Wrist

Healthy Wrist

The wrist is made up of the two bones of the forearm (the radius and ulna) and has eight separate bones, called carpals that provide movement and support to the hand. Many ligaments connect these bones to each other.

The joint surfaces are covered with a tough lubricating tissue called cartilage. Cartilage acts like a natural shock absorber, preventing both bone on bone contact and providing a smooth, pain-free surface for the bones to glide against.

Common causes of wrist pain range from repetitive stress injuries to diseases such as arthritis. Damage to your ligaments, bones or the cartilage that cushions your joints can cause pain and affect your ability to use your wrist and hand.

Topics below cover two common areas of wrist problems.

  • Arthritis
  • Injuries

Arthritic Wrist

Arthritis is a term that is defined as inflammation of the joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

There are two common types of arthritis that generally affect the wrist; osteoarthritis, and rheumatoid arthritis.

Osteoarthritis, the most common form of arthritis, results in the wearing out of the cartilage that protects the bones in the joints. Once cartilage is damaged or destroyed, cartilage cannot repair or replace itself like many other body tissues. Wrist cartilage can be compared to the tread of an automobile tire, very durable but susceptible to wear over time. As we age, the tread surface slowly erodes until the underlying bone is exposed. This exposed bone can be painful when the joint moves and bears weight.

Often the cause of arthritis is unknown, but may develop from years of wear and tear on the joint cartilage or as a result from injury to the forearm, wrist or ligaments. There is no known cure. The best that doctors can do for patients is to restore motion and reduce pain.

Common symptoms of osteoarthritis of the wrist

  • Severe wrist pain that limits everyday activity
  • Wrist pain at night causing sleeplessness
  • Limited range of motion
  • Decreased grip strength
  • Joint swelling

Rheumatoid arthritis is a systemic inflammatory condition of the joint lining, or synovium where the body’s immunological system attacks healthy tissue, causing inflammation of the joint lining and subsequent joint damage. When rheumatoid arthritis is present, the cartilage is not being provided with enough lubrication and nourishment. This leads to loss of motion and pain in the wrist.

Wrist Injuries

Common types of wrist injuries include carpel tunnel syndrome and ligament sprains and tears. These injuries can occur from long-term overuse, such as repetitive lifting, pushing, pulling and throwing. For this reason, athletes and skilled workers are particularly prone to wrist injuries.

Common types of wrist injuries include fractures, carpal tunnel syndrome, tendonitis and ligament sprains and tears. These conditions can cause wrist pain, swelling, and stiffness.

Fractures are common injuries to wrist bones because the bones in the wrist are small and intricately arranged.

Symptoms may include, swelling, discolored skin, limited ability to move your wrist, a deformed or crooked wrist, sometimes with the bone protruding through the skin.

Carpal Tunnel Syndrome is a common wrist injury that may occur from repetitive motion. It is a condition where the median nerve is compressed as it passes through the carpal tunnel in the wrist.

Symptoms may include difficulty making a fist, difficulty gripping objects with the hand(s), pain and/or numbness in the hand(s), “pins and needles” feeling in the fingers, swollen feeling in the fingers, burning or tingling in the fingers, especially the thumb and the index and middle fingers.

Tendonitis is inflammation of the tendon or area surrounding the tendon. There are many tendons located around the wrist that connect the muscles to the joint. These tendons become stressed and overworked due to various activities or overuse injuries and cause pain and tenderness around the wrist region.

Symptoms include an inability move comfortably, pain while resting or sleeping at night, difficulty bending your wrist, and swelling.

Ligament Sprains and Tears result from injuries that happen when you fall forward onto your outstretched hand. They can also occur when you push a heavy object or brace yourself during a sudden stop or collision.

Symptoms may include significant pain and swelling that becomes worse with use, bruising, inability to use your wrist normally and painful popping or clicking.

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to diagnose your wrist pain.

  • Medical history
  • Symptoms
  • Health
  • Examine
  • Exam affected joint
  • Range of motion tests
  • Joint-line tenderness
  • Joint deformities
  • X-rays

On an x-ray, a healthy joint appears as if there is a space between the bones in the joint. Although you cannot see the cartilage on an x-ray, in the healthy joint, the cartilage is working to cushion and smooth the movement of the joint. On the x-ray of a joint with osteoarthritis, there is bone on bone contact because the cartilage in the joint has worn away.

