Wrist Joint Pain

Wrist joint pain is common following inflammatory disease of wrist joint and injuries. Wrist joint inflammatory disease includes bursitis, tendonitis, ligamental inflammation and arthritis. An injury to the wrist joints causes tendon tear, ligamental tear, dislocation and fracture. There are several choices of treatment for wrist joint pain.

Wrist Joint Pain

Wrist Joint Pain Can be Caused Due to

  • Wrist Joint Sprain
  • Wrist Joint Bursitis
  • Wrist Joint Tendonitis
  • Wrist Joint Arthritis
  • Wrist Joint Dislocation
  • Wrist Joint Fracture
  • Wrist Joint Infection or Septic Arthritis.

Treatment for Wrist Joint Pain:

  1. Conservative Treatment
  2. Medications
  3. Physical Therapy (PT)
  4. Interventional Pain therapy
  5. Close Reduction Of Dislocation and Fracture
  6. Surgical Treatment
    1. Conservative Treatment for Wrist Joint Pain

      Conservative Treatments Advised for Wrist Joint Pain are as Follows-

      1. Restriction of Wrist Joint Activities
      2. Heat and Cold Therapy Treatment for Wrist Joint Pain
      3. Daily Exercise
      1. Restriction of Wrist Joint Activities

        Conservative treatment for wrist joint pain involving wrist joint restriction is achieved by applying crape bandage to wrist, hand and forearm. Alternatively restriction is also achieved by use of wrist joint braces and placement of cast.

        Indications for Wrist Joint Restriction to Treat Wrist Joint Pain are as Follows-

        • Painful Wrist Joint Movement
        • Wrist Joint Swelling
        • Wrist Joint Dislocation
        • Wrist Joint Fracture
        • Wrist Joint Sprain
        • Wrist Joint Tendonitis
        Wrist Joint Fracture
      2. Heat or Cold Therapy Treatment for Wrist Joint Pain

        Heat and Cold Therapy is an effective treatment for wrist pain There are various kind of gel pack available which can be used as heat an cold therapy.

        Indication for Heat and Cold Therapy to Treat Wrist Pain is as Follows-

        • Wrist Joint Soft Tissue Swelling
        • Wrist Joint Edema
        • Pain Caused By Tendon And Ligament Inflammation
        • Chronic Pain Caused By Dislocation And Fracture
        • Postoperative Pain
      3. Daily Exercise for Treating Wrist Joint Pain

        Daily exercise is advised to prevent muscle atrophy, joint stiffness and muscle weakness of wrist, hand and forearm.

        Indication for Daily Exercise to Treat Wrist Pain Are-

        • Prevent Muscle Stiffness
        • Prevent Muscle Atrophy
        • Prevent Muscle Weakness
        • Prevent Wrist Joint Stiffness
        • Strengthen Hand And Forearm Muscle
    2. Medications to Treat Wrist Joint Pain

      Following medications are prescribed for chronic wrist joint pain and muscle spasm caused by wrist joint disease and injuries-

      1. NSAIDs
      2. Opioids
      3. Anti-depressant analgesics
      4. Anti-epileptic analgesics
      5. Muscle Relaxants
      1. NSAIDS (Non-Steroidal Anti-inflammatory Medications) to Treat Wrist Joint Pain

        Indications for NSAIDs Treatment for Wrist Joint Pain-

        • Chronic Wrist Joint Pain Not Responding To Conservative Treatment.
        • Wrist Joint Bursitis.
        • Inflammation of the Ligament Following Injury (Sprained Wrist Joint).
        • Inflammation of the Tendon (Wrist Joint Tendonitis).
        • Inflammation of the Wrist Joint (Wrist Joint Arthritis).
        • Inflammation of the Joint Caused By Wrist Joint Dislocation and Fracture.
        • Inflammation associated with Wrist joint infection (septic arthritis).

        NSAIDs Most Often Prescribed to Treat Wrist Joint Pain-

        Motrin to Treat Pain in the Wrist-

        • Tablets are available as 200, mg, 600 mg and 800 mg.
        • Daily dosage is 1600 to 2400 mg per day.

        Naproxen-

        • Tablets are available as 275 mg, 350 mg and 500 mg.
        • Daily dosage- 750 to 1500 mg per day.

