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Treatment Options for Wrist Pain

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1 Treatment Options for Wrist Pain

2 Anatomy of the Wrist Complicated collection of many joints
Eight separate bones Complicated ligaments Source “Anatomy of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Notes The wrist is a collection of many joints and bones with one main purpose; to allow you to use your hands. The wrist has to be extremely mobile. At the same time, it has to provide the strength for gripping. The wrist comprises eight separate small bones called the carpal bones. These bones connect the two bones of the forearm, called the radius and the ulna, to the bones of the hand and fingers. The metacarpal bones are the long bones that lie mostly underneath the palm, and they are in turn attached to the phalanges; the bones in the fingers and thumb. The wrist is complicated because every small bone forms a joint with its neighbor. Ligaments connect all the small bones to each other, and to the radius, ulna and metacarpal bones. Source: , 2003

3 Causes of Wrist Pain Osteoarthritis (wear and tear)
Rheumatoid arthritis Injury (sprain or fracture) Damage to the cartilage Carpal tunnel Syndrome Source “Causes of Arthritis of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Notes The term arthritis means inflammation of a joint. Degenerative arthritis refers to inflammation of a joint due to wear and tear. Injury to the wrist, such as a bad sprain or fracture, can cause damage to the articular cartilage. The cartilage can also be damaged when too much pressure is exerted on the cartilage surface of a joint causing “bruising”. Initially, the surface may not appear to be any different but injury to the tissue may show up months later. Over many years, imbalance in the joint mechanics can lead to damaged cartilage. Since cartilage cannot heal itself, the joint is no longer able to compensate for the increasing damage and it begins to hurt. Source: , 2003

4 Symptoms of Wrist Arthritis
Pain During activity At rest or sleeping Swelling and tightness Squeaking or grinding sound when wrist is moved Stiffness and decreased movement Source “Symptoms of Arthritis of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Notes Pain is the main problem associated with degenerative arthritis. At first, pain is related to an activity. Usually, once the activity gets underway there is little pain, but after resting for several minutes, pain and stiffness increase. In later stages of degenerative arthritis, pain may be present even at rest and may interfere with sleep. Swelling may occur around the joint, and the joint may fill with fluid and feel tight, especially following increased activity. When all the cartilage is worn from the joint surface, the joint may squeak when moved. Doctors refer to this sound as crepitus. Degenerative arthritis will eventually affect the motion of a joint. The joint becomes stiff and loses motion. Source: , 2003

5 Diagnosing Wrist Arthritis
Physical examination Range of Motion test Medical history review X-Rays Blood tests Rheumatoid Factor C-Reactive Protein Source “Diagnosis of Arthritis of the Wrist ”. DePuy Orthopaedics, Inc. 2 April, Notes Diagnosing degenerative arthritis of the wrist begins with a patient history. Details about any previous injuries to the wrist joint are important to understanding why the condition exists. In addition, a physical examination of the wrist joint, and possibly other joints in the body, will be done. It will be important for your doctor to see how the motion of the wrist joint has been affected. The alignment of the wrist joint will also be assessed. X-rays will be taken to assess the damaged joint. This test to determine how bad the degenerative arthritis has become is usually the most important. The amount of cartilage remaining in the wrist joint can be estimated with the x-rays. If there is any question whether the arthritis may by caused by something other than degenerative arthritis, blood tests may be ordered to look for systemic diseases, such as rheumatoid arthritis. Source: , 2003

6 How Can My Life Change with Treatment?
A return to mobility Regaining a sense of your old lifestyle Reduce or eliminate pain