When non-surgical treatments such as diet, exercise, medications, supplements, and physical therapy fail, your orthopedic surgeon may recommend wrist replacement surgery.

You should discuss your condition and treatment options with your surgeon.

The treatment options covered here relate to osteoarthritis, although many of them may be helpful for patients with other arthritic conditions. Please ask your physician before starting any treatment.

  • Exercise
  • Physical Therapy
  • Modify Your Activities
  • Weight Control
  • Self-Help/Assistive Devices
  • Heat and Cold Treatments
  • Nutritional Supplements
  • Over-The-Counter Medications
  • Injections

Exercise

Moderate doctor-prescribed exercise is an integral part of treating arthritis. Joints that are not regularly exercised can become tight and painful. Activities such as walking, swimming or gardening can assist in keeping your bones strong and your joints limber, which may help relieve stiffness. Low-impact exercise will not wear out your joints. Although exercise may sometimes cause discomfort, proper exercise will help nourish the cartilage, strengthen the muscles, and prolong the life of your joints.

Aquatic Therapy

Aquatic therapy is an excellent form of exercise to help manage arthritis pain. Water’s buoyancy helps protect your joints from impact injury. Water also resists movement, which is helpful for strengthening.

Walking

Walking is an excellent form of endurance exercise for almost anyone, including those with arthritis. Be sure to have a good pair of walking shoes to help cushion impact. Check with your physician to obtain any exercise precautions or guidelines. You should be able to speak clearly without feeling out of breath when you are walking. Always warm up and cool down by walking slowly.

Biking

Either regular biking or stationary biking is an excellent endurance exercise. However, patients with kneecap problems may aggravate their condition with biking. Be careful not to increase the resistance or ride up and down hills too quickly. As with any endurance exercise, you should be able to carry on a conversation while you are engaged in the activity.

How much exercise is too much?

If you note increased joint swelling, decreased joint motion, unusual or persistent fatigue or continuous pain, you may be exercising too much. You should expect some muscle soreness, especially if you are just beginning an exercise program or have changed exercises. Joint pain should not last more than several hours after exercise.

For an in-depth guide on starting and maintaining a walking program, reference Walk With Ease by the Arthritis Foundation.

How do I stay consistent with exercise?
  • Seek help from a health care professional to assist you in setting up an individualized program.
  • Make a plan! Write it down! Set goals!
  • Exercise at the same time each day so it becomes part of your routine.
  • Find an exercise buddy.
  • Look for an appropriate exercise class.
  • Stay in the habit of doing some exercise each day.
  • Vary your exercise routine and rotate your exercises.
  • Evaluate your progress and enjoy your success.

Physical Therapy

Physical therapy is a very important role in the recovery process. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your wrist joint. However, you should only perform the exercises that are ordered by your surgeon.

Modify Your Activities

Proper body mechanics can lead to less strain on your joints. The following activity modification guidelines may be helpful:

  • Practice good posture by standing up straight.
  • Avoid stooping while standing.
  • Avoid impact-loading activities.
  • Avoid any activity that causes prolonged discomfort.

Weight Control

Being overweight puts weight-bearing joints under extra pressure and stress. Extra pressure on your joints can make arthritic symptoms worse, leading to pain and stiffness.

A well-balanced diet coupled with regular doctor prescribed low-impact exercise can help reduce excess body weight, decrease pressure on the joints and increase joint strength. Many claims have been made concerning diet as a cause of arthritis but none have been proven to date. Maintaining your ideal body weight will help keep your joints healthy. If you are overweight, ask your doctor to advise you on a weight-loss program to fit your needs.

Self-Help/Assistive Devices

Simple everyday tasks may be hard to accomplish with joint pain. The self-help devices listed below can help minimize pain, discomfort, stress, and can assist you in accomplishing tasks. Ask your physician or physical therapist about these self-help devices:

  • Wrist brace for rest
  • Jar openers
  • Button threaders
  • Large grips for pencils, garden tools or other hand-held objects
  • Abdominal supports to reduce stress on the back
  • Long-handled reachers or grabbers to help you pick things up without bending

Heat and Cold Treatments

Heat or cold treatments may be used to decrease pain and increase flexibility. Heat or cold treatments may be combined with the exercises prescribed by your physical therapist.