        Daypro-

        • Tablets available as 600 mg.
        • Daily Dosage- 600 to 1200 mg per day.

        Celebrex-

        • Tablet available as 100 mg and 200 mg.
        • Daily dosage- 200 to 400 mg per day.
      2. Opioids for Treating Wrist Joint Pain

        Opioids Medications-

        Opioids are divided in two groups as

        • Short Acting Opioids
        • Long Acting Opioids

        Indications for Short Acting Opioids for Wrist Joint Pain are as Follows-

        • Acute Wrist Pain- pain lasting less than 3 to 6 months.
        • Post Surgical Wrist Pain.
        • Breakthrough Pain.
        1. Short Acting Opioid Medications for Wrist Joint Pain-

          Hydrocodone: Vicodin, Lortab and Norco.

          • Vicodin- Hydrocodone of quantity 5 mg, 7.5 mg and 10 mg is mixed with 650 mg of Tylenol.

            Daily Dosage- 15 to 60 mg of hydrocodone.

          • Lortab- Hydrocodone of quantity 5 mg, 7.5 mg and 10 mg is mixed with 500 mg of Tylenol.

            Daily Dosage- 15 to 60 mg of hydrocodone.

          • Norco- Hydrocodone of quantity 5 mg, 7.5 mg and 10 mg is mixed with 350 mg of Tylenol.

            Daily Dosage- 15 to 60 mg of hydrocodone.

            Norco is preferred if higher dosage like 30 to 60 mg of hydrocodone is prescribed for pain treatment so tylenol dosage is kept below 2 gram.

          • Oxycodone- Oxy IR and Percocet.

            1. Oxy-IR- Strength of pills- 5 mg, 7.5 mg and 10 mg.
            2. Daily dosage- 15 to 60 mg.
            3. Percocet- Pills contain Oxycodone and Tylenol.
            4. Strength of Oxycodone- 5 mg, 7.5 mg and 10 mg.
            5. Strength of Tylenol- 325 mg, 500 mg and 650 mg.
            6. Daily dosage- 15 to 60 mg.
            7. Maximum allowed dosage of Tylenol 4 gm.
          • Morphine-

            1. MS IR (Morphine Sulphate Immediate Release)
            2. Available as liquid and pill.
            3. Liquid Strength- 20 mg/mL
            4. Pill Strength- 15 and 30 mg
            5. Daily Dosage 60 mg to 120 mg.
        2. Long Acting Opioids to Treat Wrist Joint Pain-

          Indications for long acting opioids to treat wrist pain or wrist joint pain are as follows-

          • Post Surgical Wrist Joint Pain Not Responding To Short Acting Opioids.
          • Chronic Wrist Joint Pain Caused By:
            1. Wrist Joint Sprain
            2. Wrist Joint Tendonitis
            3. Wrist Joint Dislocation
            4. Wrist Joint Fracture
            5. Wrist Joint Bursitis
          • Chronic Wrist Joint Pain Not Responding To
            1. NSAIDs
            2. Antiepileptic Analgesics
            3. Anti-depressant analgesics

          Long Acting Medications-Oxycodone- Oxycontin

          • Pills available as 10 mg, 20 mg, 40 mg and 80 mg.
          • Suggested safe dosage per day- 40 mg to 160 mg.

          Morphine- MS Contin

          • Pills available as 15 mg, 30 mg, 60 mg, 100 mg and 200 mg.
          • Suggested safe dosage per day- 90 mg to 200 mg.

          Methadone

          • Pills available as 10 mg.
          • Suggested safe dosage per day- 40 to 80 mg.
      3. Muscle Relaxants for Wrist Joint Pain-

        Muscle pain or spasm of muscles of hand and forearm are treated with following muscle relaxants. Muscle relaxant causes sedation and sleepiness in few patients. Combination of opioids and muscle relaxants can be fatal. Physician will frequently monitor their patients for side effects and medication consumption behavior. Wrist joint pain due to muscle spasm or muscle pain is treated with one of the following muscle relaxants.

        Baclofen

        • Pills available as 5 mg, 10 mg, 15 mg and 20 mg.
        • Suggested safe dosage per day- 30 to 60 mg.

        Flexeril

        • Pills available as 5 mg and 10 mg.
        • Suggested safe dosage per day- 20 to 30 mg.

