FAQ Category: Wrist

One of the downsides of surgery to fix one or more of the small joints in the wrist is that wrist mobility may be reduced. Researchers in Australia came up with a way to combat this problem when the radius and scaphoid bones are fused together. They removed a piece off the end of the scaphoid after stabilizing the wrist joints of five cadavers.

After the stabilization procedure, wrist movement up and down dropped 58 percent. But after taking out the tip of the scaphoid, movement improved considerably. Movements to each side also improved, though not as much.

Taking out part of the scaphoid “releases” the mid-section of the wrist, allowing more wrist movement. The procedure still needs to be tested on live human models. Nevertheless, the results look promising so far.

Taking out the end of the scaphoid–the largest bone on the thumb side of the wrist–is one of the new developments in wrist surgery. Researchers recently tested this procedure on cadavers. They modeled a type of surgery in which the joint of the forearm bone and scaphoid is permanently fixed in place. Then they took out the part of the scaphoid that was farthest from the joint.

After joint fixation, wrist movement in the forward and backward directions went down 58 percent. But after taking out part of the scaphoid, it improved to 86 percent of normal. The researchers think this procedure gives patients better results from surgery by “releasing” the mid section of the wrist, allowing more movement. However, the procedure still needs to be tested on live human models.

Talk with your doctor about his experience with this kind of surgery. He can tell you more about the procedure he has in mind and how it will benefit you.

Some doctors might argue that, when it comes to bone, there’s nothing like the original. But there are a few disadvantages to using a patient’s own bone for a surgery like this. To get the bone, the doctor has to open up a second surgical site, usually the top rim of the pelvis. As with any surgery, this brings the risk of infection, pain, and injury. Surgery using the patient’s bone also takes longer, since it takes time to shape the bone.

Bone cement is a possible substitute. It is strong and easy to shape.

However, a substance called hydroxyapatite (HA) has recently been used in place of bone cement. Compared to bone cement, HA is thought to bond better with human bone. A group of researchers recently used HA to stabilize breaks in the forearm bone (the radius) on the thumb side of the wrist. The results were excellent, even for older patients with osteoporosis. HA joined with surrounding bone within two to three months of surgery.

There are many good reasons to use a bone substitute. Your doctor can tell you more about why a substitute is preferable in your case.

Not necessarily. Researchers recently used a bone substitute called “hydroxyapatite” (HA) to fix wrist fractures in 25 patients. Forty percent of the patients were over age 60, and some had osteoporosis. In addition to HA, patients had their wrists stabilized from the outside with pins.

The results were excellent across the board. In this case, patients’ age didn’t affect surgery results. Talk with your doctor about your concerns. There may be extra measures you can take to ensure proper healing.

There are many ways to treat fractures of the radius, the forearm bone that meets with the thumb-side of the wrist. External fixation is one of them.

Researchers from Japan recently reported that external fixation that allows movement may not give enough stability for bones to heal together properly. These researchers have started to use a combination of internal and external treatments. They fix the bones in place from the outside with pins. They also implant a bone substitute called “hydroxyapatite” to help the broken bones join together.

This combination of treatments had good results for 25 patients in a range of ages. Two and a half years after surgery, all but one of the wrists treated were classified as “excellent.”

Bone implants may not be necessary in all cases. The key is to find the treatment that gives enough stability for bones to bond solidly together.

Kienbock’s disease occurs when blood stops flowing to the lunate bone in the wrist. The bone on the thumb side of the forearm (the radius) may be longer than the bone on the little-finger side (the ulna). These bones control rotation in the wrist. Surgeons have often treated Kienböck’s disease by “leveling” or evening out these bones–shortening the radius or lengthening the ulna to reduce pain in the wrist.

A group of doctors from Argentina suggested a new surgical treatment to “decompress” the wrist. They’ve had good results from making small “windows” in the radius and/or ulna for blood to flow through. In a group of 22 patients, this procedure reduced pain 91 percent of the time. Pain relief was often immediate, which is thought to be due to a change in blood pressure within the bone. Ten years later, most of the patients (72 percent) had no pain in their wrists.