HeatCold
Use prior to activity
Increases blood flow
Improves motion
Decreases joint ache
Helps relax muscles
Use after exercise
Decreases blood flow
Decreases swelling
Better for pain
Reduces inflammation

You may want to purchase a gel pack that can be kept cold in your freezer or heated in a microwave.

Nutritional Supplements

Recently, nutritional supplements have become popular with arthritis patients. Glucosamine and Chondroitin have been the most widely used. Consult your physician before beginning treatment.

Glucosamine

Glucosamine is a building block of cartilage and may be found as a hydrochloride or sulfate. It may be useful in strengthening and repairing cartilage. Studies have shown it to be effective in reducing pain, especially painful arthritis of the hands. Glucosamine is not a cure and has not been shown to rebuild cartilage.

Chondroitin Sulfate

Chondroitin Sulfate is commonly taken in conjunction with Glucosamine. It is found in cartilage and acts somewhat like a sponge for the fluid found in cartilage, which makes the cartilage more elastic and spongy. Chondroitin may help prevent the breakdown of cartilage as well.

Vitamins C and D

Some studies have indicated that patients low in Vitamins C and D may have a higher incidence of arthritis. Arthritis patients should take vitamins regularly, or as prescribed by a medical professional.

Calcium

Some people confuse osteoporosis with osteoarthritis. Osteoporosis is a thinning of the bone, not the joint. Calcium may accumulate in bone spurs around arthritic joints in response to increased pressure on the joint. However, too much calcium is not the cause of arthritis.

Talk to your physician before taking any medications.

Over-The-Counter Medications

Many medications are available to help treat arthritis and can function as a pain-reliever and as an anti-inflammatory to help relieve joint swelling and pain. These medications can lead to improvement in everyday function and quality of life. Always consult your physician before beginning treatment.

Tylenol®

The non-narcotic analgesic Tylenol® is generally effective in relieving minor pain and discomfort. The Academy of Rheumatology has suggested this as the first-line arthritis treatment. Tylenol®, however, does not reduce the inflammation caused by arthritis. Ask your physician about dosing and safety.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be purchased over-the-counter with some common forms being Aspirin, Motrin®, Advil®, and Aleve®. NSAIDs are usually indicated for mild to moderate arthritis pain and may be effective where Tylenol® is not. They are very effective in reducing inflammation caused by arthritis. However, they can also increase your chance for gastric (stomach) ulcers and can alter your blood by affecting your platelets. Therefore, patients with stomach problems, bleeding problems or on blood thinners should not take these medications. Always check with your physician before starting NSAIDs.

Patients with chronic pain may need to take medication daily. However, many may only need to take it when necessary or when they anticipate a strenuous activity that is likely to lead to pain. This may not be true for patients with inflammatory forms of arthritis such as rheumatoid arthritis or lupus.

Topical Creams

Many topical creams on the market can reduce pain from arthritis. The American College of Rheumatology does recommend Capsaicin as part of a treatment plan. Capsaicin is thought to help block the release of the body’s painkillers while also blocking a chemical that transmits pain signals. Check with your physician before applying any topical creams.

Talk to your physician before taking any medications.

Injections

Cortisone

Cortisone, which is injected directly into joints, may be used to help relieve both swelling and pain. Cortisone is a naturally occurring hormone produced by the adrenal gland. It helps regulate inflammation and when injected into a joint it can relieve or reduce both swelling and pain. Relief usually occurs within a day or two of the injection. Patients do not need to change activities following injections. Many patients elect to receive cortisone injections prior to big events when they will be more active. Occasionally, a patient may experience a flare, which increases pain for a few days.

Cortisone may play a role in weakening tendons or cartilage if used too often. Therefore, most physicians limit its use to a few times per year depending on the circumstances.

Always consult your physician before participating in any treatment option.

When non-surgical treatments fail to provide adequate relief from the symptoms of arthritis, your orthopedic surgeon may recommend joint replacement. The technique of joint replacement uses implants typically made from polyethylene (plastic) and metal alloy to replace the damaged sections of bone and cartilage in the joint. The purpose of the procedure is to restore function and mobility and to provide relief from joint pain.