        Skelaxin

        • Pills available as 800 mg.
        • Suggested safe dosage per day- 2400 to 3200 mg.

        Robaxin

        • Pills available as 500 mg and 750 mg.
        • Suggested safe dosage per day- 1500 to 2150 mg.
    3. Physical Therapy (PT) for Wrist Joint Pain

      Physical therapy is a conventional treatment provided as an adjuvant therapy to medication, interventional pain therapy and surgery. Physical therapy is prescribed before surgery as a conservative treatment and after surgery as a supporting therapy. Patient with severe wrist joint pain often resist physical therapy and in such situation injection of local anesthetics in wrist joint often precedes physical therapy.

      Goal of Physical Therapy (PT) in Treating Wrist Joint Pain-

      • Improve Joint Movements
      • Enhance Muscle Strengthening
      • Maintain Normal Muscle Tone
      • Augment Coordination.

      Indications for Physical Therapy to Treat Wrist Joint Pain

      • Chronic Wrist Joint Pain
      • Muscle Spasm of Hand And Forearm Muscles
      • Post Surgery Wrist Joint Stiffness
      • Post Surgery Wrist Joint Instability
      • Muscle Atrophy- Hand And Forearm Muscles
      • Hand and Forearm Muscle Weaknesses

      Physical Therapy Techniques to Treat Wrist Joint Pain-

      • Exercise
      • Stretching
      • Ultrasound Therapy
      • Infrared or Heat Therapy
      • Cold Therapy
      • Massage Therapy
    4. Interventional Pain Therapy for Wrist Joint Pain

      Interventional pain therapy is an invasive treatment. Choice of Interventional Pain Therapy is as follows

      1. Needle Therapy
      2. Nerve Ablation Treatment
      3. Placement of Spinal Cord Stimulator
      4. Placement of Intrathecal Catheter and Programmable Pump
      1. Needle Therapy

        Needle therapy treatment for wrist joint pain or wrist pain includes injection of medications using needles. Needle placement depends on the cause of wrist joint pain.

        Anatomical Area of Needle Placement to Relieve Wrist Joint Pain-

        • Subcutaneous Injection- Indicated for subcutaneous abscess or cellulitis.
        • Wrist Joint Injection or Wrist Joint Block (Injection within the joint) - Indicated for bursitis, sprain ligament, tendonitis, dislocation or fracture.
        • Wrist Joint Nerve block (injection close to nerve)- indicated for pinch nerve and wrist joint neuritis.
        • Cervical (neck) Epidural Injection- Indicated for chronic wrist joint pain.
        • Brachial Plexus Block performed by placing needle in axilla or neck.

        Medication Injected In Wrist Joint to Treat Pain in the Wrist-

        • Corticosteroid
        • Local Anesthetics
        • Chemical Nerve Ablation Using Phenol or Alcohol.

        Injection Procedure for Treating Pain in the Wrist-

        • Injection to ease the pain in the wrist in majority of the patient is performed under local anesthesia.
        • Physician will spray the wrist joint skin with numbing medicine so first prick or insertion of needle is painless and then he will inject local anesthetics to numb all the tissue to be treated including skin.
        • Needle placement is not very painful.
        • Image intensifier (portable X-Ray) is used to identify wrist joint structure and depth of the needle during placement of needle for injection.
        • Nerve to be treated is identified by nerve stimulator.
        • Occasional ultrasound is used to evaluate needle placement during procedure.
        • Few patients suffer with "needle phobia" (fear of needle) for such patients doctor will provide oral or intravenous antianxiety medications or sedation.
        1. Corticosteroid Injection-

          Cortisone injection is performed to reduce inflammation associated with wrist pain. Severe wrist pain caused by inflammation and nerve irritation is initially treated with NSAIDs and opioids. Inadequate pain relief is later treated with cortisone injections. Initial 2 or 3 injections are performed within 6 to 8 weeks. Later cortisone injections are repeated every 3 to 6 months. Cortisone injection is not recommended for chronic wrist pain caused by Gout and Septic Wrist Joint Arthritis.

