FAQ Category: Wrist

There are many disorders that can affect the wrist, from common diseases like arthritis to less common ones, such as Kienbock’s disease. The wrist is made of very small bones and a small canal through which nerves go through to access the hand. If anything happens to any of the structures, the bone, ligaments, muscles, nerves, and soft tissues, you can end up with a good bit of pain and restricted movement and function of the hand.

Carpal tunnel syndrome and Kienbock’s disease are two different disorders. Carpal tunnel syndrome is a repetitive stress disorder that causes irritation of the nerves that go from the forearm into the hand. Kienbock’s disease is a disease of a bone in the wrist called the lunate. With Kienbock’s disease, blood doesn’t reach the bone to provide it with nutrients and the bone cells begin to die.

Doctors do wonder if there is some role to repetitive motions with Kienbock’s disease, but nothing has been proven yet.

Right now, no-one knows what causes Keinbock’s disease, a disorder where the lunate bone in the wrist is deprived of blood, causing bone cell death. Doctors do know that it’s more common between the ages of 20 and 40 years, but that’s really about all they know. Perhaps your brother can ask his doctor if he knows of any research in this area.

de Quervain’s tenosynovitis isn’t the same thing as tendonitis, but it’s close. It’s caused by the inflammation and irritation in the tendons on the thumb side of your wrist.

Unfortunately, researchers and doctors don’t know what causes it, although they do know that women get it more than men, and the two most common age groups for it are those under 20 years and those 40 years and older.

It is called de Quervain’s tenosynovitis because Dr. de Quervain is the one who noticed the problem and recognized it as something different from other wrist problems.

Not long ago, a systematic study was done to compare the results of arthrodesis (wrist fusion) to arthroplasty (wrist joint replacement). Complication rates for the two procedures were compared. The results for arthroplasty were a little bit hard to compare because surgeons used different techniques and different implants. Likewise, different ways to fuse the wrist were employed.

Since that time, another study was done asking surgeons to place a value on expected gains from these two procedures. Experienced surgeons who are members of the American Society for Surgery of the Hand were surveyed. In general, they favored arthrodesis over arthroplasty. But there were some indications that the value they placed on fusion over replacement wasn’t necessarily based on better results from that procedure.

For most patients, the decision may rest on their expectations and goals. Wrist replacement will preserve wrist motion but may come with a higher risk of complications. Wrist fusion may be more appealing because there are fewer re-operations required. Both procedures have a risk of delayed wound healing and/or infection.

With any implant, there is a risk of subsidence (implant sinks down into the bone), pain requiring removal of the hardware, and implant imbalance. The implant can come loose or dislocate. On the other hand, major problems associated with fusion include nonunion, formation of a false joint called pseudoarthrosis, and deep infection. Any of these problems may require additional surgery.

Many improvements have been made in wrist implants since they were first introduced. Likewise, surgical technique has improved. The notion that arthroplasty is no better than arthrodesis in terms of improving function may be a value judgment offered by surgeons who don’t perform arthroplasties. It is predicted that as more studies are done, results of arthroplasty will continue to improve — much like hip and knee replacements gained in favor as the procedure evolved.

We don’t have any particulars about your wife’s fracture. But we can say that, in general, it’s better to have a nondisplaced fracture (versus displaced). Nondisplaced means the bone broke but the two ends of the bone did not separate.

With a displaced (separated) fracture, there’s a greater chance that the jagged, separated edges of the bone can puncture a blood vessel or nerve. Likewise, tendons could be cut by wrist movement. The displaced bones in the wrist rubbing across the tendons or muscles cause the damage.

It’s also possible with a displaced wrist fracture to develop acute carpal tunnel syndrome. There can be contusion, deformity, or swelling from elevated pressure within the tunnel. Any of these problems can cause median nerve dysfunction and lead to permanent damage of the median nerve. Early recognition and treatment of any of these factors can prevent long-term problems.

If your wife simply suffered a break without any of these complications, the surgeon may have counted it as a good break. You would have to ask the question directly to know for sure.

It sounds like your father has wrist stiffness, which is making it impossible for him to use his hand and wrist properly. Usually, this is first treated with physiotherapy, so if he has not yet tried that, you may want to mention this to his doctor. If physiotherapy doesn’t work for stiff wrists, patients do sometimes have surgery, but others use a special splint that stretches the wrist, called static progressive stretching.

To do this, your father would have to put on a special brace, once a day in the beginning, and adjust the angle on the brace so the wrist is stretched, but doesn’t hurt. That position is held for five minutes. Then, if it’s not painful, he increases the angle a bit and holds that position, and so on, for a set amount of time. After a few days, these sessions increase in number. This treatment seems to be quite successful in many cases.

Surgery can be done, but surgery always has risks, from infection to the surgery not clearing up the problem, so it’s always best to see if there are other ways to help before operating.

