A Journey With Wrist Osteoarthritis: Pre-Surgical Planning

  • When the pain and disability from arthritis get too much to bear, a person may decide to look for solutions. My husband is one such person who has just decided to do something about the pain which began eight years ago. His right wrist is severely afflicted with a "bone on bone" case of osteoarthritis. Being a right handed man, the pain started to interfere with daily activities like writing, eating and dressing years ago. But he is a very accepting man who decided to just live with it. An occasional anti-inflammatory medication or acetaminophen was all that was needed to keep going. On one occasion, the pain in his wrist was so severe that he could not hold onto a fork and required a steroid injection - but this was far from a regular occurrence. As long as he was careful, he got by just fine.

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    In the past year, another problem with the wrist started to compound the problem. Numbness started to creep into his thumb and half of the fingers. One day while hunting for pheasants, he could not tell whether or not his gun's safety mechanism was on or off. That moment was his tipping point. He knew that something finally had to be done. Living with pain is doable, but risking safety is not advisable.


    Since being in a managed care insurance program, he first needed to see his primary care doctor. His doctor ordered a standard X-ray of the wrist. The imaged showed that the scaphoid bone was grinding up against the radius. Additionally, a large gap was seen where the ligaments would normally be holding the wrist bones together tightly. Obviously, my husband's wrist had been through some trauma. 40 years ago, in his youth, he made a fateful decision to learn how to break bricks with his bare hand. Brick after brick, the micro-injuries accumulated. The ligaments were damaged beyond repair and the stage was set for wrist osteoarthritis that would someday force him into a surgeon's office.


    Because wrist arthritis does not necessarily cause numbness in the hand, other tests needed to be done before seeing the surgeon. In order to diagnose what exactly was causing the nerve problem, my husband saw a nerve specialist. The definitive diagnosis of median nerve entrapment at the carpal tunnel was made by the neurologist who evaluated the nervous system using a special test called the electrodiagnostic test. In layman's terms, my husband not only has wrist osteoarthritis, but he also has carpal tunnel syndrome too. Because of the complexity of his situation, he needs the care of an orthopedist that specializes in hand surgery.


    The surgeon closely looked at all of the evidence and listened to my husband's story. Without hesitation, he said that he recommends releasing the carpal tunnel to help the pinched nerve - a procedure called carpal tunnel release. Then, he would also remove some bone (proximal row carpectomy) in the wrist to relieve the grinding pain from arthritis while preserving motion. This would require two incisions, a month in a cast and three months of rehabilitation. Not a simple case, but it is very reasonable to expect a good outcome. My husband was elated with the prospect of getting some relief as a result from surgery. "Sign me up for surgery doc" was his enthusiastic reply.


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    To be continued...


Published On: January 03, 2012