7 Non-Surgical Treatment Options for Wrist Pain: Over-the-Counter Medications
Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Usually first drug used to treat arthritis Can reduce pain, swelling and redness Relief can take several months Examples: ibuprofen (Advil®, Motrin®) naproxen (Aleve®) Aspirin Reduce joint pain and inflammation Form of NSAIDs. Source “Over-the-Counter Medicines can Reduce Joint Pain”. DePuy Orthopaedics, Inc. 2 April, Notes Over-the-counter (OTC) arthritis medicines can be a very important part of your comprehensive arthritis treatment plan. Over-the-counter arthritis medicines are used to reduce the swelling, redness, joint pain and inflammation. At this time, there is no known cure for arthritis. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are usually the first drug to be used to treat arthritis. These drugs reduce inflammation, but are not steroids like cortisone, consequently the name nonsteriodal anti-inflammatory. NSAIDs can reduce joint pain, swelling, tenderness and redness. NSAIDs may take several months for relief of symptoms to be noticed. Currently, the only NSAIDs that are over-the-counter are ibuprofen (Advil®, Motrin®, and others), naproxen (Aleve®), and aspirin. Aspirin: Aspirin has been used since eighteenth century England to treat arthritis. It can reduce joint pain and inflammation in arthritis sufferers. Aspirin is a form of  NSAID. Acetaminophen – Tylenol®, Datril® Extra Strength, Tempra®, and others: Acetaminophen is a painkiller and lowers fever. However, it is not an anti-inflammatory drug so it does not decrease or reduce inflammation of arthritis. Source: , 2003

8 Non-Surgical Treatment Options for Wrist Pain: Over-the-Counter Medications
Acetaminophen Reduces pain Lowers fever Does not reduce inflammation of arthritis Examples: Tylenol® Datril® Extra Strength Tempra® Source “Over-the-Counter Medicines can Reduce Joint Pain”. DePuy Orthopaedics, Inc. 2 April, Notes Over-the-counter (OTC) arthritis medicines can be a very important part of your comprehensive arthritis treatment plan. Over-the-counter arthritis medicines are used to reduce the swelling, redness, joint pain and inflammation. At this time, there is no known cure for arthritis. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs are usually the first drug to be used to treat arthritis. These drugs reduce inflammation, but are not steroids like cortisone, consequently the name nonsteriodal anti-inflammatory. NSAIDs can reduce joint pain, swelling, tenderness and redness. NSAIDs may take several months for relief of symptoms to be noticed. Currently, the only NSAIDs that are over-the-counter are ibuprofen (Advil®, Motrin®, and others), naproxen (Aleve®), and aspirin. Aspirin: Aspirin has been used since eighteenth century England to treat arthritis. It can reduce joint pain and inflammation in arthritis sufferers. Aspirin is a form of  NSAID. Acetaminophen – Tylenol®, Datril® Extra Strength, Tempra®, and others: Acetaminophen is a painkiller and lowers fever. However, it is not an anti-inflammatory drug so it does not decrease or reduce inflammation of arthritis. Source: , 2003

9 Non-Surgical Treatment Options for Wrist Pain: Prescription Medications
NSAIDS Most popular type for osteoarthritis treatment Includes ibuprofen (Motrin®), naproxen sodium (Anaprox®), oxaprozin (Daypro®), sulindac (Clinoril®) , etc. Analgesics Provide pain relief, but do not reduce inflammation Includes Acetaminophen with codeine (Tylenol® with Codeine), Oxycodone (OxyContin®, Roxicodone®), Hydrocodone with acetaminophen (Vicodin®, Dolacet®), etc. Source “Prescription Medications to Reduce Arthritis”. DePuy Orthopaedics, Inc. 2 April, Notes NSAIDs are the most popular type of prescription drug for the treatment of osteoarthritis.   Some of the NSAIDs your doctor may prescribe may include one of the following: Ibuprofen (Prescription: Motrin®; Non-prescription: Motrin IB, Advil®, Nuprin®) Naproxen (Naprosyn®, Naprelan®) Naproxen sodium (Prescription: Anaprox®; Non-prescription: Aleve®) Oxaprozin (Daypro®) Sulindac (Clinoril®) Analgesics Unlike NSAIDs, analgesics do not fight inflammation, but instead are used to provide arthritis pain relief. Acetaminophen is the most commonly used analgesic and is available without prescription. Other types of analgesics that require a prescription include: Acetaminophen with codeine (Fioricet®, Phenaphen® with Codeine, Tylenol® with Codeine) Oxycodone (OxyContin®, Roxicodone®) Hydrocodone with acetaminophen (Vicodin®, Dolacet®) Propoxyphene hydrochloride (PP-Cap®, Darvon®) Tramadol (Ultram®) Source: , 2003