There’s a very good chance that surgery will help. A group of researchers trying out this new “decompression” technique compared their results with those of other surgeries for Kienbock’s disease. These included surgeries to even out the length of the radius and ulna (the bones in the forearms that control wrist rotation).

Patients were followed up at least two years after decompression surgery. Patients had less pain than before surgery 75 to 100 percent of the time. In these studies, surgery resulted in no pain for zero to 81 percent of patients.

Wrist movement also improved. After surgery, range of movement was about 70 to 75 percent of that in the healthy hand. Grip strength was generally at 70 to 80 percent.

These results suggest that surgery is likely to help ease your pain. Talk with your doctor about the benefits he or she expects from surgery in your case.

This disease was identified by an Austrian radiologist nearly a century ago. Kienbock’s disease affects the lunate, a small, crescent-shaped bone in the wrist. The bone deteriorates from a lack of blood supply. This leads to a condition called avascular necrosis, which literally means the bone is dead or dying.

Not necessarily. Ganglion cysts that aren’t causing pain or other problems in children tend to go away with time. A recent study showed that children less than nine years old got complete resolution of ganglion cysts within a year from the time the went to the doctor. And the only treatment was to watch and wait.

Surgery usually isn’t the best treatment for children with simple ganglion cysts. In children, about half of the cysts treated by puncturing with a needle (aspiration) come back. When surgically removed, about 35% of the cysts return. But many cysts simply go away with time. The high rate of recurrence, along with potential complications of surgery make observation of ganglion cysts in children the best bet.

Be sure to check with your doctor to make sure he or she knows the location and size of the cyst. Together you can monitor improvements and develop a plan if the cyst doesn’t go away.

Children with ganglion cysts are usually best treated by watching and waiting. However, if a child has a ganglion cyst that still hasn’t gone away after a year, the cyst may not go away by itself. When your doctor has examined the cyst, he or she may decide to give the cyst more time, especially if the cyst is not causing pain or other problems. In the event the cyst simply does not go away, your doctor may suggest surgery to remove it.

Careful. Ganglion cysts in children tend to act differently than in adults. Also, cysts that show up on the back of a child’s hand or wrist may need a different strategy than ones that develop on the front.

A recent study suggests that most painless ganglion cysts in children go away by themselves. The authors studied 14 children with simple ganglion cysts. These kids ranged in age from two to about nine years old. With no other treatment than watching and waiting, all but three (79%) of the cysts went away by themselves within one year from the time the doctor first saw them. The two cysts that didn’t go away had formed on the back of the hand, called dorsal cysts. The authors caution that dorsal cysts may need special attention and possibly other treatment strategies.

You are advised to have your doctor examine your daughter’s cyst. Recommendations can be given based on how long she’s had the cyst, and whether your doctor feels treatments other than observation are needed.

There are many possible causes of pain, numbness, and tingling in the wrist and hand including carpal tunnel syndrome. Pressure on the median nerve as it travels through the bones of the wrist can produce symptoms of CTS. This can occur for many reasons such as pregnancy, obesity, tumors, poor posture, neck problems, thyroid conditions, or even lack of vitamin B. The most common theory relates to tasks at work. Jobs that require the same hand or wrist motion over and over have been proposed as a cause of pressure on the nerve.

Once your physician has ruled out the possibility of a medical problem, a physical therapist can help you look at your sleep situation, posture, work habits, and other factors.

A wrist injury of this type can lead to death of the bone, a process called avascular (without blood) necrosis (death). The bone in the center of the wrist (called the lunate) is only supplied with blood on one side. Anything that stops the blood to this bone can cause this condition.

Other treatment can include several different kinds of surgery. One new method removes the dead or dying bone and inserts a new piece of bone (bone graft) in its place. Doctors do not usually pin the bone in place in order to avoid damaging the bone graft and its blood supply.

Over 90 years ago, Dr. Kienbock described a wrist problem that is now better understood. In the center of the wrist is a bone called the lunate (pronounced “loon-ate”).