When a wrist begins to flex, or bend inwards towards the body, this is often caused by a tightness in the tendons that are pulling the hand downward. If this isn’t stopped early enough, the bend in the wrist can become quite extreme, causing pain and limiting the function of the wrist.

If the wrist seems to be pulling the hand down, it’s important to have this evaluated by a doctor and physiotherapist to try to limit the flexion. If, however, the flexion has progressed, physiotherapy or splinting may help return the wrist to a more normal position.

Without knowing the specifics of your father’s case, we can only give general information about what may have happened. Bone death in the wrist, called avascuar necrosis is caused by lack of blood flow to the specific bone. This could be caused by a trauma, like a fracture, which interferes with the blood flow and doesn’t allow the nutrients from the blood to reach the bones. But most often, doctors don’t know what causes it.

Usually, a patient goes to see the doctor because his or her wrist is hurting but there doesn’t seem to be a reason for it. Then, after examining the wrist and taking x-rays and maybe other tests, the doctor can diagnose the bone cell death, also called osteonecrosis.

Osteonecrosis of the wrist, or death of bone cells in the wrist, isn’t a very common problem, but it does happen. In some situations, it’s easy to identify why it happened. For example, it can happen after someone breaks their wrist and the blood supply to the bone is cut off. However, many times there is no rhyme or reason as to why someone develops it.

The good news is that it doesn’t seem to be related to anything else and there are no risks that have been found that mean that someone with osteonecrosis may develop it again somewhere else.

The wrist joint is a complicated one. Some of your joints are called ball and socket joints because, like with the hip, the ball of the hip fits into the socket, and allows you to swing your leg. Other joints are hinge joints, like the elbow, where you can move your joint up and down as it would with a hinge.

The wrist is considered a hinge joint but it is more complicated than the elbow because you can also move the wrist from side to side in limited motion. Like the foot, the wrist joint has several bones leading away from it. In the hand, these bones are called carpals and these are the bones in your fingers. Other than your foot, the other joints in your body only have one or two bones entering or exiting.

When a joint is fused, bone or graft is fused together to make a strong bond. As a result, the joint can no longer bend and move as it did before. This may greatly reduce the amount of pain that someone experiences, but it also makes movements more awkward. Unfortunately, right now, when a fusion is done, it is permanent and range of motion as it was before the pain and the surgery will not return.

Carpal tunnel syndrome (CTS) is often accompanied by numbness and tingling of the fingers affected by the compressed or pinched median nerve. When there is no numbness, there can still be pain and loss of strength contributing to the problem.

In fact, a recent study showed that patients with CTS lose their ability to make a precise pinching motion needed for fine motor skills like buttoning buttons. Compared with normal adults who did not have CTS, the CTS group had a wide range of differences in their pinching ability. The result was a lack of manual dexterity and increased clumsiness.

It’s likely that this negative effect of CTS increases as the symptoms increase in severity. Precise pinch movements, thumb and finger coordination, and thumb strength were less impaired with mild-to-moderate CTS.

You could possibly benefit from some nonoperative intervention. A hand therapist could help you regain motion, strength, and coordination. Sometimes there are postural issues contributing to the problem. Splinting and modifying activities may help. Nerve and tendon gliding exercises can help free the movement of the median nerve that is often compressed or pinched causing CTS.

Early intervention is advised to avoid long-term or chronic problems with permanent impairment.

The wrist is made of eight separate small bones, called the carpal bones. There are two rows of carpal bones that connect the two bones of the forearm, the radius and the ulna, to the bones of the hand.

Kienbock’s disease is a condition in which the lunate bone loses its blood supply and dies, causing pain and stiffness with wrist motion. The lunate is one of the bones in the proximal row of carpal (wrist) bones. That’s the row of bones closest to the radius and ulna (bones of the forearm).

In the late stages of the disease, the lunate collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint.

How long the patient has before these changes take place is unpredictable. It seems to differ from patient to patient without apparent cause. Treatment ranges from conservative (nonoperative) care to a variety of surgical options.

The goal of treatment is to decrease the load across the lunate and/or bring a better blood supply to it. Treatment is determined by what stage the disease is in. Staging can be difficult since the degenerative changes occur slowly over a long period of time. Repeated imaging studies may be needed to confirm earlier suspicious findings.

There is no strong evidence at this time to suggest one treatment works better than another. The physician looks at all the factors and makes the best clinical judgment possible. The patient’s age, occupation, activity level, and findings from the diagnostic process will all be taken into consideration.

Kienbock’s disease is a condition in which the lunate loses its blood supply and dies, causing pain and stiffness with wrist motion. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint.

