Treatment Options for
Wrist Pain
Anatomy of the Wrist
Complicated collection of many joints
 Eight separate bones
 Complicated ligaments

Source: www.AllAboutArthritis.com , 2003
Causes of Wrist Pain
Osteoarthritis (wear
and tear)
 Rheumatoid arthritis
 Injury (sprain or
fracture)
 Damage to the
cartilage
 Carpal tunnel
Syndrome

Source: www.AllAboutArthritis.com , 2003
Symptoms of Wrist Arthritis

Pain
During activity
 At rest or sleeping

Swelling and tightness
 Squeaking or grinding sound when wrist
is moved
 Stiffness and decreased movement

Source: www.AllAboutArthritis.com , 2003
Diagnosing Wrist Arthritis

Physical examination

Range of Motion test
Medical history review
 X-Rays
 Blood tests

Rheumatoid Factor
 C-Reactive Protein

Source: www.AllAboutArthritis.com , 2003
How Can My Life Change
with Treatment?
A return to mobility
 Regaining a sense of
your old lifestyle
 Reduce or eliminate
pain

Non-Surgical Treatment Options for Wrist
Pain: Over-the-Counter Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)
 Usually first drug used to treat arthritis
 Can reduce pain, swelling and redness
 Relief can take several months
 Examples:



ibuprofen (Advil®, Motrin®)
naproxen (Aleve®)
Aspirin


Reduce joint pain and inflammation
Form of NSAIDs.
Source: www.AllAboutArthritis.com , 2003
Non-Surgical Treatment Options for Wrist
Pain: Over-the-Counter Medications
Acetaminophen
Reduces pain
 Lowers fever
 Does not reduce inflammation of arthritis
 Examples:

Tylenol®
 Datril® Extra Strength
 Tempra®

Source: www.AllAboutArthritis.com , 2003
Non-Surgical Treatment Options for Wrist
Pain: Prescription Medications

NSAIDS
Most popular type for osteoarthritis treatment
 Includes ibuprofen (Motrin®), naproxen sodium
(Anaprox®), oxaprozin (Daypro®), sulindac
(Clinoril®) , etc.


Analgesics
Provide pain relief, but do not reduce inflammation
 Includes Acetaminophen with codeine (Tylenol® with
Codeine), Oxycodone (OxyContin®, Roxicodone®),
Hydrocodone with acetaminophen (Vicodin®,
Dolacet®), etc.

Source: www.AllAboutArthritis.com , 2003
Non-Surgical Treatment Options for
Wrist Pain: Prescription Medications

Biological Response Modifiers
Treat rheumatoid arthritis; may postpone injury to the joints
 Includes: Infliximab (Remicade®), Etanercept (Enbrel ®)


Glucocorticoids or Corticosteroids
Treat rheumatoid arthritis; fight inflammation
 Includes: cortisone, hydrocortisone (Cortef®,
Hydrocortone®), Prednisolone (Prelone®)


DMARDS
Treat rheumatoid arthritis; slow joint destruction
 Includes: methotrexate, injectable gold, penicillamine
(Depen®), Azathioprine (Imuran®), etc.

Source: www.AllAboutArthritis.com , 2003
Non-Surgical Treatment Options for
Wrist Pain

Cortisone Injections



A powerful anti-inflammatory medication
Temporary pain relief and usually lasts several weeks
to months
There is a small risk of infection
Activity Modification
 Assistive Devices to help with:





Writing
Cooking
Bathing
Getting Dressed
Source: www.AllAboutArthritis.com , 2003
Surgical Options for Wrist Pain




Wrist joint fusion
Synovectomy
Arthroscopy
Wrist replacement
Source: www.AllAboutArthritis.com , 2003
Wrist Fusion Surgery
Fuse the bones of the joint to grow
together.
 Candidates require strength more than
flexibility.
 Results in:

Strong joint
 Elimination of pain
 Immobile elbow (no range of motion)

Source: www.AllAboutArthritis.com , 2003
Wrist Fusion Surgery
Incision is made.
 Cartilage on each side of the joint is
removed.
 A bone graft is sometimes needed.
 Bones are held together to fuse.
 Incision is closed.
 Arm is placed in a large splint or cast.

