treatment options for wrist pain. anatomy of the wrist complicated collection of many joints...

Treatment Options Treatment Options for Wrist Painfor Wrist Pain

Anatomy of the WristAnatomy of the Wrist

Complicated collection of many Complicated collection of many jointsjoints

Eight separate bonesEight separate bones Complicated ligamentsComplicated ligaments

Source: www.AllAboutArthritis.com , 2003

Causes of Wrist PainCauses of Wrist Pain Osteoarthritis Osteoarthritis

(wear and tear)(wear and tear) Rheumatoid Rheumatoid

arthritisarthritis Injury (sprain or Injury (sprain or

fracture)fracture) Damage to the Damage to the

cartilagecartilage Carpal tunnel Carpal tunnel

SyndromeSyndromeSource: www.AllAboutArthritis.com , 2003

Symptoms of Wrist ArthritisSymptoms of Wrist Arthritis

PainPain During activityDuring activity At rest or sleepingAt rest or sleeping

Swelling and tightnessSwelling and tightness Squeaking or grinding sound when Squeaking or grinding sound when

wrist is movedwrist is moved Stiffness and decreased movementStiffness and decreased movement


Diagnosing Wrist ArthritisDiagnosing Wrist Arthritis

Physical examinationPhysical examination Range of Motion testRange of Motion test

Medical history reviewMedical history review X-RaysX-Rays Blood testsBlood tests

Rheumatoid FactorRheumatoid Factor C-Reactive ProteinC-Reactive Protein


How Can My Life ChangeHow Can My Life Change with Treatment? with Treatment?

A return to mobilityA return to mobility Regaining a sense Regaining a sense

of your old lifestyleof your old lifestyle Reduce or eliminate Reduce or eliminate

painpain

Non-Surgical Treatment Options for Non-Surgical Treatment Options for Wrist Pain: Over-the-Counter Wrist Pain: Over-the-Counter

MedicationsMedications Nonsteroidal Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs

(NSAIDS)(NSAIDS) Usually first drug used to treat arthritisUsually first drug used to treat arthritis Can reduce pain, swelling and rednessCan reduce pain, swelling and redness Relief can take several monthsRelief can take several months Examples:Examples:

ibuprofen (ibuprofen (Advil®, Motrin®)Advil®, Motrin®) naproxen (naproxen (Aleve®)Aleve®)

AspirinAspirin Reduce joint pain and inflammationReduce joint pain and inflammation Form of NSAIDs.Form of NSAIDs.


Non-Surgical Treatment Options for Non-Surgical Treatment Options for Wrist Pain: Over-the-Counter Wrist Pain: Over-the-Counter

MedicationsMedicationsAcetaminophenAcetaminophen

Reduces painReduces pain Lowers feverLowers fever Does not reduce inflammation of Does not reduce inflammation of

arthritisarthritis Examples:Examples:

Tylenol®Tylenol® Datril® Extra StrengthDatril® Extra Strength Tempra®Tempra®


Non-Surgical Treatment Options for Non-Surgical Treatment Options for Wrist Pain: Prescription MedicationsWrist Pain: Prescription Medications

NSAIDS NSAIDS Most popular type for osteoarthritis treatmentMost popular type for osteoarthritis treatment Includes ibuprofen (Includes ibuprofen (MotrinMotrin®®), ), naproxen sodium naproxen sodium

((AnaproxAnaprox®®)), oxaprozin , oxaprozin (Daypro(Daypro®®)), sulindac , sulindac (Clinoril(Clinoril®®) ) , etc. , etc.

AnalgesicsAnalgesics Provide pain relief, but do not reduce Provide pain relief, but do not reduce

inflammationinflammation Includes Acetaminophen with codeine (TylenolIncludes Acetaminophen with codeine (Tylenol®®

with Codeine), Oxycodone (OxyContinwith Codeine), Oxycodone (OxyContin®®, , RoxicodoneRoxicodone®®), Hydrocodone with acetaminophen ), Hydrocodone with acetaminophen (Vicodin(Vicodin®®, Dolacet, Dolacet®®), etc.), etc.