There are several types of surgery that can be done for this problem. Treatment is determined by what stage the disease is in. The goal of treatment is to decrease the load across the lunate and/or bring a better blood supply to it. Milder forms of Kienböck’s can be treated with revascularization (restore blood flow) to the lunate.

During the operation, the surgeon moves a small section of blood vessels (and also possibly bone) from elsewhere in the wrist to the deteriorating lunate bone. Intercarpal fusion fuses the lunate to the carpal bone next to it. It’s not a complete or total fusion because not all of the wrist bones are fused together.

One of the oldest methods for treating Kienbock’s disease is called a lunate excision. The abnormal bone is removed. The empty space left by taking the bone out is filled with a piece of tendon coiled up and stuffed into the hole. An artificial lunate bone may also be used to fill this space and maintain alignment of the bones.

When the lunate has collapsed, but the wrist joint is not terribly arthritic, the four carpal bones of the proximal row may simply be removed. This allows the distal row (the other four bones) to slide down a bit and begin moving against the forearm bones instead. Without the proximal row of bones, the wrist loses its ability to perform complex movements. It becomes more of a hinge joint like the knee.

The advantage is that there is still a good deal of wrist motion. That’s better than having a wrist fusion, which is another surgical option. Proximal row carpectomy is not the first line of treatment for this condition. It’s really considered a salvage procedure. That means it’s a way to save motion at the wrist.

You didn’t mention what type of surgery you are expecting to have. This will determine the amount of motion you will have after the operation. A complete fusion leaves you without wrist motion. It may give you a strong wrist, but it’s very inflexible. A carpectomy provides flexibility but not strength.

Using a hot honey knife requires a stable joint and strength in a motion called ulnar deviation. As you slice down through the comb, grip strength is needed as well as wrist strength on the little finger (ulnar) side of the joint.

Be sure and bring this question up with your surgeon before scheduling the operation. Your occupational requirements are an important part of the decision-making process when trying to figure out which treatment will be best for you.

When someone has severe rheumatoid arthritis in a wrist, it becomes not only very painful, but difficult for them to go about their daily activities. One treatment for severe arthritis in the wrist is arthrodesis, or bone fusion. This type of surgery straightens out the wrist, cleans out the joint and sets it so it is stable. Unfortunately, the drawback is the bones are fused and range of motion becomes limited.

However, if someone’s wrists are bad enough to consider such surgery, it’s very likely that their range of motion is quite limited already so the difference before and after surgery may barely be noticed in some people.

The best person to speak to regarding your daughter’s surgery is her surgeon. He or she is best placed to answer specific questions and discuss what will be done. In general, however, surgery is only done if 1) the doctor is absolutely sure it is dorsal wrist impingement and 2) corticosteroid injections have been tried and helped somewhat, but no longer work.

The surgery is usually done arthroscopically, using small incisions, rather than opening up the whole wrist. After the surgery, the patient is given exercises to help regain the range of motion – stretching, bending and rotating the wrist. After about two weeks or so, generally strength training can begin. However, this is completely at the doctor’s discretion. As to if your daughter can resume gymnastics, that too is up to the her doctor.

There are no specific tests for dorsal wrist impingement. It is diagnosed based on the patient’s history and how and when the pain started. If someone has dorsal wrist impingement, the pain is not a generalized pain, but a specific pain in a specific spot, usually brought on by certain hand and wrist movements. The diagnosis is also made by ruling out any other wrist problems that could be causing the pain.

Hip and knee replacements are considered to be common surgeries now. Doctors have been performing them for quite a while and manufacturers are coming up with better and improved models as quickly as they can. The knee and the hip are rather straight forward joints, although they do bear a heavy load in supporting your body as you stand, walk, and move about in general. The joints have to be able to bend and rotate as needed, and be strong enough for all the demands placed on them.

The wrist, on the other hand, is more complicated. There are two bones that go from the forearm to the wrist and then the wrist is not only responsible for moving the hand around and back and forth, but the nerves and tendons that run through the wrist control the motion of your fingers. This requires a more complicated type of joint that what is used for the knee and hip.

As more wrist replacements are done, doctors and manufacturers are learning what seems to be working and what doesn’t, which is resulting in new and improved implants.

Wrist injuries are common in skateboarders. A fall on an outstretched hand can put a lot of force through that area. And there are many possible injuries that can occur. There are numerous ligaments in the wrist holding everything together.

If the force is strong enough, one or more ligaments can be damaged. Without the ligamentous support, the bones can shift and/or dislocate. Fractures can occur at the same time. Often there is damage to the nerves and blood vessels. Without proper blood supply, healing is further delayed.

It may be a good idea to see an orthopedic surgeon for an evaluation. The surgeon will carefully examine the hand, wrist, and arm. Additional tests such as X-rays or more advanced imaging may be needed. With wrist injuries, early detection of more serious problems can help provide a good result.