Source: www.AllAboutArthritis.com , 2003
Wrist Fusion Surgery
Benefits of wrist fusions
Durable and strong
 Eliminates pain of arthritis

Disadvantages of wrist fusions
Immobile joint; no range of motion
 Forces remaining joints to move more

Source: www.AllAboutArthritis.com , 2003
Synovectomy
Early stages of rheumatoid arthritis.
 Removes inflamed tissue lining.
 Potentially saves joint from further
damage.

Source: www.AllAboutArthritis.com , 2003
Synovectomy
Small incision is made.
 Arthroscope is used to inspect the joint.
 Diseased synovium is removed.
 Sling may be required.
 Physical therapy usually required.

Source: www.AllAboutArthritis.com , 2003
Synovectomy
Benefits
Alleviates rheumatoid arthritis pain in the
joint
 Joint may be saved from further damage.
 Synovium could grow back over time

Disadvantages

Not a permanent solution
Source: www.AllAboutArthritis.com , 2003
Arthroscopic Surgery

Can be used to treat several conditions,
including:
Chronic wrist pain
 Wrist fractures
 Ganglion cysts
 Ligament/TFCC tears
 Carpal tunnel release

Source: www.AAOS.org, 2003
Arthroscopic Surgery
Small camera is inserted into the wrist
to see inside your joint.
 Use small instruments to remove any
debris and smooth cartilage surfaces.

Source: www.AAOS.org, 2003
Arthroscopic Surgery
Benefits
Outpatient surgery
 Minimal invasive
 May reduce recovery time

Disadvantages (common risks with all
surgeries)

May include infection, nerve injuries,
excessive swelling or bleeding, scarring or
tendon tearing.
Source: www.AAOS.org, 2003
Wrist Replacement Surgery
Replaces diseased bone
 Results

Moveable wrist joint
 Elimination of pain

When is Wrist Replacement
Surgery Right for You?


Experience significant pain despite
non-surgical treatments.
Hand function and mobility
decreases.
Total Wrist Replacement
Components

A total wrist replacement
implant consist of:
Ellipsoid head
 Offset radial stem anchoring
the implant to your forearm.
 Elongated radial tray
 Trapezoid fixation stem adding
stability.

Source: www.Jointreplacement.com, 2003
Benefits to Patient from Surgery



Return to Mobility
Restore their lifestyle
Freedom
Total Wrist Replacement

Under 300 total wrist
replacements
estimated for 2003.
Surgical Procedure
Incision is made.
 The tendons are moved out of the way.
 A portion of the carpal bones and end
of radius and ulna are removed from
the wrist.

Source: www.Jointreplacement.com, 2003
Surgical Procedure
Components are inserted and cemented
into place.
 Tendons are placed back and wound is
closed.
 A dressing or splint is usually worn.

Source: www.Jointreplacement.com, 2003
Preparing for Joint
Replacement Surgery
Ease anxiety by mentally preparing with:
 Breathing exercises
 Meditation
 Talking with friends and family
 Learn more about wrist replacement surgery
 Brochures
 Handouts
 Websites
 Videos

Source: www.Jointreplacement.com, 2003
The Night Before Surgery
Avoid medications, such as “blood
thinners” (aspirin, ibuprofen, etc.)
 Do not consume any food or liquid after
midnight.
 Make sure you have everything you’ll
need at the hospital.
 Ask any questions you may have before
surgery.

Source: www.Jointreplacement.com, 2003
After Surgery
Pain medication for any discomfort.
 Elevate hand above heart for several
days.
 May schedule a follow-up exam within
seven days.
 Can be done as an outpatient surgery if
there are no other procedures needed.

Source: www.AAOS.org, 2003
A Caregiver’s Role
Provide support and show patience
 Help with needs that the patient can
not do, like:

Meal preparation
 Feeding
 Writing
 Dressing

Source: www.Jointreplacement.com, 2003
Recovery in the First Week
Follow surgeon’s instructions on proper
rehabilitation.
 While the wrist heals, do not pick up
heavy objects.
 See physician on what activities are
permitted.

Source: www.Jointreplacement.com, 2003
Recovery in the First Month
At two weeks, cast and splint removed
with a short arm cast for another two
weeks.
 Continued use of medication, with need
tapering off as area heals.
 At one month, a splint will be worn
during exercises and at night.

Source: www.Jointreplacement.com, 2003
Recovery After Six Weeks
Passive exercises begin to maximize the
motion of the new wrist.
 At two months, exercises started to
strengthen the muscles.
 Begin most of your normal activities at
three months.

Source: www.Jointreplacement.com, 2003
Questions?
Thank You