Injury or a break in this bone can stop the blood supply to the bone. When this happens, the bone can start to die. Wrist pain and loss of wrist motion are the two most common symptoms.

Although your condition is not very common, surgery is likely your best option. If the nerve pressure isn’t relieved soon, it is possible that muscles controlled by the nerve will continue to wither and weaken. Left untreated, the damage could become permanent.

Of the few cases like yours that have been recorded, two patients who went on to have surgery got better quickly. One had full return of hand strength and function in less than three months following her surgery. The second person had greater complications before surgery but still ended up having a full recovery by six months.

Wrist pain can be difficult to diagnose, especially when the tests come back normal. Research shows that patients with normal arthrogram and X-ray results get better without surgery about 65 percent of the time. In less than 20 percent of cases, patients get worse.

Patients who have had wrist pain for more than one year tend to wind up with more problems doing wrist activities than patients who have only been in pain for a few months. Patients who have been in pain longer may also have more wrist pain, stiffness, and weakness down the road. These symptoms may be fairly mild, though.

Talk with your doctor about ways to manage your pain. If your symptoms persist, surgery may be a good option.

Arthrograms are designed to show any lesions in the wrist joint by injecting a special substance that makes these problems visible. Some doctors have criticized arthrography, saying it sometimes misses wrist problems and gives a “normal” result.

Typically, doctors use a few different methods to diagnose wrist pain. In addition to arthrography, you probably had X-rays and a physical exam. If these tests were inconclusive and your arthrogram came out normal, there’s a good chance your symptoms will go away in time. In one study, 65 percent of patients who had normal wrist arthrograms got better. Only 17 percent got worse.

Talk with your doctor about ways to manage your wrist pain. You may also want to ask about any other diagnostic tools your doctor might try at this point.

The symptoms of a fresh fracture of the scaphoid bone usually include pain in the wrist and tenderness in the area just below the thumb. You may also see swelling around the wrist. The swelling occurs because blood from the fractured bone fills the wrist joint. Thin people will see a bulging of the joint capsule. The joint capsule is the watertight sac that encloses the joint.

Symptoms of a nonunion of the scaphoid bone are more subtle. You may have pain when you use your wrist. However, the pain may be very minimal. It is fairly common for doctors to see a nonunion of the scaphoid bone on X-rays, but the patient doesn’t remember an injury. These people probably suffered a wrist injury years ago that they thought was a simple sprain. Still, the most common symptom of a nonunion is a gradual increase in pain. Over several years the nonunion can lead to degenerative arthritis in the wrist joint.

The primary symptoms of Kienbock’s disease are pain in the wrist and limited wrist motion. Pain may vary from slight discomfort to constant pain. In the early stages there may be pain only during or after heavy activity using the wrist. The pain usually gets slowly worse over many years. The wrist may swell. The area over the back of the wrist near the lunate bone may feel tender. You may not be able to move your wrist as much as normal or grip objects as well.

Patients often have the condition for months or years before seeking treatment. Typically, the patient will report an injury to the wrist in the past or have a history of repetitive heavy use of the wrist. Kienbock’s disease most frequently affects men twenty to forty years old. It rarely affects both wrists.

If immobilizing the wrist doesn’t help, then surgery will probably be required. Attempts to restore the blood flow to the lunate are most likely to be successful at this point. The procedure to restore blood flow is called revascularization. During the operation, the surgeon moves a small section of blood vessels (and also possibly bone) from elsewhere on the patient. The segment is attached to the deteriorating lunate bone. This is done to restore blood flow to the lunate and halt its deterioration. This is a newer procedure to treat Kienbock’s disease and is not always successful.

Other treatment options at this stage include operations designed to take some of the pressure off the lunate bone. Doing this may allow the bone to heal and revascularize – or it may slow the progression of the disease. Operations to do this include a radial shortening osteotomy. In this operation, removing a small section of the bone near the wrist shortens the radius bone, allowing the bone to heal together in this shortened position. Some surgeons prefer a capitate shortening (known as the Almquist procedure) which shortens a carpal bone on the other side of the lunate.  Both operations help reduce the force on the lunate.