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Treatment Options for Wrist Pain. Anatomy of the Wrist Complicated collection of many joints Complicated collection of many joints Eight separate bones.

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Presentation on theme: "Treatment Options for Wrist Pain. Anatomy of the Wrist Complicated collection of many joints Complicated collection of many joints Eight separate bones."— Presentation transcript:

1 Treatment Options for Wrist Pain

2 Anatomy of the Wrist Complicated collection of many joints Complicated collection of many joints Eight separate bones Eight separate bones Complicated ligaments Complicated ligaments Source: 2003www.AllAboutArthritis.com

3 Causes of Wrist Pain Osteoarthritis (wear and tear) Osteoarthritis (wear and tear) Rheumatoid arthritis Rheumatoid arthritis Injury (sprain or fracture) Injury (sprain or fracture) Damage to the cartilage Damage to the cartilage Carpal tunnel Syndrome Carpal tunnel Syndrome Source: 2003www.AllAboutArthritis.com

4 Symptoms of Wrist Arthritis Pain Pain During activity During activity At rest or sleeping At rest or sleeping Swelling and tightness Swelling and tightness Squeaking or grinding sound when wrist is moved Squeaking or grinding sound when wrist is moved Stiffness and decreased movement Stiffness and decreased movement Source: 2003www.AllAboutArthritis.com

5 Diagnosing Wrist Arthritis Physical examination Physical examination Range of Motion test Range of Motion test Medical history review Medical history review X-Rays X-Rays Blood tests Blood tests Rheumatoid Factor Rheumatoid Factor C-Reactive Protein C-Reactive Protein Source: 2003www.AllAboutArthritis.com

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

7 Non-Surgical Treatment Options for Wrist Pain: Over-the-Counter Medications Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Usually first drug used to treat arthritis Usually first drug used to treat arthritis Can reduce pain, swelling and redness Can reduce pain, swelling and redness Relief can take several months Relief can take several months Examples: Examples: ibuprofen ( Advil®, Motrin®) ibuprofen ( Advil®, Motrin®) naproxen ( Aleve®) naproxen ( Aleve®) Aspirin Aspirin Reduce joint pain and inflammation Reduce joint pain and inflammation Form of NSAIDs. Form of NSAIDs. Source: 2003www.AllAboutArthritis.com

8 Non-Surgical Treatment Options for Wrist Pain: Over-the-Counter Medications Acetaminophen Reduces pain Reduces pain Lowers fever Lowers fever Does not reduce inflammation of arthritis Does not reduce inflammation of arthritis Examples: Examples: Tylenol ® Tylenol ® Datril ® Extra Strength Datril ® Extra Strength Tempra ® Tempra ® Source: 2003www.AllAboutArthritis.com

9 Non-Surgical Treatment Options for Wrist Pain: Prescription Medications NSAIDS NSAIDS Most popular type for osteoarthritis treatment Most popular type for osteoarthritis treatment Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Analgesics Analgesics Provide pain relief, but do not reduce inflammation Provide pain relief, but do not reduce inflammation Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Source: 2003www.AllAboutArthritis.com

10 Non-Surgical Treatment Options for Wrist Pain: Prescription Medications Biological Response Modifiers Biological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the joints Treat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® ) Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® )Remicade ® Remicade ® Glucocorticoids or Corticosteroids Glucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammation Treat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) DMARDS DMARDS Treat rheumatoid arthritis; slow joint destruction Treat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Source: www. AllAboutArthritis.com, 2003www. AllAboutArthritis.com

11 Non-Surgical Treatment Options for Wrist Pain Cortisone Injections Cortisone Injections A powerful anti-inflammatory medication A powerful anti-inflammatory medication Temporary pain relief and usually lasts several weeks to months Temporary pain relief and usually lasts several weeks to months There is a small risk of infection There is a small risk of infection Activity Modification Activity Modification Assistive Devices to help with: Assistive Devices to help with: Writing Writing Cooking Cooking Bathing Bathing Getting Dressed Getting Dressed Source: 2003www.AllAboutArthritis.com

12 Surgical Options for Wrist Pain Wrist joint fusion Wrist joint fusion Synovectomy Synovectomy Arthroscopy Arthroscopy Wrist replacement Wrist replacement Source: 2003www.AllAboutArthritis.com

13 Wrist Fusion Surgery Fuse the bones of the joint to grow together. Fuse the bones of the joint to grow together. Candidates require strength more than flexibility. Candidates require strength more than flexibility. Results in: Results in: Strong joint Strong joint Elimination of pain Elimination of pain Immobile elbow (no range of motion) Immobile elbow (no range of motion) Source: 2003www.AllAboutArthritis.com

14 Wrist Fusion Surgery Incision is made. Incision is made. Cartilage on each side of the joint is removed. Cartilage on each side of the joint is removed. A bone graft is sometimes needed. A bone graft is sometimes needed. Bones are held together to fuse. Bones are held together to fuse. Incision is closed. Incision is closed. Arm is placed in a large splint or cast. Arm is placed in a large splint or cast. Source: 2003www.AllAboutArthritis.com

15 Wrist Fusion Surgery Benefits of wrist fusions Durable and strong Durable and strong Eliminates pain of arthritis Eliminates pain of arthritis Disadvantages of wrist fusions Immobile joint; no range of motion Immobile joint; no range of motion Forces remaining joints to move more Forces remaining joints to move more Source: 2003www.AllAboutArthritis.com

