Tuesday, September 02, 2014

Wednesday, March 04, 2009 Ellen Galo, Community Member, asks

Q: Wrist replacement versus wrist fusion

Hi - I have serious damage to my right wrist from RA (add a little OA to that as well). My wrist bones/carpals look like swiss cheese!  There is some evidence that the scaphoid bone broke open.  Up until then, with meds, I could still bend my wrist fairly well, now it only bends 42 degrees total (about 20 each direction).  I wear a splint 24/7 and that helps keep the pain down. 

Question: Any experience with wrist replacements versus fusion?   I asked several doctors, including my GP, my Rheum. Dr. and 2 hand surgeons about which would be better/safer, if I decided to go for surgery.  Hand surgeon #1 said, you can do either, no rush, wait a few years, but that the fusion would cause less trouble and last longer.  Hand surgeon #2 said, people are happier with wrist replacement, even if they have problems with it.  However, both surgeons are 3 hours away, and 'problems' would cause me to miss a whole day of work, even for just an appointment.  GP said, fusion is better, any movement would contribute to inflammation, thus problems.  Rheumatologist agreed.

   Ironically, I scheduled the fusion with #2 hand surgeon.  He kept asking me if I was sure, if I was having pain all the time (I was then but with splint it got better). So - I cancelled, and not sorry.  Seemed better to wait until absolute necessity, then do fusion with #1 doctor!  (had better rapport with him anyway, tho' the other guy was very nice.)

Ellen

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Answers (12)
Lene Andersen, Health Guide
3/ 7/09 12:47pm

It may be six of one, half-dozen of the other - if you wrote down the pros and cons to each procedure, they may come out more or less even.

 

I don't quite get what your GP means with movement contributing to inflammation, because if your wrist was replaced, there wouldn't be a joint there that could be inflamed, but I've had a long week and my brain is fried. However, both my wrists have been fused for decades - one from the RA, run from a synovectomy that ended up fusing - and the lack of movement doesn't seem to create too much problems in my everyday life. Since you're wearing a splint, you already know how well you'd function with a fused wrist, so that might give you some insight. It's my impression that wrist replacement, like finger replacements, have yet to be as effective long term as need and hip replacements, so that may factor into your decision, as well. You might want to ask your doctor if you go for fusion now, can you get the replacement later when the success rate of wrist replacement may increase, which would enable you to do both.

 

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Laura, Community Member
3/ 5/09 7:23am

Hi Ellen,

I'm in the same predicament, except for my left middle finger.  I was given the option of replacement or fusion.  I was told fusion would be better, the replacement will only last approx 5 years, but I think that in 5 years do it again, big deal!  Maybe Medical Science will be greatly improved.

My hand surgeon said that not many finger joint replacements are done and he's highly recommending the fusion.  I am opting to wait a while as you are.  He also said I should wear a splint to avoid the pain.  I am constantly  hurting myself. 

I would be interested to know what you end up doing.

Good Luck

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dee, Community Member
4/ 6/09 7:01am

hi i am new here today i have RA in my hands and feet i take celebrex and darvocet for pain and have had injections in my left foot and left wrist they helped my foot but not my wrist at all. i am left handed and have had 4 different surgeries on my left wrist since 2000!! all for different problems, the first one was to replace my lunate bone in my wrist from repetitive motion and sports when i was younger, the second was for a ganglion cyst that was hurting and getting bigger, the third was for tendon release and carpal tunnel , i was doing better until i fell at work on the ice three times last feb. after the first fall i tried to get up and fell on my hands and knees twice as it was solid ice needless to say i suffered a herniated disc, a tear in my disc and a broken right wrist and reinjured left wrist, i had carpal tunnel surgery again on the left wrist in august and it did not do a thing my pain is worse and have constant spasms in my fingers and radiating pins and needles. i wear a splint 24/7 and have no relief at all so i am opting for the wrist fusion surgery probably in june. i cannot use my left hand at all anymore and now my right wrist is hurting more because i use it for everything. i am hoping the surgery will help me get on with my life and improve it so i can at least go back to work part time as a office manager. i am interested to find out if anyone here has had the surgery? or your opinions also ! dee