Non-Surgical Treatment Options for Non-Surgical Treatment Options for Wrist Pain: Prescription MedicationsWrist Pain: Prescription Medications

Biological Response ModifiersBiological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the jointsTreat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (RemicadeIncludes: Infliximab (Remicade®®), Etanercept (Enbrel ), Etanercept (Enbrel ®®))

Glucocorticoids or CorticosteroidsGlucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammationTreat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (CortefIncludes: cortisone, hydrocortisone (Cortef®®, ,

HydrocortoneHydrocortone®®), Prednisolone (Prelone), Prednisolone (Prelone®®) ) DMARDSDMARDS

Treat rheumatoid arthritis; slow joint destructionTreat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine Includes: methotrexate, injectable gold, penicillamine

(Depen(Depen®®), Azathioprine (Imuran), Azathioprine (Imuran®®), etc.), etc.


Non-Surgical Treatment Non-Surgical Treatment Options for Wrist PainOptions for Wrist Pain

Cortisone InjectionsCortisone Injections A powerful anti-inflammatory medicationA powerful anti-inflammatory medication Temporary pain relief and usually lasts several Temporary pain relief and usually lasts several

weeks to monthsweeks to months There is a small risk of infectionThere is a small risk of infection

Activity ModificationActivity Modification Assistive Devices to help with:Assistive Devices to help with:

WritingWriting CookingCooking BathingBathing Getting DressedGetting Dressed


Surgical Options for Wrist PainSurgical Options for Wrist Pain

Wrist joint fusionWrist joint fusion SynovectomySynovectomy ArthroscopyArthroscopy Wrist replacementWrist replacement


Wrist Fusion SurgeryWrist Fusion Surgery

Fuse the bones of the joint to grow Fuse the bones of the joint to grow together.together.

Candidates require strength more Candidates require strength more than flexibility.than flexibility.

Results in:Results in: Strong jointStrong joint Elimination of painElimination of pain Immobile elbow (no range of motion)Immobile elbow (no range of motion)



Incision is made.Incision is made. Cartilage on each side of the joint is Cartilage on each side of the joint is

removed.removed. A bone graft is sometimes needed.A bone graft is sometimes needed. Bones are held together to fuse. Bones are held together to fuse. Incision is closed.Incision is closed. Arm is placed in a large splint or Arm is placed in a large splint or

cast.cast.



Benefits of wrist fusionsBenefits of wrist fusions Durable and strongDurable and strong Eliminates pain of arthritisEliminates pain of arthritis

Disadvantages of wrist fusionsDisadvantages of wrist fusions Immobile joint; no range of motion Immobile joint; no range of motion Forces remaining joints to move moreForces remaining joints to move more


SynovectomySynovectomy

Early stages of rheumatoid Early stages of rheumatoid arthritis.arthritis.

Removes inflamed tissue lining.Removes inflamed tissue lining. Potentially saves joint from further Potentially saves joint from further

damage.damage.



Small incision is made.Small incision is made. Arthroscope is used to inspect the Arthroscope is used to inspect the

joint.joint. Diseased synovium is removed.Diseased synovium is removed. Sling may be required.Sling may be required. Physical therapy usually required.Physical therapy usually required.



BenefitsBenefits Alleviates rheumatoid arthritis pain in the Alleviates rheumatoid arthritis pain in the

jointjoint Joint may be saved from further damage.Joint may be saved from further damage. Synovium could grow back over timeSynovium could grow back over time

DisadvantagesDisadvantages Not a permanent solutionNot a permanent solution


Arthroscopic SurgeryArthroscopic Surgery

Can be used to treat several Can be used to treat several conditions, including:conditions, including: Chronic wrist painChronic wrist pain Wrist fracturesWrist fractures Ganglion cystsGanglion cysts Ligament/TFCC tearsLigament/TFCC tears Carpal tunnel releaseCarpal tunnel release

Source: www.AAOS.org, 2003


Small camera is inserted into the Small camera is inserted into the wrist to see inside your joint.wrist to see inside your joint.

Use small instruments to remove Use small instruments to remove any debris and smooth cartilage any debris and smooth cartilage surfaces.surfaces.



BenefitsBenefits Outpatient surgeryOutpatient surgery Minimal invasiveMinimal invasive May reduce recovery timeMay reduce recovery time

Disadvantages (common risks with all Disadvantages (common risks with all surgeries)surgeries) May include infection, nerve injuries, May include infection, nerve injuries,

excessive swelling or bleeding, scarring excessive swelling or bleeding, scarring or tendon tearing. or tendon tearing.