You must decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery

Wrist replacement surgery, also called arthroplasty, removes the damaged bone and cartilage in a joint. The bone is resurfaced with implants made from metal alloy and polyethylene (plastic) to re-create the smooth gliding surface that were once intact. The purpose of the procedure is to restore movement and decrease or eliminate pain.

Several indications for wrist replacement surgery that are not treatable by other methods include osteoarthritis, rheumatoid arthritis, bone fracture and trauma.

Benefits of Wrist Replacement

  • Eliminate or reduce pain
  • Enhance movement and mobility
  • Improve quality of life
  • Return to normal activity
  • Low-impact sports and activities

Total wrist replacement is one option available to you and your surgeon. Only your orthopedic surgeon can determine if you are a candidate for this implant or if another type of implant would better suit your unique situation.

Complications

While uncommon, complications can occur during and after surgery. Some complications include infection, implant breakage, nerve damage, and fracture. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

Preparing for Surgery

Patients should begin preoperative strengthening exercises to help them prepare for surgery and their recovery. Patients may be given a comprehensive nutrition plan to help ensure optimum health before surgery.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

After Surgery

Wrist replacement is usually performed as an outpatient procedure. Most patients will wear a splint for 14 to 30 days. During that time, most surgeons will recommend finger and gentle wrist movement

At home, it is important to continue with your exercises as your physician has instructed. It is a good idea to enlist the help of friends or family to help you once you do return home.

Recovery

Patients who have had wrist replacement surgery typically require many weeks before returning to any type of lifting or repetitive movement activities. Every person’s recovery time will vary. Your surgeon will tell you when you can return to normal everyday activities and will also tell you which activities to avoid.

You will typically not be allowed to participate in high-impact activities or contact sports. These types of activities place extreme pressure on the wrist joint, which could lead to complications.

Planning ahead and preparing for your wrist surgery can help ensure you a smooth surgery and an easier recovery.

The following recommendations can help you with this process.

  • Preparing For Wrist Surgery
  • Caring For Your New Wrist Implant
  • Caregivers Guide

Preparing for Wrist Surgery

When you and your orthopedic surgeon decide that joint replacement surgery is the best option to relieve pain and restore motion, you will begin the normal preparation for surgery. You should notify your surgeon about any of the medications you are presently taking because some medications must be stopped before surgery. All surgeries carry certain risks and possible complications. Before surgery, your surgeon will explain the possible complications. Your orthopedic surgeon may ask you to see your primary care physician to make sure that you do not have any health conditions that may complicate your surgery.

You may be asked to donate blood before your surgery. There are several options regarding blood donation and surgery, and all of these options should be explained to you.

Surgery also requires anesthesia. There may be some options regarding anesthesia and they will be explained to you. Your options will be based on your health history, the medications you presently take, and the results of your physical examination.

Your surgeon may also recommend that you start a strengthening program before surgery. The prescribed exercises are designed to help add strength and flexibility. Strengthening your muscles before surgery can assist your postoperative recovery.

After surgery your surgeon will give you a specific recovery plan that you should carefully follow. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your recovery schedule. It takes time for your joint to heal properly.

Planning ahead for your return home

  • Launder all of your dirty clothing before your surgery. Have loose, comfortable clothing set aside for your recovery time.
  • Prepare single-serving meals before your surgery. These meals can be heated quickly in a microwave and there is less to clean up.
  • Be sure to remove loose rugs and other trip hazards such as electrical cords and magazine racks from walking paths to avoid accidents or falls. If necessary, widen furniture paths to accommodate a walker or cane.
  • Place regularly used items such as remote controls, medications, and reading materials in easy-to-reach locations.
  • Un-tuck bedding to allow for easier access in and out of your bed. If your bedroom is on a second floor, it may be helpful to temporarily relocate your sleeping arrangements to the first floor. This will avoid having to climb stairs when you are not feeling your best.
  • Having some assistance after total joint replacement can also be very beneficial. Contact family members or friends ahead of time so they may make the necessary arrangements to assist in your recovery.

