Wrist

How Regenerative Therapies Make Sense After Wrist Replacement Surgery?

By Last updated on April 5, 2020 Last updated on April 5, 2020 No Comments

DO YOU HAVE WRIST PAIN?

Wrist Replacement Surgery

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 is comprised of 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 can deteriorate, a natural process but one that can cause pain. When this happens it is called arthritis which is very common. Arthritis of the wrist can interrupt so many daily processes, so it is important to take care of them once this 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 eventually. The recovery process can be long, but there are certain forms of therapy that 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 beginning of the wrist joint is 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 one through five.

Each of these bones plays an important and unique role in all functions of the hand. Every time a bone in the 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 be exacerbated by a previous injury in which the joint became 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 the age of 50. The degeneration that characterizes arthritis is natural but can cause great discomfort leading to disruption of daily activities. 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 a patient’s specific needs in mind and can be tailored to them. These plans generally include:

  • Limiting Activity: the first step in most treatment plans is to eliminate any unnecessary activity that may be exacerbating pain. This can include playing tennis, writing or typing frequently, or even using a cell phone. In many cases, 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 the use of over-the-counter NSAIDS (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen or Naproxen. This also may be accompanied by a regimen of icing the area regularly – consistent application of ice can help reduce inflammation and pain.
  • Splint: doctors may recommend patients to use a splint or similar mechanism to stabilize the wrist joint. Immobilization of the joint can provide temporary relief from pain, especially when pain is felt most during certain activities.
  • Physical Therapy: certain motions of the wrist 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 that provide support.
  • Steroid Injections: if the aforementioned aspects of a treatment plan are not working well enough to reduce pain and discomfort, some doctors will suggest corticosteroid injections. These use a synthetic hormone that mimics the natural hormone called cortisol. Cortisol that is produced in the body has anti-inflammatory properties, so injecting the synthetic version of it 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 actually 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 sometimes be inevitable depending on the extent of damage done. This is especially true in older patients whose joints have been degenerating for a longer period of time.

Treatment seeks to not only provide a more comfortable life but also eventually treat the problem – this is why doctors turn to surgery, as the aforementioned treatment options do not fix the source of the problem.

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 is an invasive procedure that 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 which will increase wrist function. Surgeons sometimes opt to remove the carpal bone structure completely, replacing it with artificial equipment. In some cases, the carpal or metacarpal bones will be fused together using a bone graft or screws to provide structure.

Patients may also be faced with the option of wrist fusion surgery. This form of surgery seeks to fuse bones together 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 painkillers, but these come with their own set of risks which should also be considered.
  • Physical Therapy: it is important to keep the joint moving after a surgical procedure. 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 overexertion of the wrist and bending it in a way that can harm it.

Recovery from wrist replacement surgery typically only lasts a couple of months until a patient is able to live their lives normally. Reduced pain is expected within a month or two of surgery as the body heals. It is important that patients 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 this 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 a long and arduous process which is why 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 process of recovery.

Regenerative Medicine and How it Can Help Recovery From Wrist Replacement Surgery

The field of regenerative medicine is becoming better understood every day with new advancements in the field. Doctors are already seeing significant improvements in patients who choose to try regenerative therapies, especially patients who have already undergone surgery.

CELLAXYS offers two types of regenerative therapy:

  • Stem Cell Therapy: stem cells are already used throughout the body because of their healing properties. This form of therapy involves harvesting these cells from either blood cells, fat cells, or bone marrow. Once extracted, the cells are processed and reinjected into the area of injury or degeneration. The increased concentration of healing properties allow an injury to heal faster than it would without injections.
  • Platelet-Rich Plasma (PRP) Therapy: platelets in our blood contain proteins and growth factors which aid in healing. When an injury occurs, platelets swarm to it to begin healing. This form of therapy takes a blood sample and places it in a centrifuge to isolate platelets from plasma. The concentrated platelets are then injected into the area that is causing pain. Similar to stem cell therapy, it is using the body’s own natural healing properties.

Both of these types of treatment 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.

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. Having these tissues where they should be is crucial to the healing process as they provide structure and mobility to the joint.

In wrist replacement surgery, bones are removed, fused, and/or hollowed out to make space for the foreign objects. Healing them as fast as possible will allow patients to return to their former activities with decreased pain.

The process of receiving regenerative therapy is an outpatient procedure and typically takes less than two hours. 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 a matter of days.

Not all doctors are aware of the potential benefits that regenerative medicine offers, so it is sometimes necessary to seek out a specialist. Cellaxys has several experts in the field who can provide consultation.

Conclusion

Wrist pain from arthritis can be detrimental to the enjoyment of life, but there are several treatment options out there that offer pain relief and treatment.

The complex structure of bones, cartilage and soft tissue that makes up and surrounds joints mean that treatment plans will be tailored to each patient’s personal needs. If surgery is the next step in the treatment process, regenerative medicine can be an option to speed up this process.

It takes a long time to reach the point where surgery is an option as trying less invasive treatment methods takes time. The recovery process from surgery does not have to be extremely long when coupled with regenerative medicine. They offer the option to return to normal, pain-free life in a short period of time.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Regenerative Orthopedic and Sports Medicine
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan State University Alumni

DO YOU HAVE PAIN IN YOUR BODY?

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