Wrist Replacement SurgeryWrist Replacement Surgery

Replaces diseased boneReplaces diseased bone ResultsResults

Moveable wrist jointMoveable wrist joint Elimination of painElimination of pain

When is Wrist Replacement When is Wrist Replacement Surgery Right for You?Surgery Right for You?

Experience significant pain Experience significant pain despite non-surgical despite non-surgical treatments.treatments.

Hand function and mobility Hand function and mobility decreases.decreases.

Total Wrist Replacement Total Wrist Replacement ComponentsComponents

A total wrist replacement A total wrist replacement implant consist of:implant consist of: Ellipsoid headEllipsoid head Offset radial stem Offset radial stem

anchoring the implant to anchoring the implant to your forearm.your forearm.

Elongated radial trayElongated radial tray Trapezoid fixation stem Trapezoid fixation stem

adding stability.adding stability.

Source: www.Jointreplacement.com, 2003

Benefits to Patient from Benefits to Patient from SurgerySurgery

Return to MobilityReturn to Mobility Restore their lifestyleRestore their lifestyle FreedomFreedom

Total Wrist ReplacementTotal Wrist Replacement

Under 300 total Under 300 total wrist replacements wrist replacements estimated for estimated for 2003.2003.

Surgical ProcedureSurgical Procedure

Incision is made.Incision is made. The tendons are moved out of the The tendons are moved out of the

way.way. A portion of the carpal bones and A portion of the carpal bones and

end of radius and ulna are end of radius and ulna are removed from the wrist.removed from the wrist.


Surgical ProcedureSurgical Procedure

Components are inserted and Components are inserted and cemented into place.cemented into place.

Tendons are placed back and Tendons are placed back and wound is closed.wound is closed.

A dressing or splint is usually worn.A dressing or splint is usually worn.


Preparing for Joint Preparing for Joint Replacement SurgeryReplacement Surgery

Ease anxiety by mentally preparing with:Ease anxiety by mentally preparing with: Breathing exercisesBreathing exercises MeditationMeditation Talking with friends and familyTalking with friends and family

Learn more about wrist replacement surgeryLearn more about wrist replacement surgery BrochuresBrochures HandoutsHandouts WebsitesWebsites VideosVideos


The Night Before SurgeryThe Night Before Surgery

Avoid medications, such as “blood Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.) thinners” (aspirin, ibuprofen, etc.)

Do not consume any food or liquid Do not consume any food or liquid after midnight.after midnight.

Make sure you have everything Make sure you have everything you’ll need at the hospital.you’ll need at the hospital.

Ask any questions you may have Ask any questions you may have before surgery.before surgery.


After SurgeryAfter Surgery

Pain medication for any discomfort.Pain medication for any discomfort. Elevate hand above heart for several Elevate hand above heart for several

days. days. May schedule a follow-up exam May schedule a follow-up exam

within seven days.within seven days. Can be done as an outpatient Can be done as an outpatient

surgery if there are no other surgery if there are no other procedures needed. procedures needed.


A Caregiver’s RoleA Caregiver’s Role

Provide support and show patienceProvide support and show patience Help with needs that the patient Help with needs that the patient

can not do, like:can not do, like: Meal preparationMeal preparation FeedingFeeding WritingWriting DressingDressing


Recovery in the First WeekRecovery in the First Week

Follow surgeon’s instructions on Follow surgeon’s instructions on proper rehabilitation.proper rehabilitation.

While the wrist heals, do not pick While the wrist heals, do not pick up heavy objects. up heavy objects.

See physician on what activities See physician on what activities are permitted. are permitted.


Recovery in the First MonthRecovery in the First Month

At two weeks, cast and splint At two weeks, cast and splint removed with a short arm cast for removed with a short arm cast for another two weeks.another two weeks.

Continued use of medication, with Continued use of medication, with need tapering off as area heals.need tapering off as area heals.

At one month, a splint will be worn At one month, a splint will be worn during exercises and at night. during exercises and at night.


Recovery After Six WeeksRecovery After Six Weeks

Passive exercises begin to Passive exercises begin to maximize the motion of the new maximize the motion of the new wrist.wrist.

At two months, exercises started At two months, exercises started to strengthen the muscles.to strengthen the muscles.

Begin most of your normal Begin most of your normal activities at three months. activities at three months.


Questions?Questions?

Thank YouThank You

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