10 Non-Surgical Treatment Options for Wrist Pain: Prescription Medications
Biological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (Remicade®), Etanercept (Enbrel ®) Glucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (Cortef®, Hydrocortone®), Prednisolone (Prelone®) DMARDS Treat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (Depen®), Azathioprine (Imuran®), etc. Source “Prescription Medications to Reduce Arthritis”. DePuy Orthopaedics, Inc. 2 April, Notes Biological Response Modifiers Once given as part of a second-line treatment strategy for rheumatoid arthritis, biological response modifiers are now being used earlier in treatment. These drugs may postpone structural injury in the joints of rheumatoid arthritis patients. Unlike traditional drugs, these biologic agents target the specific area of the immune system that is a factor in the progression of the disease. Etanercept (Enbrel®) Infliximab (Remicade®) Glucocorticoids or Corticosteroids For over 50 years, glucocorticoids have been used to treat rheumatoid arthritis and other types of arthritis.  Glucocorticoids are hormones that fight inflammation and are similar to the naturally occurring hormones in our body. These drugs are available in many forms including pills and injections. Because there are serious side effects to high dosages and long term usage, doctors are now using lower doses to treat inflammation and joint damage. Cortisone Hydrocortisone (Cortef®, Hydrocortone®) Methylprednisolone (Medrol®) Prednisolone (Prelone®) Prednisone (Deltasone®, Orasone®, Prednicen-M®, Sterapred®) Triamcinolone (Aristocort®) DMARDs Over time, DMARDs slow joint destruction in people with rheumatoid arthritis. The effects of DMARDs are generally slow and can take several months to make a difference. Experts are now prescribing DMARDs earlier in the treatment of rheumatoid arthritis and are often using a combination of two or three drugs. Methotrexate is one of the most widely used DMARDs on the market and has been used for over twenty years. Approximately half of all people with rheumatoid arthritis are taking methotrexate®. Other DMARDs include: Injectable gold Penicillamine (Depen®) Azathioprine (Imuran®) Chloroquine Hydroxychloroquine (Plaquenil®) Sulfasalazine (Azulfidine®)   Side Effects Every drug has possible side effects. Be sure to talk with your doctor about possible side effects before taking a new medication. If you notice a side effect, contact your doctor immediately to discuss whether or not you should continue to take that medication. Your doctor may change your medication or reduce the amount of the drug you are taking. Only your doctor will be able to advise you on the best possible course of treatment. Source: , 2003

11 Non-Surgical Treatment Options for Wrist Pain
Cortisone Injections A powerful anti-inflammatory medication Temporary pain relief and usually lasts several weeks to months There is a small risk of infection Activity Modification Assistive Devices to help with: Writing Cooking Bathing Getting Dressed Source “Treating Arthritis of the Wrist”. DePuy Orthopaedics, Inc. 2 April, Notes Cortisone is a very powerful anti-inflammatory medication. When injected into the joint, cortisone can help relieve the pain. Pain relief is temporary and usually only lasts several weeks to months. There is a small risk of infection with cortisone injections. Arthritis pain and stiffness in the wrists can make it difficult to carry out many activities of your daily life. Fortunately, there are many assistive devices designed to help you with your daily tasks. Assistive Devises Writing There are many assistive devices that hold your pencil or pen to help ease your wrist arthritis pain. You may also wish to try roller-ball pens since they move easier on paper than pencils or ballpoint pens. Instead of writing checks each month, you may want to set up online checking with your bank. You may also be able to order large-sized checks from your bank to make writing easier.  If you use a computer, you need to have a wrist and hand rest attachment for your keyboard. Phoning A large keypad requires less effort to punch in the numbers. In addition, speaker phones can allow you to hold a conversation without having to hold the phone next to your ear. Head set phones can also help out. Getting Dressed Many companies offer clothing for people who have physical challenges. Instead of having buttons or zippers, these clothes come with Velcro®. You can also purchase dressing aids such as buttoners and unbuttoners, zipper openers, and sock or shoe aids. There are also elastic shoelaces that allow you to take your shoes on and off without unlacing them. Cooking You will find there are many catalogs that sell assistive devices to help with cooking, eating and drinking. An electric can opener is a basic for the kitchen and you may wish to consider a bottle opener. Using lightweight dishes and pots and pans will put less stress on your hands and wrist. Use knives that are intended to reduce the strain on your hands by letting you use your entire arm when preparing foods. Bathing You may wish to install an automatic faucet with a sensor that dispenses water at a predetermined temperature. You can install wrist blades to help you turn the faucets. Wrist blades are wider handles that allow you to turn the faucet by pushing with your wrist, forearm or hand. Source: , 2003