          Indications for Corticosteroid Injection to Treat Wrist Joint Pain-

          • Wrist Joint Sprain Caused By Inflammation of Ligaments.
          • Wrist Joint Tendonitis Caused By Inflammation of Wrist Joint Tendon.
          • Wrist Joint Bursitis Caused By Inflammation of Wrist Joint Bursa.
          • Wrist Joint Arthritis Caused By Inflammation of Wrist Joint Cartilages and Bones.
          • Wrist Joint Fracture Causing Severe Pain.
          • Wrist Joint Dislocation Causing Inflammatory or Pinched Nerve Pain.
          • Post-Surgical Pain.

          Contraindication for Corticosteroid Injection to Treat Wrist Joint Pain

          • Gout
          • Septic Arthritis
          • Skin Infection
          • Septicemia
          • Allergies to Corticosteroids
        2. Local Anesthetic Injection-

          Therapeutic value of just local anesthetic injection is very limited. The procedure is performed only as a diagnostic procedure. Wrist joint is often treated with local anesthesia to relieve pain prior to aggressive physical therapy.

          Indications for Local Anesthesia Injection to Treat Wrist Joint Pain-

          • Diagnostic Injection- Procedure is performed to evaluate cause of pain.
          • Painful Physical Therapy- Injection is performed prior to aggressive physical therapy.
          • Painful Wrist Joint- Injection is performed prior to nerve conduction or radiological study.
          • Post-Surgical Pain- Intolerable pain following wrist joint surgery is treated with wrist joint injection using local anesthesia.

          Contraindication for Corticosteroid Injection to Treat Wrist Joint Pain

          • Septic Arthritis
          • Skin Infection
          • Septicemia
          • Allergies to Local Anesthetics
        3. Chemical Nerve Ablation (Nerve Destruction)

          Procedure is selectively performed using alcohol and phenol to destruct (ablate) irritated or pinched nerve. This treatment is very rarely needed for wrist joint pain.

          Indication for Nerve Ablation to Treat Wrist Joint Pain-

          • Chronic Wrist Joint Pain Caused By Nerve Irritation Or Pinched Nerve
          • Pinched Nerve Pain Caused By Wrist Joint Fracture Or Dislocation Not Responding To Pain Medications, Physical Therapy, Corticosteroid Injection And Surgery.
          • Pinch Nerve Pain Following Surgery.
          • Radial, Median or Ulnar Nerve Neuropathy Causing Selective Peripheral Nerve Pain.

          Nerve Ablation Techniques to Treat Wrist Joint Pain -

          • Phenol Injection of Pinched or Irritated Nerve.
          • Alcohol Injection of Pinched or Irritated Nerve.

          Diagnosis of Pinched or Irritated Nerve-

          • Pain Specialist Will Conduct Detailed Examination To Diagnose And Evaluate The Nerve Causing Pain.
          • Pinched Or Irritated Nerve Is Identified By Nerve Conduction And Nerve Stimulation Study.

          Procedure Notes-

          • Procedure is performed in Out-Patient Surgery.
          • Choice of Treatment Is Discussed With Patient Prior To Surgery.
          • Treatment is performed under Local Anesthesia.
          • Needle is placed over Nerve for Phenol or Alcohol Injection.
          • Phenol Injection for Wrist Joint Pain- Phenol is selectively injected near or over the nerve. Procedure is painful and pain lasts for short period. Phenol destructs peripheral nerve by neurolysis. Procedure is very rarely performed.
          • Alcohol Injection for Wrist Joint Pain- Alcohol is very rarely used. Alcohol injection is very painful and pain lasts for prolonged time. Nerve when regenerate causes severe neuropathic pain.

          Complication Following Phenol or Alcohol Injection-

          • Destruction of surrounding soft tissue, since liquid phenol and alcohol spreads rapidly in soft tissue
          • Severe scar tissues are formed because of surrounding soft tissue damage. Chemical inflammation of soft tissue is induced by phenol and alcohol.
          • Nerve regeneration follows severe neuropathic pain
          • Cryo or radiofrequency nerve ablation is preferred over phenol or alcohol injection. Alcohol or phenol spreads over surrounding soft tissue causing severe destruction and scarring.

          Contraindication for Phenol or Alcohol Injection to Treat Wrist Joint Pain

          • Septic Arthritis
          • Skin Infection
          • Septicemia
          • Allergies to Phenol
      2. Nerve Ablation Treatment for Wrist Joint Pain

        Radiofrequency Nerve Ablation

        Radiofrequency needle is much smaller in diameter than cryo probe. Radiofrequency needle is placed just like cryo probe over pinched or irritated nerve. Radiofrequency waves are generated at the tip of the needle, which results in increased temperature. Temperature is maintained between 75 to 90 degree C for 75 to 90 seconds to accomplish nerve ablation.