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Ellen Galo, Community Member
4/ 6/09 8:43am

Hi Dee,

Mine has not gotten bad enough for surgery - the splint is really helping, unless I overdo it badly.  But if I were in your situation, I think I'd go ahead with the fusion for sure. Because you've run through the gamut - as the orthopedic PA put it, manage it for as long as you can without, before going for surgery.

Just my opinion ...

Ellen

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dee, Community Member
4/ 6/09 3:41pm

hi ellen i am glad the splint is helping you? mine use to not anymore i have the pain with or without the splint and i bought the best one i could with the thumb enclosure also but it just don't matter anymore? so it does look like i am heading towards the fusion surgery especially if i want to work again! take care ellen i wish you the best with your wrist also! deeWink

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Ellen Galo, Community Member
4/ 6/09 7:10pm

I'd like to hear how things proceed for you, let me know what and when you're scheduled for - you'll be in my thoughts & prayers!

Ellen

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dee, Community Member
4/ 7/09 6:28am

hi ellen i will let you know when i will have the surgery probably not until june? as it is going thru comp. it always takes forever lol today i am going back to the back specialist as along with the herniated disc and tear in my back i have been having neck pain for almost two months now. the chiropractor says it is coming from the back pain ? so i have to find out cause it is traveling from my neck to my shoulder and down my left  arm now . i am also waiting for injections for my back as i will not have surgery so this is the last alternative they are not cortisone shots though this is a series of 3 syn-disc injections. hopefully they will help the pain? take care and have a good day deeInnocent

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Ellen Galo, Community Member
4/ 7/09 7:21am

Wow - wishing you luck!   and a happy Easter...

Ellen

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dee, Community Member
4/ 8/09 7:13am

hi ellen thanks i wish you well also!! happy easter to you and your family also!! deeWink

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denise, Community Member
10/24/11 2:43pm

hi u sorry i have not been back here alot of problems with both wrists now i did have the total left wrist fusion last november but had to have the metal bar taken out in january because of constant pain and swelling. the left wrist is totally fused but still have pain and swelling every day. i drop everything i pick up and have constant burning pain when i use it also. i hope you have better luck with your surgeries?  i also have carpal tunnel in the right wrist i broke when i fell 2 years ago now too. so i am in pain with the right wrist also. i go back to see the surgeon this friday but i know what he is gonna say" there's nothing else i can do for you denise" i am seriously thinking about going out of state to look for another specialist to help me i also developed arthritis in the left carpal now so my wrist is clicking constantly oh and the best part is i have a big lump on the side of my wrist that looks disgusting and the surgeon said the only way he could get rid of it would be to cut my bone out? i don't think so hope you are doing well ellen take care denise

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Brianne, Community Member
4/22/09 11:13pm

I am a 23 year old feamale that had multiple injuries due to competitive cheerleading.  I saw multiple doctors and had three operations prior to my wrist fusion.  I had an excellent doctor that because of my age tried all possible alternatives; however, none of the alternatives significantly reduced my pain.  I chose (with much hesitation from my family) to have a wrist fusion.  It was the best decision I have ever made.  Although I have limited motion, I am able to do so much more than I could do before.  The pain im my wrist prevented me from performing everyday activities; however, now I am able to do so much more.  It is true I have lost the ability to perform some tasks with my fused wrists, but with the enormous reduction in pain I do not even notice.  I adjusted to doing some tasks with the unfunsed wrist, but it has become natural.  I do not regret the operation at all; in fact, I wish I would have had it earlier. 

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dg, Community Member
12/ 1/09 3:18pm

can you play golf?

