Wrist Arthroplasty: Understanding Wrist Joint Replacement

Have you stopped doing daily activities because of wrist pain? Do you find it hard to complete tasks at work or home? You are not alone.

About 1 out of every 7 Americans have wrist arthritis. But this is only one cause of wrist pain.

Don’t let wrist pain interfere with your life. Make an appointment with a hand/wrist specialist. There are many treatments including wrist arthroplasty that can help you regain normal function.

Keep reading to learn more about wrist arthroplasty.

Overview of the Wrist Anatomy

The wrist, or radiocarpal joint, is a complex joint. It contains 8 small carpal bones and the end of the radius which is the forearm bone above the thumb. The scaphoid bone is the carpal bone near the base of your thumb. This bone is the one most often injured.

The other forearm bone, the ulna, joins to the articular disk. This lies between the carpal bones and the ulna.

The wrist is a synovial joint that contains a double-layered capsule. The outer part of the capsule attaches to the radius, ulna, and the carpal bones closest to your arm. The inside layer has synovial membranes that release synovial fluid to lubricate the joint.

The wrist contains 4 ligaments. A ligament is fibrous connective tissue that attaches bones together. It keeps the bones in proper alignment and maintains stability.

The 4 ligaments of the wrist are the:

• Palmar radiocarpal which allows the hand to follow the forearm when the palm turns to face up
• Dorsal radiocarpal which lets the hand follow the forearm when the palm turns to face down
• Ulnar collateral prevents the wrist from moving sideways too far
• Radial collateral also works to prevent excessive movement of the wrist side to side

The wrist also contains tendons. The tendons attach to muscles and bones. They contribute to wrist movement.

The ulnar and radial arteries supply blood to the wrist joint. Three nerves provide motor and sensory information to and from the joint.

Motor nerves tell the muscles to move and sensory nerves tell the brain about sensations. The three nerves are the median, radial, and ulnar nerves.

The wrist is an ellipsoidal type synovial joint. This means that it can move along two axes. The wrist can move up and down and side to side.

There are 4 medical terms for these movements. To understand these motions, hold your arm out with your palm facing down.

• Flexion describes when you bend your hand down toward the front of your forearm
• Extension describes when you bend your hand up toward the back of your forearm
• Adduction describes when you bend your hand sideways toward your little finger
• Abduction describes when you bend your hand sideways toward your thumb

Understanding the wrist anatomy allows you to know what is happening in your wrist. If you need surgery, you will also have a better understanding of the procedure.

Common Wrist Problems

Wrist pain can result from disease or injury. Joint pain, or arthralgia, may involve the bones, ligaments, or connective tissue.

Inflammation or swelling in the joint may result from arthritic problems. Osteoarthritis and rheumatoid arthritis often present with wrist pain.

Repetitive motion injuries describe damage caused by prolonged repetition of a movement that causes irritation. Pain is often felt in the wrist, hands, fingers, and forearm.

Carpal tunnel syndrome occurs with frequent or continuous pressure on the median nerve.

De Quervain’s Disease describes a swelling of the tendons that go from the thumb to the wrist.

Tumors in the bones are very rare causes of wrist pain. Soft tissue tumors, called sarcomas, can cause pain.

Kienböck’s disease is a debilitating condition that causes chronic pain and decreased function. When this disease affects the wrist, damage occurs to the carpal bones. Also, the lunate bone loses its blood supply.

Bacterial infections and dermatitis can also contribute to pain in the wrist.

Wrist Trauma

Trauma to the wrist can cause pain, swelling, and decreased ability to move the wrist. This may result from a strain, sprain, or fracture. Wrist trauma often occurs with falls or injuries that over-extend the hand.

If the pain continues or is severe, it may indicate a torn ligament in the wrist. Depending on the level of severity, wrist ligament sprains have 3 types.

A Grade 1 means that the wrist ligaments have stretched but have not torn. Grade 2 describes a ligament that is partially torn. Grade 3 describes a complete tear of the ligament.

Fractures of the hand, wrist, or thumb may range from a thin crack to a shattered or crushed bone. The hand, wrist, and thumb are very important to your daily activities. There are many intricate parts that must coordinate for you to use your hands.

Even minor injuries need evaluation. If damage to one small part isn’t treated, it may result in further injury and loss of function.

When you have a fracture, the pain is often intense and prevents you from moving your hand, wrist, or thumb. If you have these symptoms, see a doctor. Don’t take chances with your hands.

Most fractures result from some type of trauma. Yet, some fractures occur due to osteoporosis or overuse injuries. If you have intense pain and loss of function, see your doctor.

Ergonomics and Wrist Pain

Ergonomics is the applied science that works to design and arrange items people use frequently. The goal is to increase efficiency and safety. Several medical conditions result from poor ergonomic settings.

Medical problems, often called repetitive motion injury, include tendon and nerve disorders. This can result in pain, tingling, and loss of function.

