Hand and Wrist Surgery
Wrist and finger replacements, fusions, carpal tunnel release and other surgeries for hands and wrists.
If the hands are injured or arthritis in the fingers or wrists leads to deformity and/ or interferes with function, surgery may be an option – or a necessity. Here are some of the most commonly performed arthritis-related hand and wrist surgeries.
Wrist fusion. This procedure involves surgically removing the surfaces of the joints affected by arthritis and joining the bones with plates and screws until they grow together, or fuse. If the entire wrist is not involved, the surgeon may perform a partial fusion, in which the joints that are not damaged are preserved, allowing some movement of the joint. For more extensive arthritis, the surgeon may fuse the entire wrist, which leaves the wrist rigid and immobile, but usually free of pain.
Wrist replacement. Unlike hip or knee replacement, wrist replacement can be performed on an outpatient basis. To replace a wrist, the surgeon makes an incision on the back of the wrist and cuts away the damaged joint surfaces of the ulna, the radius and in some cases the first row of carpal bones. The surgeon then inserts a metal prosthesis into the center of the radius, which is held in place with cement. Depending on the prosthesis design, the carpal component of the artificial joint may be inserted in the center bone of the hand (the third metacarpal) or screwed into the remaining row of carpal bones. This part of the prosthesis is also cemented in place. A polyethylene spacer is inserted between the two metal components, and the carpal bones may be fused together to hold the prosthesis. Unlike wrist fusion, wrist replacement can allow movement of the wrist; however, it is not appropriate for people who put heavy demands on their wrists.
Finger joint fusion. Similarly to wrist, certain joints of the fingers can be fused to ease pain and correct deformity. The most commonly fused finger joint is the distal phalangeal joint (DP), the joint closest to the nail.
Finger and thumb joint replacement. For the proximal and metacarpophalangeal joints (MCPs) where mobility is more important, joint replacement is possible. For pain and deformity in the MCP joints a doctor often uses flexible silicone implants. A doctor may also replace the basal joint, the joint at the base of the thumb.
Carpal tunnel release. In this procedure, the surgeon releases, or cuts free, the carpal ligament from the median nerve to relieve the symptoms of carpal tunnel syndrome. Traditionally this has been done through an open surgical procedure, meaning the wrist was opened. In recent years, surgeons have used two less invasive approaches to carpal tunnel surgery:
- The mini open approach, which involves a smaller incision, a shorter recovery time and possibly a lower risk of complications than the traditional procedure.
- The endoscopic approach, which involves making small incisions in the palm and wrist and inserting one or two camera-equipped tubes called endoscopes to view the inside of the wrist on a monitor. Guided by the image on the monitor, the doctor inserts small tools into the tubes and through the incisions to perform the procedure. For some people this approach involves less pain and a shorter recovery time than traditional carpal tunnel release.
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