Caring For Your New Wrist Implant

It is important that you move properly during the first 4-8 weeks after your surgery. Do not use your surgical arm to push yourself up from a seated or lying position. You may not participate in any contact sports or lift anything heavier than one pound. Avoid placing your arm in any extreme position, such as straight out to the side or behind your body.

Continue the prescribed exercises during your entire recovery period, and talk to your doctor about developing an exercise program after you fully recover. Swimming, walking, and bicycling are excellent sources of low-impact exercise if your surgeon feels that these activities are appropriate for your individual condition.

Follow your surgeon’s check-up plan. It is common to visit with your surgeon at three, six, and nine months after surgery and annually thereafter.

Caregivers Guide

As a caregiver, your role is important for helping your friend or loved one recover from joint replacement surgery. When at home, there are a variety of things you need to know for the patient’s safety, recovery, and comfort. This information will help you with some of the many questions and concerns as you prepare to care for your joint replacement patient.

  • Home Safety and Avoiding Falls
  • Body Changes
  • Blood Thinners
  • Incision Care
  • Controlling Discomfort
  • Recognizing & Preventing Potential Complications
  • Pulmonary Embolus

Home Safety and Avoiding Falls

  • Pick up throw rugs and tack down loose carpeting. Cover slippery surfaces with carpets that are firmly anchored to the floor or that have non-skid backs.
  • Place regularly used items such as remote controls, medications, and reading materials, in easy-to-reach locations.
  • Place frequently used cooking supplies and utensils where they can be reached without too much bending or stretching.
  • Be aware of all floor hazards such as pets, small objects, or uneven surfaces.
  • Provide good lighting throughout. Install nightlights in the bathrooms, bedrooms, and hallways.
  • Keep extension cords and telephone cords out of pathways. Do NOT run wires under rugs, this is a fire hazard.
  • Do not let the patient lift heavy objects for the first three months and then only with your surgeons permission.
  • Un-tuck bedding to allow for easier access into and out of the patients bed.

Body Changes

  • The patient’s appetite may be poor. Make sure they drink plenty of fluids to keep them from getting dehydrated. Their desire for solid food should return.
  • Joint replacement patients may have difficulty sleeping, which is normal. Do not let the patient sleep or nap too much during the day.
  • The patient’s energy level will be decreased for the first month.
  • Pain medications that contain narcotics promote constipation. Follow the surgeon’s recommendations for using stool softeners or laxatives such as milk of magnesia if necessary.

Blood Thinners

Blood thinners may be given to help avoid blood clots in the patient’s legs. Always follow the surgeon’s recommendations regarding blood thinners.

Incision Care

  • Keep the incision dry.
  • Keep the incision covered with a light dry dressing until the staples or sutures are removed.
  • Patient should request showering/bathing instructions from surgeon.
  • Notify the surgeon if there is increased drainage, redness, pain, odor, or heat around the incision.
  • Take the patient’s temperature if he or she feels warm or sick. Call the surgeon if it exceeds 100.5ºF.

Changing the Dressing (ONLY IF DIRECTED BY SURGEON)

  1. Wash hands.
  2. Open all dressing materials (ABD pads, 4×4 if needed, Betadine® swab if indicated).
  3. Remove old dressing.
  4. Inspect incision for the following:
    a. increased redness
    b. increase in clear drainage
    c. yellow/green drainage
    d. odor
    e. surrounding skin is hot to touch
  5. If Betadine® is ordered, take one Betadine® swab and paint the incision from top to bottom. Then turn the swab over and paint the incision from bottom to top. Use remaining swab to paint the drain site.
  6. Pick up ABD pad by one corner and lay over incision. Be careful not to touch the inside of the dressing that will lie over the incision.
  7. Place one ABD pad lengthwise and place the other ABD crosswise to form a “T” (to cover drain site).
  8. Tape dressing in place.

Controlling Discomfort

  • Pain medicine should be taken at least 30 minutes before physical therapy.
  • Encourage patient to gradually wean him or herself from prescription pain medication. Follow the surgeon’s recommendations for taking over-the-counter medication in place of prescription pain medication.
  • Have patient change position every 45 minutes throughout the day.
  • Use ice for pain control. Applying ice to the affected joint will decrease discomfort, but do not use for more than 20 minutes at a time each hour. Use ice before and after the patient exercises according to their prescribed program. A bag of frozen peas wrapped in a kitchen towel makes an ideal ice pack. Mark the bag of peas and return them to the freezer (to be used as an ice pack later).