12 Surgical Options for Wrist Pain
Wrist joint fusion Synovectomy Arthroscopy Wrist replacement Source “Arthritis and Your Joints: Wrist ”. DePuy Orthopaedics, Inc. 2 April, Source: , 2003

13 Wrist Fusion Surgery Fuse the bones of the joint to grow together.
Candidates require strength more than flexibility. Results in: Strong joint Elimination of pain Immobile elbow (no range of motion) Source “Wrist Joint Fusion ”. DePuy Orthopaedics, Inc. 2 April, Notes Wrist fusion or arthrodesis eliminates pain by allowing the bones that make up the joint to grow together, or fuse, into one solid bone. The procedure involves a trade-off; it reduces pain, but also reduces the patient’s ability to move the joint. Fusions were very common before the invention of artificial implants in other joints and they are still very commonly used in the wrist. With a fusion, the hand can still be turned palm up and palm down by rotating the forearm, but the wrist itself will not bend. While range of motion is limited, strength is preserved and pain can be reduced significantly. Regaining strength is especially important to young people who work with their hands doing labor-intensive activities. These patients need strength more than flexibility. The wrist fusion reduces pain and gives them a strong wrist that is good for gripping. Patients who need more movement than strength should consider another type of operation, such as an artificial wrist joint replacement. Source: , 2003

14 Wrist Fusion Surgery Incision is made.
Cartilage on each side of the joint is removed. A bone graft is sometimes needed. Bones are held together to fuse. Incision is closed. Arm is placed in a large splint or cast. Source “Wrist Joint Fusion ”. DePuy Orthopaedics, Inc. 2 April, Notes Procedure A wrist fusion begins by making an incision down the back of the wrist. Since most of the blood vessels and nerves are on the other side of the wrist, this helps prevent damage to these structures. Most wrist-fusion operations use bone graft taken from the pelvic bone to help the wrist bones grow or fuse together, which requires incisions on the back of the wrist and a small incision over the pelvic bone. Next, the tendons and ligaments on the back of the wrist joint are moved to the side to allow visibility of all the bones and joints of the wrist. The cartilage surface of each joint that is to be fused is removed, leaving many small bones with some space between them where the cartilage has been removed. The bone graft that has been taken from the pelvis is placed between each of the bones. The metal plate is attached with metal screws to hold the bones in the proper alignment without moving while the bones grow together and fuse. The metal plate is not removed unless it causes problems. At the end of the operation, the incisions are sutured together and the arm is placed in a large splint or cast. Source: , 2003

15 Wrist Fusion Surgery Benefits of wrist fusions
Durable and strong Eliminates pain of arthritis Disadvantages of wrist fusions Immobile joint; no range of motion Forces remaining joints to move more Source “Wrist Joint Fusion ”. DePuy Orthopaedics, Inc. 2 April, Notes Procedure Wrist fusion or arthrodesis eliminates pain by allowing the bones that make up the joint to grow together, or fuse, into one solid bone. The procedure involves a trade-off; it reduces pain, but also reduces the patient’s ability to move the joint. Fusions were very common before the invention of artificial implants in other joints and they are still very commonly used in the wrist. With a fusion, the hand can still be turned palm up and palm down by rotating the forearm, but the wrist itself will not bend. While range of motion is limited, strength is preserved and pain can be reduced significantly. Regaining strength is especially important to young people who work with their hands doing labor-intensive activities. These patients need strength more than flexibility. The wrist fusion reduces pain and gives them a strong wrist that is good for gripping. Patients who need more movement than strength should consider another type of operation, such as an artificial wrist joint replacement. Source: , 2003