        • Radiofrequency nerve ablation using radiofrequency heat.
        • Alternative to phenol or alcohol injection is radiofrequency or cryo nerve ablation procedure,
        • Radiofrequency or cryo needle following nerve stimulation is placed over pinched or irritated nerve. Radiofrequency needle generate temperature of 75 to 90 degree C over nerve and Cryo probe is cooled down to -90 degree C to cause a nerve lesioning resulting in nerve ablation.

        Cryo Nerve Ablation

        Procedure involves placing of cryo probe over irritated or pinched nerve. Cryo probe is much wider in diameter than radiofrequency needle. Procedure involves tiny incision to insert cryo probe. Probe is placed over nerve following nerve stimulation test. Probe temperature is maintained at -70 to 90 degree C for 3 minutes.

      3. Placement of Spinal Cord Stimulator to Treat Wrist Joint Pain

        Spinal Cord Stimulator is rarely indicated for wrist joint pain. Spinal Cord Stimulator includes stimulator and generator. Proximal (front) end of spinal cord stimulator is placed in epidural space. Distal (outer or back) end of stimulator is connected to generator. Generator creates electrical impulses, which is transmitted through stimulator to epidural space. Electrical impulses are transmitted to spinal cord through dura, arachnoid, CSF and pia membrane. Pain receptors are located over dorsal (back of the) spinal cord. Electrical impulses modulate pain receptors and transmission of pain impulses to brain. Modulation of pain receptors blocks transmission of pain impulses to brain. Spinal cord stimulator may not relieve all chronic pain.

        Indications for Placement of Spinal Cord Stimulator-

        • Pain caused by wrist joint diseases not responding to medication, physical therapy, interventional treatment and surgery.
        • Chronic Pain caused by wrist joint injuries and not responding to medication, physical therapy, interventional treatment and surgery.
        • Alternative therapy to opioids, if oral opioids are contraindicated because of serious side effects.
        • Inadequate pain relief with intrathecal opioids.

        Surgical Procedure for Spinal Cord Stimulator-

        Placement Of Spinal Cord Stimulator Involves Two Stage Procedures.

        • Diagnostic Phase
        • Therapeutic Phase

        Diagnostic Phase-

        • First stage is diagnostic procedure.
        • During diagnostic phase stimulator is placed over pinched nerve (peripheral electrode) at wrist joint or epidural space (epidural electrode) in neck.
        • Stimulator is tried for 2 to 3 weeks to evaluate pain relief.
        • Epidural or peripheral electrode is stimulated using external generator.
        • Pain relief over 50% is considered satisfactory by majority of the patient and permanent placement is considered.

        Therapeutic Phase-

        • Permanent placement of stimulator and generator.
        • Stimulator is placed after 1 to 1.5 cm skin incision either over peripheral nerve at wrist joint or epidural space in neck.
        • Generator is placed following 2 to 2.5 cm skin incision under abdominal or gluteal skin.
        • Distal (opposite) end is connected to generator.
        • Generator is programmed from external programmer by physician.
        • Generator is switched on or off and patient's programmer changes intensity of the stimulation.
        • Continuous use of Generator will exhaust battery in 4 to 6 years requiring the generator to be changed.

        Complications Involving Spinal Cord Stimulator

        • Infection of stimulator and generator pockets.
        • Bleeding in stimulator and generator pockets.
        • CSF leak causing CSF fluid accumulation in stimulator pockets.
        • Opioids side effects and inadequate pain relief.
        • Meningitis.
        • Encephalitis.
      4. Placement of Intrathecal Catheter and Programmable Pump

        Opioids are most effective pain medications. Therapeutic requirement of oral opioid dosage may change rapidly in few patients because of resistance and tolerance to opioids. Patient may be dependent or addicted to opioids resulting in increased demands of large daily dosage of opioids for adequate pain relief. Number of patients visiting ER because of opioid side effect has increased substantially in recent years. Fatality rate caused by opioids has significantly increased in last 10 to 15 years. Chronic pain not responding to oral opioids, physical therapy, interventional pain therapy or surgery is often treated by intrathecal pain medications.

