The wrist is made up of eight small bones (carpals) connected to each other, the lower arm bones (radius and ulna), and to the hand (metacarpals) by ligaments. Many tendons traverse the wrist for movement and to power the fingers and thumb. Wrists are prone to damage in falls, sports injuries, overuse and arthritis. Some conditions and injuries of the wrist may require surgery to diagnosis and treat.
Fractures of bones of the distal radius, ulna or the carpal bones range from simple to complex. These often occur after a Fall On an Outstretched Hand (aka: FOOSH) while walking, running or sports participation. Simple fractures may be repaired with splinting or by surgical realignment of the bones. More complex or unstable fractures are treated using thin pins, tiny screws, low profile, thin plates, or anchors to repair ligaments which hold the bones in proper alignment required for optimum mobility.
Wrist Ligament Injuries
Wrist ligament injuries are often painful and debilitating, because of the clinical requirements of the wrist bones for proper alignment and ligament elasticity needed for mobility. Wrist ligaments are critical not only among the carpal bones and the radius, but also between the radius and the ulna, which is the joint for rotation. The triangular fibrocartilage complex (TFCC) constitutes the critical group of ligaments that permit smooth rotation of the wrist into the palm up and palm down positions. The extensor carpi ulnaris sub-sheath is a critical ligament for stability of the pinkie side of the wrist and the extensor carpi ulnaris (ECU) tendon, which moves the wrist in the direction of the small finger. Damage to these structures occurs in falls (FOOSH), racquet sports, and baseball. Arthroscopic and minimally invasive surgery is available to repair these problems when splinting and physical therapy do not.
Carpal Tunnel Release
Surgery for carpal tunnel syndrome is indicated when other treatment methods are ineffective or signs and symptoms of nerve damage are present. The goal of surgery is to relieve pressure on the median nerve in the wrist by widening the space around it. This may be done as an endoscopic procedure or through open surgery. Endoscopic carpal tunnel release generally results in a faster postoperative recovery and return to work and sports. Nerve recovery is identical.
Cartilage and Ligament Tears
Cartilage is a slippery substance coating each bone that allows the bones in the wrist to move smoothly along side each other. Ligaments are tough cords that connect bones to bones. Tears can occur in the cartilage or the ligaments during a hard fall on the hand. In some cases, these tears may require arthroscopic or minimally invasive surgery to repair. Sometimes, after a fracture of the wrist, scar tissue can form in the ligaments and among the bones, which can restrict movement and cause pain. Occupational and physical therapy usually alleviate this condition, while surgery is reserved for stubborn cases.
Fusion of small bones (carpals) in the wrist to each other or to the radius bone in the forearm is done to provide stability and to reduce pain in severe cases of arthritis and ligamentous deficiency. The medical term for these procedures is “limited wrist arthrodesis”. Benefits include increased strength and less pain. While some movement is sacrificed there is generally increased strength due to increased stability and pain reduction.
Proximal Row Carpectomy (PRC) is a form of surgery which removes the arthritic carpal bones in the first row of the wrist in order to improve motion and strength and to reduce pain. Interposition of wrist capsular ligaments between the remaining bones may be used to augment the cartilaginous gliding surface. Sometimes, Osteochondral Autograft Transfer System (OATS) can be used to take normal cartilage from donor sites in the wrist or the knee to resurface arthritic wrist bones.
Replacement of the wrist joint, Total Wrist Arthroplasty, may be done to relieve pain and stiffness in severe cases of degenerative, inflammatory and traumatic arthritis. Arthroplasty requires removal of some of the small bones in the wrist to make room for the artificial joint. The new joint is fitted and cemented into place.
Home exercises and extensive occupational and physical therapy are needed to optimize strength, flexibility and return to sports, overcoming preoperative deficiencies and postoperative swelling.
The wrist is one of the most complex joint systems in the body. Many problems occurring in the wrist can be treated with therapy, rest or medication. Sometimes surgery is needed to repair bone, cartilage or ligaments, and to restore mobility and alleviate pain. Surgeons work to find the best treatment option for you through experience, research, addressing your questions and concerns both before and after treatment.
View an Actual Arthroscopic Wrist Surgery
The midcarpal joint is shown. The triquetrum is seen on the right, lunate next and the capitate is above. Finally, the scaphoid is viewed, demonstrating a fracture of the scaphoid as exemplified by the defect in the articular cartilage running diagonally across the screen, and opposite the capitate, which is seen above.
Read more about the general surgical procedure: Arthroscopic Surgery.