16 Synovectomy Early stages of rheumatoid arthritis. Early stages of rheumatoid arthritis. Removes inflamed tissue lining. Removes inflamed tissue lining. Potentially saves joint from further damage. Potentially saves joint from further damage. Source: 2003www.AllAboutArthritis.com

17 Synovectomy Small incision is made. Small incision is made. Arthroscope is used to inspect the joint. Arthroscope is used to inspect the joint. Diseased synovium is removed. Diseased synovium is removed. Sling may be required. Sling may be required. Physical therapy usually required. Physical therapy usually required. Source: 2003www.AllAboutArthritis.com

18 Synovectomy Benefits Alleviates rheumatoid arthritis pain in the joint Alleviates rheumatoid arthritis pain in the joint Joint may be saved from further damage. Joint may be saved from further damage. Synovium could grow back over time Synovium could grow back over timeDisadvantages Not a permanent solution Not a permanent solution Source: 2003www.AllAboutArthritis.com

19 Arthroscopic Surgery Can be used to treat several conditions, including: Can be used to treat several conditions, including: Chronic wrist pain Chronic wrist pain Wrist fractures Wrist fractures Ganglion cysts Ganglion cysts Ligament/TFCC tears Ligament/TFCC tears Carpal tunnel release Carpal tunnel release Source: 2003www.AAOS.org

20 Arthroscopic Surgery Small camera is inserted into the wrist to see inside your joint. Small camera is inserted into the wrist to see inside your joint. Use small instruments to remove any debris and smooth cartilage surfaces. Use small instruments to remove any debris and smooth cartilage surfaces. Source: 2003www.AAOS.org

21 Arthroscopic Surgery Benefits Outpatient surgery Outpatient surgery Minimal invasive Minimal invasive May reduce recovery time May reduce recovery time Disadvantages (common risks with all surgeries) May include infection, nerve injuries, excessive swelling or bleeding, scarring or tendon tearing. May include infection, nerve injuries, excessive swelling or bleeding, scarring or tendon tearing. Source: 2003www.AAOS.org

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

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

24 Total Wrist Replacement Components A total wrist replacement implant consist of: A total wrist replacement implant consist of: Ellipsoid head Ellipsoid head Offset radial stem anchoring the implant to your forearm. Offset radial stem anchoring the implant to your forearm. Elongated radial tray Elongated radial tray Trapezoid fixation stem adding stability. Trapezoid fixation stem adding stability. Source: 2003www.Jointreplacement.com

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

26 Total Wrist Replacement Under 300 total wrist replacements estimated for Under 300 total wrist replacements estimated for 2003.

27 Surgical Procedure Incision is made. Incision is made. The tendons are moved out of the way. 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. A portion of the carpal bones and end of radius and ulna are removed from the wrist. Source: 2003www.Jointreplacement.com

28 Surgical Procedure Components are inserted and cemented into place. Components are inserted and cemented into place. Tendons are placed back and wound is closed. Tendons are placed back and wound is closed. A dressing or splint is usually worn. A dressing or splint is usually worn. Source: 2003www.Jointreplacement.com

29 Preparing for Joint Replacement Surgery Ease anxiety by mentally preparing with: Ease anxiety by mentally preparing with: Breathing exercises Breathing exercises Meditation Meditation Talking with friends and family Talking with friends and family Learn more about wrist replacement surgery Learn more about wrist replacement surgery Brochures Brochures Handouts Handouts Websites Websites Videos Videos Source: 2003www.Jointreplacement.com

30 The Night Before Surgery Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.) Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.) Do not consume any food or liquid after midnight. Do not consume any food or liquid after midnight. Make sure you have everything you’ll need at the hospital. Make sure you have everything you’ll need at the hospital. Ask any questions you may have before surgery. Ask any questions you may have before surgery. Source: 2003www.Jointreplacement.com

31 After Surgery Pain medication for any discomfort. Pain medication for any discomfort. Elevate hand above heart for several days. Elevate hand above heart for several days. May schedule a follow-up exam within seven days. May schedule a follow-up exam within seven days. Can be done as an outpatient surgery if there are no other procedures needed. Can be done as an outpatient surgery if there are no other procedures needed. Source: 2003www.AAOS.org

32 A Caregiver’s Role Provide support and show patience Provide support and show patience Help with needs that the patient can not do, like: Help with needs that the patient can not do, like: Meal preparation Meal preparation Feeding Feeding Writing Writing Dressing Dressing Source: 2003www.Jointreplacement.com

33 Recovery in the First Week Follow surgeon’s instructions on proper rehabilitation. Follow surgeon’s instructions on proper rehabilitation. While the wrist heals, do not pick up heavy objects. While the wrist heals, do not pick up heavy objects. See physician on what activities are permitted. See physician on what activities are permitted. Source: 2003www.Jointreplacement.com

34 Recovery in the First Month At two weeks, cast and splint removed with a short arm cast for another two weeks. 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. Continued use of medication, with need tapering off as area heals. At one month, a splint will be worn during exercises and at night. At one month, a splint will be worn during exercises and at night. Source: 2003www.Jointreplacement.com

35 Recovery After Six Weeks Passive exercises begin to maximize the motion of the new wrist. Passive exercises begin to maximize the motion of the new wrist. At two months, exercises started to strengthen the muscles. At two months, exercises started to strengthen the muscles. Begin most of your normal activities at three months. Begin most of your normal activities at three months. Source: 2003www.Jointreplacement.com

36 Questions?

37 Thank You


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