        Purpose of Intrathecal Catheter and Programmable Pump-

        • Intrathecal pain medications are delivered into CSF from programmable pump through a catheter.
        • Variable dose are delivered by changing concentration of opioids.
        • Opioids are delivered close to spinal cord and pain receptors.
        • Opioids modulate pain impulses going to brain.
        • Pain felt is less by 50% or more than normal intensity of pain.

        Device Details-

        • Programmable pump is a flat metal box shaped like hockey puck and contains two chambers.
        • Top chamber has computer device, which controls a motor.
        • Motor delivers consistent amount of opioids stored in bottom chambers.
        • Physician controls computer chips with programmer. Physician can change various modes of drug delivered to achieve optimum pain relief.

        Indications for Intrathecal Catheter and Programmable Pump to Treat Wrist Joint Pain-

        • Chronic Wrist Joint Pain Caused By Wrist Joint Diseases And Injuries.
        • Chronic Wrist Joint Pain Not Responding To Medication, Physical Therapy, Interventions Treatment And Surgery.
        • Oral Opioids Are Contraindicated Because Of Serious Side Effects.
        • Inadequate Pain Relief With Spinal Cord Stimulator.

        Complications Involving Intrathecal Catheter and Programmable Pump to Treat Wrist Joint Pain

        • Infection Of Pump Or Catheter Pockets
        • Bleeding On Pump Or Catheter Pocket
        • CSF Leak Causing CSF Fluid Accumulation In Pump Or Catheter Pockets
        • Opioids Side Effects
        • Meningitis
        • Encephalitis
    5. Close Reduction Treatment for Wrist Joint Pain

      Close Reduction is the treatment often tried for wrist joint dislocation and fracture. Isolated wrist joint dislocation and fracture of radius or ulna is often reduced to normal position without performing any surgery. Close reduction is performed under deep sedations or general anesthesia. Wrist joint movement is restricted with cast for 6 to 8 weeks. Orthopedic Surgeon mostly performs close reduction.

      Procedure-

      • Wrist joint is stretched and pulled by surgeon and his assistant in opposite direction until the joint is aligned in normal anatomical
      • Fracture and dislocated fragments are maintained in normal aligned position until cast is applied.
      • Wrist joint is examined using X-Ray or Image Intensifier to confirm the normal anatomical aligned position.

      Indication for Close Reduction to Treat Wrist Joint Pain-

      • Wrist Joint Dislocation
      • Fracture of Radius or Ulna or Both
      • Fracture of Carpal Bone

      Advantages of Close Reduction Procedure for Treating Wrist Joint Pain-

      • Procedure is Performed Under Sedation
      • Open Reduction And Surgery Is Avoided
      • Recovery Is Faster
      • Infection Avoided

      Disadvantages of Close Reduction Procedure-

      • Procedure May Fail.
      • Casting May Not Prevent Recurrence Of Dislocation Or Fracture.

      Casting

      • Casting is applied over wrist joint following close reduction, external fixation and internal fixation of fracture and dislocation. Casting is applied to prevent wrist movement and in few cases elbow joint movements.
      • Casing is rigid mold made from plaster. Cast is often removed and replaced because of improper tightness, softness of the cast and to accommodate soft tissue swelling.
      Casting for a Stable  Distal Radius Fracture
    6. Surgery for Wrist Joint Pain

      External fixation does not include skin incision, but repair of torn ligament and internal fixations involves skin incision. Treatment involving skin incision is also known as open reduction of wrist joint dislocation and fracture.

      Surgical Treatment of Wrist Joint Pain Includes Following Surgeries-

      1. Repair of Torn Ligaments
      2. External Fixation Of Fracture And Dislocation
      3. Internal Fixation of Fracture and Dislocation
      1. Repair of Torn Ligament-

        Wrist joint pain caused by torn ligament is treated with suturing of two ends of torn ligaments. Surgery involves minor skin incision.

      2. External Fixation of Wrist Joint Fracture or Dislocation

        Isolated fracture or dislocation can be treated with external percutaneous fixation.

        Procedure-

        Fracture or dislocation is reduced under sedation like closed reduction. One or more pins are inserted in dislocated or fractured fragments through the intact skin. Fracture or dislocation is maintained in aligned position by external fixator.