16 Synovectomy Early stages of rheumatoid arthritis.
Removes inflamed tissue lining. Potentially saves joint from further damage. Source “Synovectomy: a Surgery for Rheumatoid Arthritis Pain ”. DePuy Orthopaedics, Inc. 2 April, Notes One of the surgical procedures available for rheumatoid arthritis is a synovectomy. Mostly used in the early stages of rheumatoid arthritis, a synovectomy removes inflamed lining tissue (synovium) from inside the affected joint. Most commonly, this procedure is used on knees, but it can be used on other joints such as the shoulder, wrist and elbow. One of the benefits of this surgery is that it can alleviate rheumatoid arthritis pain in the joints by removing diseased tissue. The joint itself may also be saved from further damage. The synovium could grow back over time. However, this isn’t a permanent solution in most cases.  Be sure to discuss with your doctor the benefits and disadvantages of this surgery in your particular case. Source: , 2003

17 Synovectomy Small incision is made.
Arthroscope is used to inspect the joint. Diseased synovium is removed. Sling may be required. Physical therapy usually required. Source “Synovectomy: a Surgery for Rheumatoid Arthritis Pain ”. DePuy Orthopaedics, Inc. 2 April, Notes You will be given either a local or general anesthetic depending on your situation and your doctor’s advice. In many cases, you may be able to go home the same day or you may stay in the hospital for one to two days. The surgeon will enter the joint through a small incision with an arthroscope, a narrow tube with a light at the end of it that is connected to a television. The arthroscope allows the doctor to see inside the joint to remove the diseased tissue. The surgeon’s team may pump a sterile saline solution into the joint in order to clean it. Air may also be pumped in to expand the joint space, allowing the surgeon to see easily inside of the joint. Source: , 2003

18 Synovectomy Benefits Disadvantages
Alleviates rheumatoid arthritis pain in the joint Joint may be saved from further damage. Synovium could grow back over time Disadvantages Not a permanent solution Source “Synovectomy: a Surgery for Rheumatoid Arthritis Pain ”. DePuy Orthopaedics, Inc. 2 April, Notes If medication, exercise and physical therapy fail to greatly alleviate rheumatoid arthritis pain, you and your doctor may start to consider surgery. One of the surgical procedures available for rheumatoid arthritis is a synovectomy. Mostly used in the early stages of rheumatoid arthritis, a synovectomy removes inflamed lining tissue (synovium) from inside the affected joint. Most commonly, this procedure is used on knees, but it can be used on other joints such as the shoulder, wrist and elbow. One of the benefits of this surgery is that it can alleviate rheumatoid arthritis pain in the joints by removing diseased tissue. The joint itself may also be saved from further damage. The synovium could grow back over time. However, this isn’t a permanent solution in most cases.  Be sure to discuss with your doctor the benefits and disadvantages of this surgery in your particular case. Source: , 2003

19 Arthroscopic Surgery Can be used to treat several conditions, including: Chronic wrist pain Wrist fractures Ganglion cysts Ligament/TFCC tears Carpal tunnel release Source “Wrist Arthroscopy”. American Academy of Orthopaedic Surgeons. 2 April, Notes Several conditions can be treated using arthroscopic surgery, including chronic wrist pain, wrist fractures, ganglion cysts and tears in the ligaments or the triangular fibrocartilage complex (TFCC). Source: 2003

