Hicksville Physical Therapy’s patient resource about wrist fusion.
There are many reasons regarding the origin of arthritis in the wrist, such as trauma. Fortunately, there are several non-surgical treatments available that may successfully put a hold on the issue. However, if pain persists despite these methods, your doctor may recommend something called a wrist fusion, also known as arthrodesis.
Below, this resource will outline:
The wrist joint is greatly complex; perhaps the most complex within the human body, as it is actually made up of many bones and joints. This is due to how the wrist works: it must be greatly mobile in order to provide an entire range of motion, as well as supply the strength needed for grabbing and lifting.
Within the wrist are eight small bones, known as the carpal bones.
These bones connect the radius and the ulna, which make up the forearm, to the metacarpal bones, the long bones that are found within the palm, that then connect to the bones of the fingers, or phalanges.
Every bone is connected to one another by ligaments
Also found in the wrist is articular cartilage. This soft, lubricated material known as a “shock absorber” allows for smooth movement when a joint is used by preventing bone ends from rubbing against one another. Damaged articular cartilage causes bones to rub against each other, leading to pain. When this happens it is known as degenerative arthritis, sometimes referred to as osteoarthritis.
Related Document: Hicksville Physical Therapy’s Guide to Wrist Anatomy
Reasons for wrist fusion surgery?
Any of the small joints that make up the wrist can potentially become arthritic. When this happens, an individual will experience great pain in use. Movement will grow difficult, and some may lose strength in grip as well. In advanced cases, deformity can occur. This is where a wrist fusion comes into play.
Simply put, a fusion joins bones together so that they grow into one. This eliminates pain, as bone ends can no longer cause friction by rubbing against one another. This type of treatment can improve alignment, as well as prevent further deformation. Differing from a typical joint fusion which may only be made up of a few bones, a wrist fusion joins several; up to 12 or even 13 bones.
Following a wrist fusion, you will lose a great deal of motion, as all of the joints that allow for movement have now been formed into one bone. However, you will regain strength as well as ease pain. This type of solution is ideal for those who need strength over flexibility.
What do I need to do to prepare for wrist fusion surgery?
Once decided that a wrist fusion is right for you, you will begin the preparation process. Your surgeon may recommend a complete physical to confirm that you are able to undergo the procedure. Prior to surgery you will be directed to not eat nor drink anything beforehand, typically from midnight on. Time spent in the hospital following surgery varies from surgeon to surgeon, as well as hospital protocol.
Wrist fusion procedure
The direct produce varies from surgeon to surgeon. Some procedures involve taking what is known as a bone graft; tissue transplanted from one bone to another to encourage bone growth. Where this sample is taken differs, although common areas include the pelvis or the radius. Some surgeons do not use bone grafts.
Typically, you will be put under for surgery using a general anesthetic; however, in some instances, surgery is done via local anesthetic while you’re awake.
To begin, your surgeon will clean the area with an antibacterial solution. Next, an incision is made down the back of the wrist. The surgeon will move the tendons and ligaments in order to expose the bones underneath. Articular cartilage is removed, and the joints are then fused. If your surgeon opted for a bone graft, it will then be placed between the spaces of the joints and bones.
A metal plate is then attached to the wrist via metal screws to keep the bone from moving as the bones grow together. This plate is generally permanent.
Understanding possible complications
In congruence with every surgical procedure, complications can arise. It is important to understand that every surgery comes with a risk, including but not limited to:
Every surgery carries with it the risk of an infection. In most cases, an antibiotic will be prescribed prior, reducing the risk. If any of the surgical areas become infected, an additional surgery may be needed in order to remedy it.
Nerve and Blood Vessel Injury
Due to their close proximity to the wrist joint, injury to the nerves and blood vessels during the course of operation is a rare but realistic risk. Temporary damage to the nerves and blood vessels due to retractors is also a possibility.
In some instances, the implanted plate may cause irritation. Short-term treatments, such as medication or physical therapy may remedy the area. However, if this is not the case and irritation continues, your surgeon may remove the plate once the fusion has taken place.
A nonunion occurs when the bones do not fuse in a manner as planned, which could lead to needing an additional surgery if the area is still painful.
Post-op wrist fusion surgery
In order to prevent movement following surgery, you will be placed in an elbow-length cast for roughly six weeks give or take, depending on your surgeon. After the first one to two weeks post-op, your surgeon, most likely, will check the area as well as remove any stitches needed. You will also most likely be prescribed painkillers for any discomfort you may experience.
Your surgeon may also recommend that you keep your wrist elevated for the first few days.
What will my recovery be like?
Generally, after six-eight weeks your cast will be replaced by a removable splint. Stiffness and soreness of the hand is typical following the removal of the cast. Physical therapy differs from surgeon to surgeon as well as patient to patient.
Your physical therapist may firstly focus on post-operative pain and swelling through means of gentle treatments, such as massage therapy, and light hand exercises. Throughout the recovery process your surgeon may routinely x-ray the area to check the healing process. Once the fusion is completed, your therapist may move on to a strengthening program conducive to getting back to daily activities safely.