Recognizing & Preventing Potential Complications

Signs of Infection
  • Increased swelling and redness at incision site
  • Change in color, odor of drainage
  • Increased pain in surgical joint
  • Fever greater than 100.5º F
Blood Clots in Legs

Surgery may cause the blood to slow and coagulate in the veins of the patient’s legs, creating a blood clot. This is why patients take blood thinners after surgery. If a clot occurs despite these measures, the patient may need to be admitted to the hospital to receive intravenous blood thinners. Prompt treatment usually prevents the more serious complication of pulmonary embolus.

Signs of blood clots in leg
  • Swelling in thigh, calf or ankle that does not go down with elevation.
  • Pain, heat and tenderness in calf, back of knee or groin area. NOTE: Blood clots can form in either leg.
Prevention of blood clots
  • Foot and ankle pumps
  • Walking
  • Compression stockings
  • Blood thinners such as Coumadin® or Heparin

Pulmonary Embolus

This is an emergency, if suspected CALL 911 immediately
An unrecognized blood clot could break away from the vein and travel to the lungs.

Signs of a pulmonary embolus
  • Sudden chest pain
  • Difficult and/or rapid breathing
  • Shortness of breath
  • Sweating
  • Confusion
Prevention of pulmonary embolus
  • Prevent blood clot in legs
  • Recognize a blood clot in leg and call physician promptly

Physical Therapy and Exercises for the Wrist

You may be prescribed a number of physical therapy exercises. Physical therapy is simply an exercise program that gently stretches and strengthens specific muscles and joints. The exercises you may perform are gentle, range of motion (stretching) exercises designed to restore movement and strength to your joint and to promote blood flow for healing.

It is important to stay proactive in your physical therapy since it can have a direct impact on the total outcome of your surgery. Remember to stay diligent and don’t give up. Ask for help if you need it. Friends, family members, and even neighbors can be helpful during your recovery, especially if you ask for their assistance before your surgery.

Physical therapy is a very important role in the recovery process. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your shoulder joint. However, you should only perform the exercises that are ordered by your surgeon.

What is Arthritis?

Arthritis is a term that is defined as inflammation of a joint and used to describe over 100 different conditions that can affect the human body. Arthritis affects millions of Americans each year with symptoms including pain, stiffness, swelling, and loss of motion in affected joints.

Why does my wrist hurt?

The bones in a joint are covered with a tough, lubricating tissue called cartilage to help provide smooth, pain-free motion to the joint. As the layer of cartilage wears away, bone begins to rub against bone, causing the irritation, swelling, stiffness, and discomfort commonly associated with arthritis.

What are the benefits of joint replacement?

The purpose of a joint replacement is to help restore pain-free or near pain-free movement to a joint. Activities that could not be performed before surgery may be resumed as directed by your surgeon after total joint replacement surgery. Your orthopedic surgeon may have several patients who would be willing to speak with you about their experiences before and after total joint replacement surgery. Ask your orthopedic surgeon about this beneficial resource.

What is a wrist replacement?

Wrist replacement surgery, also called arthroplasty, removes the damaged bone and cartilage in a joint. The bone is resurfaced with implants made from metal alloy and polyethylene (plastic) to re-create the smooth gliding surface that were once intact. The purpose of the procedure is to restore movement and decrease or eliminate pain.

How long does the typical wrist implant last?

A total joint implant’s longevity will vary from patient to patient. All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition. It is important to remember that an implant is a medical device that is subject to wear, which may lead to mechanical failure. Following all of your surgeon’s recommendations after surgery may enhance longevity, there is no guarantee that your particular implant will last for any specific length of time.

Do implants fail and can they be replaced?

Since implants are mechanical devices, they are subject to conditions that can lead to mechanical failure. The most common reason for implant failure in wrist replacements is implant loosening or implant wear that leads to loosening. Implant wear particles can react with the bone, causing thinning of the bone that can lead to implant loosening. In most cases, failed implants can be revised successfully to provide good results.

What are my non-surgical options before considering joint replacement?

