Our wrist joints are important for almost all movements of the hand. Whether you are picking up a cup, playing tennis, or waving “hello,” it is important to have minimal pain in the joint that allows these motions to happen.
The wrist comprises a complex network of nerves, bones, and soft tissue that allow wrists to move around smoothly. Being aware of this structure can give an individual an idea of what is going on in their body.
Over time our tissues naturally deteriorate, which can cause pain. This common ailment is called arthritis. Arthritis of the wrist can interrupt many daily processes, so it is important to take care of the issue after the diagnosis has been made.
The treatment process for arthritis involves non-invasive methods, to begin with, but may lead to wrist replacement surgery. This is an invasive process that seeks to rid a patient of pain. The recovery process can be long, but certain forms of therapy can speed this up called regenerative medicine.
Anatomy of the Wrist
The wrist is made up of many small bones and joints, which all play a role in the functionality of the wrist. The groups of bones involved are:
- Radius and ulna: The wrist joint begins at the distal ends of the radius and ulna, the two bones inside the forearm.
- Carpal bones: After the radius and ulna, you will find the 8 carpal bones. They are arranged in layers of 4 bones, each at the base of the hand. These bones are called:
- Trapezium
- Trapezoid
- Capitate
- Hamate
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
- Metacarpal bones: These are what eventually lead to the bones found in fingers. They are located at the center of the hand and are labeled by number; metacarpal bones 1-5.
Each of these bones plays an important and unique role in all hand functions. Every time a bone in a hand meets another bone, a joint is formed between them. The function of joints is to provide mobility. Joints are made up of rubbery, fleshy pieces of soft tissue called articular cartilage, which provides a cushion between bones so that they don’t rub against one another.
Arthritis of the Wrist
Arthritis can be caused by natural degeneration of soft tissue or exacerbated by a previous injury in which the joint was misaligned or damaged. After being injured or damaged, the joint becomes inflamed and causes pain. When this occurs, there is a potential for damage in several areas:
- Bone damage: As bones are no longer gliding softly against one another, they are experiencing constant resistance from other surrounding bones. This can cause pain and deterioration of the bones over time.
- Tendon and muscle damage: As the joint deteriorates, it can affect the structure of muscles and ligaments surrounding it. Soft tissues will often realign in an attempt to make up for the lost motion, which can lead to added stress, damage, tears, and pain.
Arthritis is one of the most common causes of joint pain in the country and affects most people over 50. Once confronted with wrist pain, an individual should seek the advice of a doctor to discuss a treatment plan.
Treatment of Arthritis in the Wrist
The well-understood nature of arthritis means that conventional treatment plans are fairly uniform, and doctors are generally familiar with what to do. All treatment plans are devised with patients’ specific needs in mind and can be tailored to them. These plans generally include:
- Limiting activity: The first step in most treatment plans is eliminating any unnecessary activity that may exacerbate pain. This can include playing tennis, writing or typing frequently, or even using a cell phone. Doctors will recommend a change in these regimens that could help chronic pain. For example, someone who plays tennis but is experiencing pain during the game might be suggested to try a less aggressive form of activity such as swimming.
- Anti-inflammatory measures: As arthritis progresses, the joint becomes more and more inflamed, so doctors may recommend using over-the-counter NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen or naproxen. This also may be accompanied by a regimen of regularly icing the area–consistent ice application can help reduce inflammation and pain.
- Splint: Doctors may recommend patients use a splint or similar mechanism to stabilize the wrist joint. Immobilization of the joint can temporarily relieve pain, especially when pain is felt most during certain activities.
- Physical therapy: Certain wrist motions can help strengthen the muscle rather than exacerbate pain. The goals of physical therapy are to increase range of motion, increase comfort, and strengthen muscles surrounding an injury to increase support.
- Steroid injections: If the aspects mentioned above of a treatment plan are not working well enough to reduce pain and discomfort, some doctors suggest corticosteroid injections. These use a synthetic hormone that mimics the natural hormone called cortisol. Cortisol produced in the body has anti-inflammatory properties, so injecting the synthetic version into a painful area or injury can reduce inflammation and pain. These types of injections have several risks that should be considered and have been proven to damage soft tissue over time.
These are the least invasive forms of treatment and are often a gateway to surgery. Though doctors will try non-invasive options before even considering surgery, it can be inevitable depending on the extent of damage done. This is especially true in older patients whose joints have degenerated for longer.
