FAQ Category: Wrist

Wrist ganglion cysts can be very painful and may limit motion and strength in the wrist and hand. They are often removed to give relief of symptoms. In a small number of cases,
the cyst may come back.

Studies show the recurrence rate varies from none at all up to seven percent. It’s uncommon but not rare. Doctors think the cyst may be more likely to come back if the
entire cyst, lining, and stalk are not removed. Sometimes the stalk isn’t visible. This is where the cyst connects to the joint capsule. The channel between the joint and cyst allows fluid to escape from the joint into the cyst. If the connection isn’t found and
removed, fluid can build up again, allowing the cyst to come back.

The operation for removing the cyst continues to improve over time. It’s no longer necessary to open the wrist up to find the cyst and remove it. Now doctors can use an arthroscope to look inside the joint and take the cyst out without ever making an open cut. Even arthroscopic surgery is improving as doctors find that less and less time is needed for recovery afterwards.

You may have developed stiffness if you were put in a splint for two or three weeks after the operation. With the newer protocols after this kind of surgery, stiffness is rare.

Treating wrist fractures that aren’t displaced is usually done with casting. A displaced fracture means the bones don’t line up together. One side of the fracture has shifted up, down, or away from the other bone.

Casting a displaced fracture isn’t a good idea because the bone heals in the misaligned position.

When casting a nondisplaced fracture, the wrist is out of action for a little over a month. It takes a few more weeks to get your motion and strength back when the cast comes off.

With surgery, a screw is placed to hold the two bones together. No cast is required so motion is restored sooner. You’ll probably be able to get back to work sooner, depending on what you do.

There are always increased risks with surgery of any kind. Many doctors suggest treating the fracture with casting and watching it carefully. If X-rays show it isn’t healing then surgery can be done at that time. Usually the need for further treatment is clear by six weeks.

Fracture of the scaphoid bone at the base of the thumb usually requires casting for six to eight weeks. Patients are advised to avoid twisting motions or any activity that could result in a fall onto the outstretched hand.

It may be possible to get what’s called a functional cast. The elbow and thumb are left free to move. The wrist is put in a position of slight extension (cocked back a little). This position allows most people to perform daily activities.

Your doctor may advise against the gripping and pulling required by your job during the early days of healing. It would be a good idea to let the doctor know your work needs. Ask about a functional cast and any limits on motion or activities based on your injury.

Good question. Most doctors advise their patients to avoid activities that would put them at risk for another fall with an outstretched hand. Patients are usually encouraged to be as active as possible. Activities that involve sudden twisting should also be avoided.

Horse back riding is considered a high-risk activity for orthopedic injuries. Although your wrist might be protected in the cast, a fall on that hand could reinjure the wrist.

With the wrist in a cast, the elbow and shoulder joints are at increased risk of injury. The impact transfers the force to these areas.

You may want to ask your surgeon this question. He or she has a good idea of the stability of your wrist and may have a different opinion. It’s your doctor’s opinion that counts the most.

Some surgeons will consider a partial wrist fusion or arthrodesis. Studies show it isn’t always a reliable way to get pain relief. It may preserve some motion but patients report that doesn’t mean they can use the wrist.

Motions like wiping after going to the bathroom and using the hand in small spaces remain difficult tasks. Other activities such as writing, using a hammer, or lifting objects over the head can also be difficult if not impossible.

Discuss all the pros and cons of partial versus complete wrist fusion with your surgeon before deciding.

Long-term studies of this question are few and far between. A recent report from the Hand and Upper Extremity Clinic in Boston offers some insight.

hey studied 22 patients with wrist fusion ranging from one year to 15 years later. More than half still had wrist pain, some rated as “severe”. All but one patient said they would suggest a friend have wrist fusion for a similar problem.

Many patients report going back to work, even those in manual labor. Most said pain relief was enough to do what they needed to do each day at home and at work. Eighty percent of patients interviewed do say the quality of life is less after wrist fusion.