  • Exercise or physical therapy can strengthen the muscles around the affected joint(s), possibly providing relief from pain while improving mobility and function.
  • Medical management including nonsteroidal anti-inflammatory medications or steroid injections may assist in reducing painful joint inflammation and restoring function.

When should I have joint replacement surgery?

Your surgeon will evaluate your health history, perform a physical examination, and take x-rays to decide if you are a candidate for this surgery. You must then decide if your discomfort, pain or stiffness, and overall loss of quality of life justify undergoing surgery. Generally, there is no harm in waiting to have surgery if conservative, non-surgical treatments are effective.

Is age a consideration for joint replacement?

Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

What can I expect from the surgical procedure?

  • Operation- approximately 1 1/2 to 2 hours
  • Outpatient surgery
  • Rehabilitation-usually 3 to 4 months of regular exercise at home. This will vary with each patient and with each surgeon.

Where will my incision be?

The incision is usually made of the on the back of the wrist to gain access to the joint.

Will I notice anything different about my new wrist?

Yes, you may have some numbness on the outside of the scar. The area around the scar may feel warm. You may also notice some clicking when you move your wrist as a result of the artificial surfaces coming together

Will I notice anything different about my new shoulder?

Yes, you may have some numbness on the outside of the scar. The area around the scar may feel warm. You may also notice some clicking when you move your shoulder as a result of the artificial surfaces coming together.

Are there risks from surgery?

While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, malalignment, and premature wear. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever and factors such as the patient’s post-surgical activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimize the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up to date and may be shown how to prepare your home to avoid falls.

How can I prepare for surgery?

Proper preparation and a great attitude are the best ways to accomplish a rapid recovery from joint replacement. With the help of a physical therapist, get yourself as physically fit as you can before surgery. Proper nutrition and optimal medical condition can help avoid complications. See your physician prior to surgery to ensure your blood pressure, heart, and lungs are in good shape. Be prepared to continue with your exercise program after surgery.

What type of rehabilitation can one expect following surgery?

Exercise is necessary for proper healing. Early movement is important to prevent the muscles in the wrist from becoming tight. The types of exercises you may perform are gentle, range of motion exercises designed to help restore motion to the muscles in the shoulder. As your rehabilitation continues, you may begin strengthening exercises that are designed to restore strength to your shoulder.

A regular exercise program at home to promote strengthening and mobility will continue up to 12 months following surgery. It is important to follow your surgeon’s prescribed recovery outline. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your exercise schedule without contacting your surgeon.

What activity range can be expected after this surgical procedure?

Although wrist replacement is designed to restore motion and decrease pain, it does not return your wrist to “normal.” Like any mechanical devise, it can wear out with use. Activities like heavy lifting or manual labor can cause early wear and failure of the wrist implant. Many activities should not begin until the soft tissues around the wrist heal, which can take 3 to 6 weeks. All postoperative activities should be cleared with your surgeon.

How long until I can resume my regular activities after surgery?

Patients with total wrist replacement typically require several weeks before returning to any type of lifting or repetitive movement activities. Talk to your doctor before participating in an activity that may place excess stress or movement on your shoulder. Consult with your surgeon or therapist for advice on acceptable activities.

When will I be able to return to work?

Returning to work depends on your type of work and can be as early as 2 to 6 weeks for sedentary jobs. Returning to a job that requires significant use of the arm will usually take at least 3 months. Office workers often return in 2 to 3 weeks, while patients with more strenuous jobs may require more time away from work. The timing of your return to work depends considerably upon your commitment to recovery.

Are regular visits with your surgeon required after surgery?

The surgeon will set a follow-up schedule for the first year after surgery to evaluate your progress. Usually these follow-ups occur three, six and nine months after the surgery. Annual visits may be required thereafter. Complications can occur with implants, so seeing the surgeon when you notice a change in symptoms can assist in evaluating any changes that may occur with your new joint.

All patient education materials are provided by OrthoPatientEd.com and have been reviewed by our Advisory Board of leading Orthopedic Surgeons to ensure accuracy. All materials are provided for informational purposes only and are not intended to be a substitute for medical advice from your orthopedic surgeon. Any medical decisions should be made after consulting a qualified physician.
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