20 Arthroscopic Surgery Small camera is inserted into the wrist to see inside your joint. Use small instruments to remove any debris and smooth cartilage surfaces. Source “Wrist Arthroscopy”. American Academy of Orthopaedic Surgeons. 2 April, Notes Arthroscopy (ar-THROS-ka-pea) is an outpatient surgical procedure used by orthopaedic surgeons to diagnose and treat problems inside a joint. The surgeon makes small incisions, less than half an inch long, and inserts a pencil-sized instrument called an arthroscope. The arthroscope contains a small lens, a miniature camera and a lighting system. This projects three-dimensional images of the joint on a television monitor, enabling the surgeon to look directly inside the joint and identify the trouble. Tiny probes, forceps, knives and shavers can then be used to correct many problems at the same time. Several conditions can be treated using arthroscopic surgery, including chronic wrist pain, wrist fractures, ganglion cysts and tears in the ligaments or the triangular fibrocartilage complex (TFCC). Source: 2003

21 Arthroscopic Surgery Benefits
Outpatient surgery Minimal invasive May reduce recovery time Disadvantages (common risks with all surgeries) May include infection, nerve injuries, excessive swelling or bleeding, scarring or tendon tearing. Source “Wrist Arthroscopy”. American Academy of Orthopaedic Surgeons. 2 April, Notes Arthroscopy (ar-THROS-ka-pea) is an outpatient surgical procedure used by orthopaedic surgeons to diagnose and treat problems inside a joint. The surgeon makes small incisions, less than half an inch long, and inserts a pencil-sized instrument called an arthroscope. The arthroscope contains a small lens, a miniature camera and a lighting system. This projects three-dimensional images of the joint on a television monitor, enabling the surgeon to look directly inside the joint and identify the trouble. Tiny probes, forceps, knives and shavers can then be used to correct many problems at the same time. Several conditions can be treated using arthroscopic surgery, including chronic wrist pain, wrist fractures, ganglion cysts and tears in the ligaments or the triangular fibrocartilage complex (TFCC). Source: 2003

22 Wrist Replacement Surgery
Replaces diseased bone Results Moveable wrist joint Elimination of pain

23 When is Wrist Replacement Surgery Right for You?
Experience significant pain despite non-surgical treatments. Hand function and mobility decreases.

24 Total Wrist Replacement Components
A total wrist replacement implant consist of: Ellipsoid head Offset radial stem anchoring the implant to your forearm. Elongated radial tray Trapezoid fixation stem adding stability. Source “Wrist Joint Replacement Components”. DePuy Orthopaedics, Inc. 2 April, Notes A total wrist replacement implant consists of: An ellipsoid head, which simulates the curvature of the patient's natural joint to allow for a functional range of motion, allowing the patient to flex and extend the wrist and move it side-to-side. An offset radial stem. This stem anchors the implant in your forearm. The special shape of this component is designed to enhance the function of the tendons used to extend the wrist and to produce optimum stability of the implant, which is crucial to long-term success. An elongated radial tray surface with a molded bearing made of plastic (polyethylene). This component is crucial to "load sharing," distributing forces over the entire surface of the implant. Load sharing is vital to the success of orthopaedic implants. A trapezoid fixation stem. This component is secured to the patient's bone to add stability as well as eliminating rotation of the implant within the bone. A curved metacarpal stem. This component is shaped to accommodate the natural curvature of the medullary canal to secure the wrist implant within the hand. Source: 2003

25 Benefits to Patient from Surgery
Return to Mobility Restore their lifestyle Freedom

26 Total Wrist Replacement
Under 300 total wrist replacements estimated for 2003. *Copyright 2002 by Solucient LLC

27 Surgical Procedure Incision is made.
The tendons are moved out of the way. A portion of the carpal bones and end of radius and ulna are removed from the wrist. Source “Wrist Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, Notes The operation to replace an arthritic wrist begins with an incision through the skin on the back of the wrist. The surgeon can then move the tendons extending over the back of the wrist out of the way. This allows the surgeon to access the joint capsule on the back of the wrist joint, which is then opened to expose the wrist joint surfaces. A portion of the carpal bones and the end of the radius and ulna are then removed from the wrist to make room for the new artificial wrist joint. The bones of the hand and the radius bone of the forearm are prepared using special instruments that form holes in the bones to fit the stems of the artificial joint components. Next the components are inserted into the holes. Once the proper fit is obtained, the surgeon will test the range of motion of the joint to ensure that it moves correctly. Once satisfied with the fit, the surgeon cements the two sides of the joint into place. The tendons are placed back into their proper position and the wound is closed. Following surgery, patients are placed into a bulky bandage and a splint. A small plastic tube may be used to drain any blood that gathers under the incision to prevent excessive swelling from the blood. (This is sometimes referred to as a hematoma.) This plastic drain will probably be removed within 24 hours. Source: 2003