        Indication for External Fixation to Treat Wrist Joint Pain-

        • Unstable Dislocation and Fracture of Wrist Joint Following Closed Reduction.
        • Failed Closed Reduction.

        Procedure Notes-

        • Using X-Ray or image intensifier surgeon will identify fracture or dislocated segment of the wrist joint.
        • Proximal (close to elbow joint) pin is inserted in proximal fragments of fracture or dislocated wrist joint bone. Distal pin (close to fingers) is inserted in distal fragment of fractured radius or ulna bone or dislocated carpal bone of the wrist joint.
        • External fixator holds the external end of the pins.
        • External fixator can pull pins away from each other thus maintaining an alignment and separation of dislocated or fractured fragments.
        • Wrist joint is placed in cast until dislocation or fracture of wrist joint is healed.

        Advantages of Percutaneous Fixation

        • Open Surgery is avoided.
        • Better Joint Stability after Reduction of Dislocated or Fractured Wrist Joint than Close Reduction.
        • Permanent Placement Of Hardware Is Avoided.
        • Minimum Soft Tissue Injury.
        • Less Painful Procedure Than Open Fixation.
        • Scarring and Surgical Trauma is Avoided.
        • Cast is Applied For 2 to 3 Weeks In Most Cases.

        Disadvantage-

        • Bulky instruments and frame around wrist joint and forearm.
        • Inability to use injured hand and arm.

        Complications-

        • Fail to Reduce Or Maintain Dislocated Or Fractured Wrist Joint.
        • Infection Caused By Internal Pins.
        • Nerve Injury While Placing Pins.
        • Bleeding and Hematoma Resulting From Laceration Of Blood Vessels While Placing Pins In Fractured Segments.
        • Laceration or Tear Of Ligaments And Tendon By Pin.
      3. Internal Fixation (Plates, Screws, Pins) to Treat Wrist Pain

        Indications for Internal Fixation to Treat Wrist Pain-

        • Displaced Fracture
        • Unstable Fracture After Closed Reduction
        • Compound Fracture
        • Failed External Fixation
        • Fracture or Dislocation Needs To Be Reduced Under Vision To Prevent Permanent Nerve Injury In Presence Of Symptoms Like Tingling, Numbness And Weakness
        • Dislocation Associated With Fracture

        Advantage of Internal Fixation Procedure to Treat Wrist Joint Pain-

        • Internal Fixation Prevents Vascular and Nerve Injury.
        • Cast Can Be Removed in 2 to 3 Weeks.
        • Early Physical Therapy Prevents Long-Term Muscle Atrophy And Joint Stiffness.
        • Increased Joint Stability.

        Disadvantage of Internal Fixation Procedure-

        • Procedure is Performed Under Anesthetics.
        • Recovery Involving Wound Healing Can Be Prolonged If Followed By Infection.
        • Infection May Need Long-Term Antibiotic Treatment.

        Complications of Internal Fixation Surgery

        • Inability to maintain normal alignment of fracture or dislocated wrist joint.
        • Plate and screws may be misplaced.
        • Joint infection may force to remove hardware.
        • Surgical soft tissue injury may cause nerve damage, vascular tear or tendon rupture.

        Internal fixation Surgery Options-

        There are several surgical options for treatment of dislocation and fracture of wrist joints.

        Surgical Options Are As Follows-

        • "K" Wire Placement
        • Screw and Plate

        Procedure-

        • Fracture and dislocation is identified with X-ray and image intensifier.
        • Skin incision is made following general anesthesia or regional anesthesia.
        • Fracture or dislocation is exposed with special equipment. Fracture or dislocation is reduced manually. Fracture and dislocation is fixed with following procedures.

        Fixation of Fracture or Dislocation-

        • "K" Wires- "K" wire is a stainless steel wire, which holds the fragments of fractured bones together. Surgery is indicated for carpal or metacarpal fracture. K wires are also used to maintain dislocated wrist joint bones in normal anatomical position.
        • Plate and Screws- Fracture or dislocation is reduced manually or by using equipment during surgery. The dislocated or fractured fragments are anchored in normal anatomical position by using a metal plate, which is fastened to adjacent bone by screws. Plate and screws are made of stainless steel or titanium. Plates are shaped to maintain anatomical curves of wrist joint.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 10, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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