Examples of behaviors that may result in these musculoskeletal disorders include:

• Doing the same motion over and over in the same manner with few or no breaks
• Holding one position for a long time
• Keeping part of the body in a none “neutral” position for prolonged periods of time
• Direct pressure on nerves or tendons
• Sudden, jerking or snapping movements
• Cold temperatures
• Prolonged exposure to vibration

Strategies to decrease repetitive motion injuries include:

• Change up repetitive work
• Avoid holding your muscles in tension
• Make sure you are maintaining a neutral body posture
• Avoid resting your wrists on hard, sharp surfaces or edges
• Use a light touch when typing and using a mouse
• Avoid fast, jerking movements
• Keep your hands and fingers warm
• Take breaks if you work with tools that vibrate

Taking steps to prevent repetitive motion injury can prevent pain and interruption of your daily activities.

When Should You See a Doctor?

Many people feel unsure about when they should call a doctor for pain in the wrist. Ask yourself these questions. Does the pain stop you from doing normal activities?

Do you feel any numbness or tingling? Is it getting worse? Do you have little or no feeling in your fingers or hand?

Are you unable to perform simple hand movements? Are your hands too weak to hold things?

If you answered yes to any of these questions, it’s time to call the doctor. These may be symptoms of a wrist problem.

How Is Wrist Pain Diagnosed?

Healthcare providers use a variety of tools to assess and diagnose wrist abnormalities. First, they will ask you about the history of your pain. When did the problems start?

Are the problems present all the time? What makes it worse? What makes it better?

Have you received treatment for wrist problems in the past? Do you have any medical conditions? What medication do you take?

Next, the practitioner will perform a physical exam. This allows for an increased understanding of your pain and how much you can move your wrist.

They may order diagnostic tests such as X-rays, CT scan, MRI, or Nerve conduction studies. Sometimes they perform an arthroscopy. This involves making a small incision and using a tiny camera to look in the wrist.

After making a diagnosis, your provider will develop a treatment plan.

What is Wrist Arthroplasty?

In some cases, surgery is needed. The procedure may release a ligament or other tissue that is pressing on a nerve and causing pain. This may also restore blood flow to the wrist.

Surgery may also remove bone or cartilage fragments. Fractured bones are often secured using pins, screws, and plates. Arthroplasty may be necessary to restructure or replace the joint.

Wrist arthroplasty is the term for a wrist replacement. This surgical procedure replaces the diseased or damaged wrist joint with an artificial joint. The goal is a stable, pain-free wrist joint that allows normal function.

A total wrist arthroplasty helps preserve wrist motion. This procedure usually lasts for about 10 to 15 years.

Wrist implants may loosen or fail sooner if patients place high physical demands on their wrist. For example, heavy household or work activities, use of crutches, canes, or walker, or with repetitive motion.

Procedure for Wrist Arthroplasty

Wrist implants are made from metal and plastic. It includes two parts called the radial and distal components.

The radial component inserts against the end of the radius bone. The surgeon inserts the stem of a flat metal piece into the canal of the radius bone. A plastic cup fits over the metal piece to create a socket for the artificial joint.

The distal component is a metal piece that replaces the small carpal bones of the wrist. It is round in shape so that it fits into the plastic socket on the end of the radius. It has 2 metal stems that fit inside the bones of the hand.

The distal component also has an ellipsoidal head that creates the normal curve of the wrist. It also allows the wrist to move in the normal 2 planes.

The surgeon may place a cast on your arm after the surgery.

Preparation for Wrist Arthroplasty

Your surgeon will give you specific pre-operative instructions. It’s important to follow all instructions so there will be no delay in your procedure. Instructions may include stopping medications such as methotrexate and immune-modulating drugs and non-steroidal anti-inflammatory drugs.

Patients who have rheumatoid arthritis often require a comprehensive pre-operative exam. If the patient needs a hip or knee replacement, the wrist arthroplasty should follow these surgeries. Remember that increased weight bearing on the wrist can damage the wrist implant.

Before surgery, you may do exercises to maintain strength and function in your other arm, legs, and joints. This will increase your stability after surgery. Postoperative rehabilitation will prove easier when your other muscles and joints are strong.

After Surgery Care

Your surgeon will provide detailed instructions for your care following surgery. Take prescribed medications as instructed.

Following is an example of what you might expect.

First 2 weeks: Keep your wrist in a neutral position and do not move it. You may have a cast to help with this.

Elevate your arm to decrease swelling. Be sure to move your shoulder and elbow so they do not become stiff.

3 to 5 weeks: A splint may replace the cast. Your doctor may let you gently move your fingers and wrist. Gentle massage of the scar can help break up the tissue and prevent tightening.

6 to 12 weeks: A dynamic splint may be used and allow a little more movement. You can gradually return to normal activities. If you haven’t already started physical therapy, you may begin during this time.

You may do passive range of motion exercises. This involves moving your operative hand up and down using your other hand. Don’t move the hand very far side to side.

Do You Have Wrist Problems?

Are you experiencing pain or decreased movement in your wrist? Does this interfere with your daily activities? If so, it’s time to talk with a doctor.

Physicians who specialize in the hands and wrists provide a thorough examination. They are also able to offer state-of-the-art treatments including wrist arthroplasty.

Our physicians have completed fellowship training and/or board certification. As hand specialists, we treat the hand, wrist, fingers, elbow, thumb pain and other problems. Treatments include minimally invasive procedures.

You rely on your hands for most activities in your life. It’s important to receive the best care possible so that you may return to normal function. Contact us today to ask questions and schedule an appointment.