28 Surgical Procedure Components are inserted and cemented into place.
Tendons are placed back and wound is closed. A dressing or splint is usually worn. Source “Wrist Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, Notes The bones of the hand and the radius bone of the forearm are prepared using special instruments that form holes in the bones to fit the stems of the artificial joint components. Next the components are inserted into the holes. Once the proper fit is obtained, the surgeon will test the range of motion of the joint to ensure that it moves correctly. Once satisfied with the fit, the surgeon cements the two sides of the joint into place. The tendons are placed back into their proper position and the wound is closed. Following surgery, patients are placed into a bulky bandage and a splint. A small plastic tube may be used to drain any blood that gathers under the incision to prevent excessive swelling from the blood. (This is sometimes referred to as a hematoma.) This plastic drain will probably be removed within 24 hours. Source: 2003

29 Preparing for Joint Replacement Surgery
Ease anxiety by mentally preparing with: Breathing exercises Meditation Talking with friends and family Learn more about wrist replacement surgery Brochures Handouts Websites Videos Source “Preparing Your Mind Before Joint Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, Notes Several kinds of relaxation techniques may be helpful for joint replacement surgery patients. These include: Breathing exercises—Using awareness and conscious control over breathing to bring about relaxation. Meditation—Relaxing the body and calming the mind by focusing on a repeated word or sound. Patient Education Before Joint Replacement Surgery Another helpful tool is simply learning more about what to expect before and after joint replacement surgery. You may feel tense, have trouble concentrating, or develop unexplained physical symptoms, such as a pounding heart, chest pain, an upset stomach, or constant tiredness. Such people might benefit from learning new ways to relax before their surgery. On the other hand, certain joint replacement patients may tend to intellectualize this event. This type of patient is always looking for information on the Web, in books and magazines, and on television, they really want to know all the nitty-gritty details about their upcoming surgery. This type of patient feels reassured by focusing much of their energy into gathering information. Whichever type of patient you tend to be, your best pre-op prep plan should consist of both relaxation techniques and patient education. This well-rounded strategy will help you deal with the anxiety related to joint replacement surgery and the recovery process. Source: 2003

30 The Night Before Surgery
Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.) Do not consume any food or liquid after midnight. Make sure you have everything you’ll need at the hospital. Ask any questions you may have before surgery. Source “The Night Before Joint Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, Notes Be sure to take all of your normal medications unless the doctor has instructed you not to take certain medications. Medications such as "blood thinners" (coumadin, aspirin, ibuprofen and the other anti- inflammatory medications) may cause a greater blood loss. Your doctor has probably already had you stop taking these medications. Ask to make sure! You can eat about anything you wish the night before surgery. You can eat solid food until midnight. After midnight, you should not eat or drink anything unless your doctor has told you otherwise. This means nothing - not coffee, not water, not ice chips. Make sure you have everything you'll need at the hospital, that all of your questions are answered and that you have your advanced directives available if you wish. Source: 2003

31 After Surgery Pain medication for any discomfort.
Elevate hand above heart for several days. May schedule a follow-up exam within seven days. Can be done as an outpatient surgery if there are no other procedures needed. Source “Wrist Replacement Surgery”. American Academy of Orthopaedic Surgeons. 2 April, Notes A wrist joint replacement can be done as an outpatient procedure, unlike a hip or knee replacement. Wrist replacement surgery is often combined with other procedures to correct deformities or disorders in the tendons, nerves, and small joints of the fingers and thumb. You will have to wear a cast for the first several weeks. When the cast is removed, you will have to wear a protective splint for the next six to eight weeks. Although pain relief is immediate, you will have to do gradual exercises for several weeks to restore movement and, eventually, to increase power and endurance. Wrist arthroplasty can improve motion to about 50 percent of normal. The physical demands that you place on the wrist prosthesis will have an effect on how long the implant lasts. You will not be able to use a hammer often or pneumatic tools. You may only be able to lift a limited amount of weight. A fall on the outstretched hand may break the prosthesis, just as it might fracture a normal wrist. So you will want to avoid activities such as roller sports that could result in a fall. Source: 2003

