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Surgery of the Hand and Wrist

by Nancy Callinan, MA, OTR, CHT

When arthritis strikes the hands or wrists, it can change how they look, cause pain, and make it difficult for us to do things we’ve taken for granted, from opening a door to grasping a cup of coffee to working at a computer. There are numerous joints in the hand and wrist, and arthritis can affect any of them. (For more information about these joints and the makeup of the hand and wrist, see “The Hand and Wrist.”) There are also many different surgical options for each joint.

Surgery isn’t necessarily the best option in every case. Doctors usually try conservative measures first. These can help reduce pain and inflammation while slowing the rate at which the arthritis worsens. Conservative management of arthritis may include medicines, rest, exercise, heat or cold treatment, activity modification, and the use of splints. Corticosteroid injections may control symptoms that affect only one or two joints. Often these conservative methods are effective in managing arthritis. If they don’t provide adequate relief, or if the arthritis has affected the position of the fingers or wrist so that the hand can’t function well, surgery may be the answer.

Everyone is affected by arthritis differently, and the decision to proceed with surgery is a very individual one. Many factors have to be weighed, including the type of arthritis, the damage it has done, how quickly it is getting worse, the individual’s health, the individual’s activity level and job requirements, the surgical options available, and the individual’s goals.

First things first

If you are considering hand or wrist surgery, it’s a good idea to start off by finding a qualified surgeon with whom you can discuss the options available, what goals are realistic, and the expected outcome. (To find a surgeon, ask your primary-care physician or rheumatologist to make a recommendation. You can also check the Web sites listed in “For More Information.”) For some people, the main goal is pain relief. Others are more concerned with restoring lost function or with improving the hand’s appearance. In any case, the surgeon needs to understand your particular goal or goals so he or she can tell you what options might help you reach them, and whether your expectations are realistic. So that you can make the most informed decision, the surgeon should also discuss with you the possible risks and complications of any surgery. You should also understand that in many cases, the surgery won’t really be successful unless you are careful to follow an after-surgery program of therapy and splinting. You may also face restrictions on some activities for a time after surgery. It’s vital that you understand this ahead of time because if you don’t follow after-surgery recommendations, you won’t get the full benefit of the surgery. In a sense, it will have been a waste of time. The best outcome will depend on a cooperative effort between you, your surgeon, and your therapist.

Definitions of surgical terms

Several different types of surgery are used for the hand and wrist affected by arthritis.

Arthrodesis means surgical fusion, or joining together, of the joint. This is usually done to align a joint in a more cosmetically acceptable position or to position it so that it will function better. With arthrodesis, the joint is more stable and thus less painful. In most cases, the surgeon takes the cartilage and surface layer of bone from the ends of the bones to be fused and then puts a pin or wire through the joint to hold it together. New bone grows on the ends of the existing bones and fuses them. When the pin is removed several weeks later, the joint is stiff, but it is in a better position for functional use. This surgery is used for joints in which stability is more important than mobility. It is done most often in the wrist.

Arthroplasty means joint replacement. Joint replacements may be done on joints in the fingers, on the joint at the base of the thumb, or less often, on the wrist. Damaged bone at the joint is removed and, depending on the particular joint involved, is replaced with tendon tissue or with implants made of carbon, silicone, or plastic and metal.

Excision is usually the removal of a cyst or bony prominence from a finger or wrist.

Synovectomy means removal of inflamed synovial tissue from a joint. Removing the inflamed tissue can relieve the pain and swelling and possibly slow or prevent joint damage that inflammation can cause. In time, however, the diseased tissue usually grows back.

Tenosynovectomy means removal of inflamed synovial tissue from around a tendon. Inflamed tissue around a tendon, or tenosynovitis, may cause pain when the tendons try to move the fingers, and in severe cases it may actually get in the way of movement. If medicines are not effective in controlling the tenosynovitis, tenosynovectomy may be considered.

Last Reviewed on September 15, 2010

Nancy Callinan is Manager of Hand Therapy at TRIA Orthopaedic Center in Minneapolis, Minnesota.

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