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Surgery of the Hand and Wrist

by Nancy Callinan, MA, OTR, CHT

Arthritis of the wrist

The ulna, the long forearm bone that joins the wrist at the little finger side of the hand, has a knob-like bony prominence on its wrist end. Sometimes, this knob becomes enlarged, causing pain when the tendons glide over it. Sometimes, the tendons may even rupture or tear, worn down by the constant friction. Excision surgery is used to correct it. During surgery, the surgeon smooths the enlarged bone and covers the area with a layer of soft tissue taken from the joint capsule or a ligament so that the tendon won’t wear down.

When the wrist is unstable or painful, arthrodesis helps to stabilize it. Arthrodesis is an effective alternative to arthroplasty at the wrist, but it does result in loss of wrist motion. How much wrist motion is lost depends on how many bones need to be fused. Usually, two of the small wrist (carpal) bones are fused to the radius, the long bone of the forearm that attaches to the thumb side of the hand. If you have this surgery, your surgeon may use bone taken from another part of your body to help promote healing and new bone growth so that the carpals will fuse. After surgery, your wrist will be immobilized in a splint or cast for up to 10 weeks. You may retain 25% to 50% of normal wrist motion following arthrodesis.

After surgery

You may feel pain after your surgery. Be sure to take any pain medicine recommended by your physician. Sometimes, after-surgery swelling can contribute to pain, but you can minimize swelling by propping your hand up above your heart whenever possible for the first two days. You can also use a cold pack to reduce swelling and pain. If swelling persists, your surgeon may recommend a compressive wrap or glove. It is important to keep the surgical incision clean and dry, so you may need to put a plastic bag over your hand for showering and bathing. Follow the recommendations of your surgeon or therapist regarding moving your hand after surgery.

Planning ahead

You depend on your hands every day for numerous tasks, so the restrictions in hand use that occur after surgery can significantly affect your independence. If you are planning to have hand or wrist surgery, here are a few things you can do ahead of time to make life easier when you can only use one hand:

• Ask family or friends to help you after surgery.
• If you are the cook in the family, prepare meals ahead of time and freeze them, or purchase easily prepared items.
• Collect bags to use in the shower. The bags that the newspaper comes in are a perfect size for protecting your hand and its splint or cast during bathing for the first few days after surgery.
• Make sure all packages are easy to open. Transfer pills to containers that you can open with one hand. Use toothpaste that comes in a pump or with a flip-top lid.
• Ask your surgeon how soon you can use your hand following surgery. Inquire about driving and returning to work also.
• Plan to wear clothing that will be easy to put on and take off. Avoid tight clothing and clothes that fasten in the back. Loose shirts and pants with elastic or drawstrings work well.
• If you use a cane, crutches, or a walker, you may need to make some modifications. In some cases, you can add a platform to crutches or a walker to reduce any stress on the operated hand. Ask your surgeon about possible modifications — what they might be and who can help you with them.

With careful planning, a qualified surgeon, and attention to proper after-surgery care and therapy, you could be on the way to some wonderful changes in your life.

Last Reviewed on September 15, 2010

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

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