, through the portals.


The camera projects 3D images of the wrist joint to the television monitor for the viewing of the surgeon. The surgeon uses these images as a guide for his or her use of instruments in the wrist joint. Knives, shavers, probes, and forceps are all tools the surgeon might use to correct problems diagnosed in the wrist joint.

Fractures

A wrist fracture is a broken wrist. The wrist joint consists of eight small bones connected to the radius and ulna. A fracture can occur in any of the 10 bones in and around the wrist. The radius is the most common broke to break. A broken radius is referred to as a distal radius fracture.


Fractures of the wrist can be stable. If a fracture is undisplaced, this means the bones have not moved out of position due to the damage. Displaced breaks can be treated with a splint or cast if stable. Unstable fractures on the other hand, often require surgery. Without surgery, the bones in the wrist will move to an incorrect position and heal. This can make the wrist look crooked after recovery. Some fractures in the wrist can be very severe. Fractures that shatter into multiple pieces or fractures that disrupt the smooth joint surface tend to make the wrist unstable. Open fractures can also occur when a fragment of broken bone breaks through the skin. Open fractures have a higher risk of infection.


Besides the type and severity of the fracture, other factors that influence treatment include the overall health, age, and activity of the patient. If surgery is required to stabilize an unstable fracture, the surgeon may use an arthroscopy procedure and instruments like rods, pins, plates, screws, and more to fix the fracture so that it heals properly.

 
Tendon Debridement

The wrist is a very complex joint that consists of eight small bones, which are connected to the ulna and radius. Tendons in the wrist connect the muscles in the arm and hands to the bones in the wrist. Due to injury or regular wear and tear, the tendons can become torn or damaged. If the tendons are partially torn, a surgeon can fix the tissue. However, if the tendons are completely torn, the surgeon may have no choice but to perform a tendon debridement procedure if nonsurgical treatments fail to be effective for the patient.


Tendon debridement is a procedure that is commonly performed to manage tendinitis, which is inflammation of the tendons. During the tendon debridement procedure, the surgeon cleans the tendon and removes all damaged tissue to relieve pain and inflammation.


During the tendon debridement procedure, the surgeon will make small incisions in the skin around and on the wrist joint. These incisions, which are no bigger than half an inch in length, are called portals. The surgeon will insert a small camera called an arthroscope through the incision to project images from within the wrist to the television monitor. The surgeon will rely on these images to diagnose a torn or damaged tendon within the wrist joint. He will then create more incisions to insert more instruments. Some instruments the surgeon may use to remove damaged tendons during the tendon debridement procedure include probes, forceps, knives, and shavers.

 
 
Carpal Tunnel Release

Patients suffering from carpal tunnel can opt to undergo the carpal tunnel release procedure. This procedure is often considered when the patient is still experiencing severe symptoms even after months of nonsurgical treatment. The symptoms must be ongoing for a few months. If there is sign of nerve damage, the carpal tunnel release surgery would be considered far more urgent to prevent further nerve damage. Good candidates for the carpal tunnel release procedure experience severe symptoms that hinder normal day-to-day activities. No strength in the thumb and persistent loss of coordination and feeling in the hands or fingers are two examples of such symptoms. Risks of nerve damage or existing damage to the median nerve makes surgery necessary. Carpal tunnel release may also be necessary to remove growths and tumors.


During carpal tunnel release surgery, the surgeon will cut the transverse carpal ligament in order to reduce pressure on the median nerve and improve the symptoms experienced by the patient. The surgeon will make the incision at palm’s base to give the doctor a good view of the transverse carpal ligament. Once the ligament is cut, the surgeon will close the skin with stitches. The surgeon will leave the gap where he or she cut the ligament alone so that scar tissue will develop.


In most cases, patients can go home after the open carpal tunnel release surgery on the same day. This procedure is performed under regional or local anesthetic. The patient will need to have the stitches removed after about two weeks. It is recommended that patients avoid using the hand heavily for three weeks to give it a chance to heal. The pain and numbness could subside immediately or after a few months.

 
Hand Fractures

The framework of the hand consists of many bones. This framework serves as the attachment point for the muscles responsible for making the fingers and wrist move. Force can cause a fracture to occur by breaking a bone in the hand.

 

Symptoms and signs of hand fractures include swelling, pain, and the general weakness of the hand. The fracture of the hand is the same as a break. Fractures may involve broken bone pieces that remain stable and aligned. Other fractures can be unstable because the bone fragments are prone to shifting and displacing. Some hand fractures break the surface of the joint while others occur in the bone’s shaft. If a high energy force caused the fracture, the bone may have been shattered into a number of pieces. A compound fracture is when fragments of the bone break the skin. Compound fractures have a higher risk of infection.


To treat a non-displaced fracture, a physician may place the hand in a cast or splint. If the fracture has been set already, the cast or splint will protect it. A physician may need to use pins and wires to set displaced fractures without making cuts. This is referred to as internal fixation or closed reduction. Some fractures require open reduction surgery to properly set the bone.