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starlight, Community Member
6/12/14 11:47am

my husband had his right thumb/wrist/hand blown up from a malfunctioning firework. He has had three surgeries and still lives in daily chronic pain. He does not have much movement of the wrist and, has just seen another surgeon who,has suggested fusion to defeat the pain. I am trying to learn as much as i can about the fusion process, and the issues he may run into. He is a network specialist who runs his own business and works on the computer at times 14 hours a day. He also builds electronic componets and computers. I hate seeing him in so much pain daily, and it has changed his personality as a result of the injury, the lengthy healing process, the costs due to not having insurance, depression and so many troubles being able to find the reason for the pain. He had a permanent screw put in the bone as well as bone grafting and, after about a year and half the cat scan and mri showed the bone had started to push out the screw, and the screw was actually wearing a crater into another bone due to being out of place of the initial placement after his bone grew and therefore pushed the screw back out. the sugeon did take the screw out and, thought that should relief the daily pain but, unfortunately it did nothing for the pain. he said the pain when moving did decrease slightly but, not noticable enough for the screw to have been the primary reason for the daily pain. I know he is now weighing the option of fusion and I am doing my best to stay optomistic that this could possibly relieve him of his daily pain. The worst pain is when his thumb is hit or pushed. I am wondering if it would be best to fuse the thumb as well as the wrist. I am actually going to be taping my wrist and thumb to see just how many daily activities are interfered with enoough to cause frustration that would superseed the living with daily pain. Also, I wonder what will happen if the fusion doesn't defeat the pain? This is my worst fear, that he will choose the fusion to end his daily traumatizing pain and, end up with the same pain and absolutley no movement of the wrist. he is right handed and the effected wrist is unfortunatley also the right. :( I don't know if i have an actual question, I am just trying to find any opinions of those that have had the wrist fusion or gone through somthing similar. i saw chiropractor mentioned, and wonder what they are able to do for this type of injury. None of his doctors have ever mentioned him seeking out a chiropractic opinion or referral.

 

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ignite44, Community Member
5/11/09 1:31am

Hi Briane,

 

I'm a recently retired 64 year old male with a damaged right wrist from a 35 year old injury.  I was able to play golf until last year by wearing a hard plastic brace to keep it immobile, but had to stop because of the pain and swelling.  I saw a orthopedic surgeon who specializes in hand/wrist and he wants to do a fusion because of the arthritis in the joint.  The only reason I'm considering this is so I can continue to play golf.  Question:  Are your fused wrists strong?  Do you feel like the fusion could be damaged by repeated shocks to the hands/wrists?

 

Thanks,

 

Tom

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dg, Community Member
12/ 1/09 3:19pm

Did you have the wrist fusion, and can you play golf?  I would really like to talk to you.  I am 63.

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john, Community Member
1/14/11 2:01pm

Yes can you play golf after fusion im 49 im thinking about going under the knife?

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Julie, Community Member
10/26/11 9:08pm

Hi Ellen,

 

I had my right wrist fused 11 yrs ago and ironicly my left hand experienced rupture of 2 tendons a few days ago.  I saw a hand surgeon yesterday and she said because of my ulna being displaced, do to RA, and limited flexion and extension that I may want to consider either wrist replacement or fusion. 

 

I am going to see another surgeon as she does not do these procedures.  I am interested in hearing what the dr says.

 

The wrist fusion that I had done on my rt wrist has help well and the pain in mostly gone.  I have adapted to it.  It really only has a few limitations.  It is hard to pick small things up from the floor,  opening some things and applying lotions with that hand to the same side of your body.  I just use the other hand for these things; until now.

 

Taking away the pain was worth it.   I would do it again but do want to hear the benefits of replacement.

 

 

Oh, I see now that your posting was over 2 yrs ago.  What did you end up doing?

 

Be well,

 

 

 

Julie

 

 

 

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By Ellen Galo, Community Member— Last Modified: 06/12/14, First Published: 03/04/09