Every surgery and every surgeon is slightly different so it’s always best to ask your surgeon this very question. Surgery for de Quervain disease is usually done to free up two tendons in the wrist and thumb area.

The abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) can become inflammed and scarred down with fibrotic tissue in de Quervain disease. The surgeon will
make an incision in the skin to get to the tendons. Each tendon will be carefully cut loose from anything keeping it from moving smoothly and freely.

If there is nerve pain or numbness and tingling, the surgeon might cut or apply heat to the nerve. This will stop the nerve from sending painful messages to the brain. It won’t affect the muscle’s power or function.

It’s possible but very unlikely. The onset of diabetes is usually signaled by three key symptoms: increased thirst, urination, and hunger. Numbness, pain, and tingling in the fingers and toes (neuropathy) are complications of long-term diabetes.

If your son is putting in a lot of training hours playing volleyball, he may be having a problem called de Quervain disease. Repeated motions and trauma to the base of the thumb are common in volleyball players. Inflammation of the thumb tendons can occur leading to de Quervain disease.

It’s best to have him see a medical doctor for a proper diagnosis. This will put aside your fears and possibly nip the problem in the bud. Early detection for most conditions results in faster recovery and better outcomes.

Removing the pisiform bone from the wrist is called a pisiformectomy. A recent study of 21 patients with pisiformectomy reported good results. Everyone got relief from their pain.

All but one person could use the wrist for any activity without pain. The one patient with pain reported problems only with strenuous wrist motion.

Everyone had wrist motion on the pisiformectomy side equal to wrist motion on the unoperated side. Wrist function didn’t seem to be hampered by removing the bone.

The pisiform bone is located in the wrist on the side of the little finger. It has one joint that moves against the slightly larger triquetrum bone. Degenerative arthritis of this joint is really not uncommon because it gets a lot of use.

When the wrist bends, the pisiform flexes. When the wrist extends, the pisiform also extends and moves slightly toward the thumb side. With normal motion, multiple forces act on the pisiform-triquetrum joint. Forceful or repetitive use of this joint is the main reason for arthritic changes.

Acute injury from trauma with tendon rupture is the second most common reason for arthritis in this joint. Tight ligaments and tight fibrous bands of tissue across the pisiform can also create compression and eventual problems.

Kienbock’s disease is the loss of blood supply to the lunate bone in the wrist. This causes painful loss of motion and decreased grip strength. Without enough blood, the bone starts to break down and even collapse.

The cause of this problem isn’t known. Many theories exist such as one bone in the forearm being longer than the other and putting increased load on the lunate. Some think it’s caused by the type of blood supply to the wrist, others suggest the shape of the lunate as the cause.

The disease affects men and women of all backgrounds. This condition has been reported in housewives, police officers, students, office workers, and even the unemployed. Even though it was first seen in 1910, not much is known about this problem.

Treatment for this disease of the wrist is based on the results of X-rays and MRIs. The more advanced cases need surgery to remove bone or tissue fragments and restore blood supply to the area.

There are two ways to perform this operation. The doctor can cut the wrist open, fuse the bones, and bring a small blood vessel to the lunate bone. A second method is to use an arthroscope to smooth the tissue and fuse the bones together. An arthroscope is a tool doctors use to look inside the joint without cutting it open.

A recent study showed that the fusion rate is faster with open surgery. However, there is a shorter hospital stay and faster return to activities with arthroscopic surgery. You will probably wear a cast, brace, or splint for a few weeks. Once your doctor gives you the go-ahead to move the wrist, don’t overdo it. Follow your doctor’s advice closely after the operation for a faster recovery time.

Regaining grip and pinch strength are part of the recovery process from an arm injury. Nerves control the muscles. If there has been a nerve injury, rehab takes longer. If more than one nerve was damaged, then return of grip strength may be delayed even more.