Wrist Replacement Surgery
If arthritis has advanced enough and other treatment options fail to treat pain and discomfort, doctors may recommend wrist replacement surgery, sometimes called total wrist arthroplasty. This invasive procedure seeks to reduce pain and discomfort by providing a whole new joint structure in the wrist.
The procedure is performed using generalized or localized anesthesia. It involves placing pieces of plastic and/or metal into the bones, increasing wrist function. Surgeons sometimes completely remove the carpal bone structure, replacing it with artificial equipment.
In some cases, the carpal or metacarpal bones will be fused using a bone graft or screws to provide structure.
This option is called wrist fusion surgery. This surgery seeks to fuse bones when the joints fail to do their job. This essentially eliminated the need for joints in some areas. The surgery is also very invasive and can be more drastic than wrist replacement surgery. Wrist replacement surgery offers the option of continuing certain activities that require total wrist functionality, whereas wrist fusion surgery may not allow a patient to participate in certain activities anymore.
Once completed, doctors will discuss a recovery plan with patients. These plans generally include:
- Prescription pain medication: After surgery, over-the-counter medications are not often strong enough for pain relief. This is why doctors prescribe pain medication, but these come with their own set of risks, which should also be considered.
- Physical therapy: Keeping the joint moving after a surgical procedure is important. This allows the soft tissues around it to heal in the correct position.
- Cast and brace: After the surgery, most patients are placed in a cast to immobilize the injury, but it is recommended that they begin certain wrist motions once the cast is removed after a couple of days. Wrist braces are commonly used in the recovery process to avoid injury during daily activities. Motions to avoid include overexerting the wrist and bending it in a way that can harm it.
Recovery from wrist replacement surgery typically only lasts a couple of months before a patient can live their lives normally. Reduced pain is expected within a month or two of surgery as the body heals. Patients must follow their treatment plans as prescribed so that they heal on time and do not cause further damage to the wrist.
All surgical procedures come with a set of risks, for wrist replacement surgery includes infection, blood clots, stroke, and rejection of foreign objects in the body. Doctors will be aware of these risks and should discuss them with patients before allowing them to undergo surgery.
Surgical options can feel extreme but may be necessary to restore the quality of life. Treating pain can be long and arduous, so it is important to locate the source of the pain. There is a form of treatment that also seeks to treat problems that may arise during the healing process after surgery and may speed up the recovery process.
How Regenerative Medicine Eases Recovery From Wrist Replacement Surgery
Regenerative medicine works best on soft tissue, cartilage, tendons, and bone. After surgery such as wrist replacement, these tissues are displaced and possibly damaged. Choosing to use regenerative therapies increases the chances that these tissues will heal correctly.
CELLAXYS offers two types of regenerative therapy:
Cell-Based Therapy
Cell-based therapies focus on the autologous tissues, the natural cells and tissues in your body. You may also know these procedures as “stem cell therapies.” They involve replacing the damaged cells from your adipose (fat) cells, blood cells, or bone marrow with healthier ones. The new cells are processed in a laboratory and reinjected into the area of injury.
Depending on your situation, your doctor may suggest one of the two types of cell-based therapies:
- Minimally Manipulated Adipose Tissue transplant (MMAT): This procedure replaces the damaged cells of your adipose tissues with healthy ones. MMAT is effective in multiple treatments. Your healthcare provider can perform several transplant locations in the same MMAT procedure.
- Bone Marrow Concentrate (BMAC): This procedure harvests damaged cells from your bone marrow and replaces them with healthy cells.
The doctor will put you under anesthesia during the procedure, so you won’t feel the pain. Cell-based therapies usually take about 1.5-2 hours to complete. Both MMAT and BMAC are performed as outpatient procedures. This means you’re likely to go home after the process.
Platelet-Rich Plasma (PRP) Therapy
Platelets are a crucial component of our blood, possessing exceptional healing and tissue growth factors. They release almost 10 types of growth factors to boost the growth of healthy tissues and cells in your body. Then, they attract healing cells from the blood and produce a sticky web called fibrin. Fibrin lays the groundwork for new tissues to start developing.
Platelet-rich plasma or PRP therapy isolates platelets from plasma and injects them into the affected area. It promotes healing in those areas and helps treat multiple orthopedic and spine injuries. PRP completes in about 45 minutes.
PRP and cell-based therapies may involve imaging technology such as MRI or X-ray to guide the placement of the needle. This ensures that the healing properties are placed in the correct location where they will best be able to do their jobs.
The recovery process is minimal, and patients should expect to see results within a couple of days. There is a small risk of increased pain at the injection site, but this typically goes away in days.