32 A Caregiver’s Role Provide support and show patience
Help with needs that the patient can not do, like: Meal preparation Feeding Writing Dressing Source “Caregiver’s Roles and Responsibilities”. DePuy Orthopaedics, Inc. 2 April, Notes This volunteer must be resilient, as duties for this position as the caregiver to a joint replacement patient include (but are not limited to): Helping patient stand, sit, lie down, and move from room to room and place to place; Providing help with bathing/grooming, dressing, feeding, and using the bathroom; Doing (or arranging for) the shopping, cleaning, cooking, laundry and errand-running; Keeping track of medical appointments and providing transportation to and from the hospital, the surgeon’s office, the physical therapist’s, and to any other appointments; Picking up prescriptions or manage delivery of prescriptions; Administering medications, changing dressings, keeping track of assistive devices (cane, walker, crutches, etc); Communicating with the healthcare team about any changes or concerns; Managing finances, including paying regular household bills and handling the patient’s insurance paperwork. Source: 2003

33 Recovery in the First Week
Follow surgeon’s instructions on proper rehabilitation. While the wrist heals, do not pick up heavy objects. See physician on what activities are permitted. Source “Rehabilitation Timeline After Wrist Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, Notes Your First Day at Home As with most surgeries, you will probably not be feeling well for the first day or two after returning home. You should arrange to have someone available to help you with many of the things you could normally do for yourself. You will probably need someone to cook and help you move around. While the wrist heals, you will not be able to pick up heavy objects. Ask your surgeon what types of activities are acceptable. Source: 2003

34 Recovery in the First Month
At two weeks, cast and splint removed with a short arm cast for another two weeks. Continued use of medication, with need tapering off as area heals. At one month, a splint will be worn during exercises and at night. Source “Rehabilitation Timeline After Wrist Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, Notes What You Can Expect in the First Month At about two weeks after surgery, your cast and splint will be removed and replaced with a short arm cast. You will then remain in the short cast for another two weeks. A physical or occupational therapist will help you plan your exercise program. The first meetings will focus on controlling the pain and swelling of surgery. It may include heat, massage, compressive dressings and other treatments. You will probably need to continue using the pain medication, although it should taper off as the area heals. It is usually suggested that you take drugs for pain about 30 minutes or so before you do your physical therapy. This helps you do more therapy and get better quicker. Source: 2003

35 Recovery After Six Weeks
Passive exercises begin to maximize the motion of the new wrist. At two months, exercises started to strengthen the muscles. Begin most of your normal activities at three months. Source “Rehabilitation Timeline After Wrist Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, Notes Six Weeks after Surgery and Beyond In the sixth week, passive exercises will begin in an effort to maximize the recovery of the motion of your new wrist. Use of the splint may be reduced as the rehabilitation program proceeds. If you have a cast instead of a splint, it may be removed at this time. At two months, exercises will be started to strengthen the muscles of the wrist and hand. At three months, you may begin most of your normal activities. X-rays may be taken to see how well you are healing. It is very important to follow the instructions of your surgeon and physical therapist during this time. If you do too much too soon you will have unneeded pain or you may cause the new wrist to loosen. If you don't do enough, the wrist may stiffen up and you won't get the full benefit of the operation. Long term, the demands you place on your new wrist will have an effect on how long it lasts. You will not be able to use a hammer, pneumatic tools or use other things that will cause an impact to be sent through the new wrist. Since a fall on the outstretched hand might break the new wrist, try to avoid activities such as roller-skating that could cause you to fall. Also be extra careful in slippery conditions such as wet or icy sidewalks. Source: 2003

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