Researchers in the Netherlands compared groups of workers with arm injuries. They found that patients with both an ulnar nerve and a median nerve injury had a slower recovery. Ulnar nerve damage especially affects grip strength. It takes longer for this nerve to repair itself.

One other factor should be considered. There is greater loss of muscle strength if the blood vessels to the forearm, wrist, or hand were cut or damaged. Healing and recovery take longer if this is the case.

Type A personality describes someone who is hard working to the point of being driven and unable to relax. The Type A person works hard and plays hard. They tend to be over achievers and have a strong sense of time urgency.

A study of patients with arm injuries was done in the Netherlands. This showed white-collar workers (office workers) return to work sooner than blue-collar workers (manual laborers). The authors of this study think this is because of the workers’ level of education. Type of personality wasn’t studied.

There are other factors that decide how soon a patient returns to work. These include the level of injury, the extent of the injury, and how strong is the patient’s grip. The higher the injury (for example, above the elbow), the worse the result. Patients with more than one nerve or tendon cut also had poorer results.

Overall, the most important factor in returning to work after an arm injury was following the hand therapist’s advice. Type A patients may be more likely to complete the prescribed exercise program, but this hasn’t been proven yet.

Your doctor, along with a physical or occupational therapist will advise you on this decision. A hand therapy program is suggested based on studies done in the Netherlands. Workers with arm injuries who follow a standard hand therapy program return to work sooner than those who don’t finish the program.

The therapist will measure muscle strength and nerve function. The therapist will also include functional testing. This shows if your recovery is enough to carry out your job tasks. Based on test results, the therapist advises the doctor and the patient when retraining or a different job is needed.

There aren’t too many choices for young, active patients. There’s been some success using wrist replacements in older, less active patients.

Wrist fusion or partial fusion is one possibility. The results of partial fusion still aren’t clear. Pain relief is unpredictable. Having some motion should improve function, but it doesn’t always do so.

Many patients who have a partial fusion go on to have a complete fusion later. After the full fusion, some report they should have converted to a complete fusion sooner.

If you haven’t already done so, a rehab program to manage pain and improve strength and function is also a possibility. A conservative approach always leaves room for the more invasive surgical treatment later.

Wrist fusion, also known as wrist arthrodesis is often used to reduce pain and improve hand function. Most of the hand function lost after trauma is related to pain and stiffness.

According to a recent study, many patients are able to return to manual labor after a wrist arthrodesis. Return to work may depend on the type of work you do.

For example, using a jackhammer or sledgehammer to break up concrete isn’t advised. Operating heavy machinery, digging, and lifting some things is possible. Most patients find a loss of handgrip and wrist strength after fusion. Depending on what you do, this may interfere with your job.

Studies of long-term results from wrist fusion report the following:

As the old saying goes, “Don’t throw the baby out with the bath water.” In other words, steroid injections have their place. A single injection to the carpal tunnel area can reduce swelling and give relief from symptoms. It may even cure the problem.

Patients who get relief from pain, numbness, and tingling with a steroid injection may be good candidates for surgery. If the symptoms are relieved but return some time later, surgery is likely to have a good result. These are the findings of a recent study at the University of Louisville in Kentucky.

Sometimes, a second steroid injection is needed. This is okay, too. Multiple injections aren’t advised because of the negative effects of steroids.

There’s no quick and easy answer to this for each patient. However, there are some factors that can help with this decision. For example, studies show that patients on worker’s compensation have the worst results of all patients.

Age and sex don’t seem to make any difference. A positive nerve conduction velocity (NCV) test points to a good result for workers and for patients with diabetes. NCV measures the speed of nerve messages. In general, patients with diabetes are less likely to be helped by the surgery compared with patients who don’t have diabetes.

Some doctors suggest using a steroid injection into the carpal tunnel area as a test. Steroids can reduce swelling and relieve symptoms completely. If the pain, numbness, and tingling return after a steroid injection, surgery is advised. A study at the University of Louisville (Kentucky) showed that relief from steroid injection is the best way to predict good results from surgery.