Arthroscopic wrist surgery is a minimally invasive wrist surgery done to evaluate and treat a wide range of wrist injuries and conditions. The procedure is typically performed in an outpatient facility using regional anesthesia. This insures the hand and arm will be numb and the patient will not be able to feel any pain during the procedure. A sedative may also be administered to further relax the patient.
To complete the surgery, an orthopedic physician makes small surgical cuts (less than 1 centimeter each) on the back of the wrist. He or she will look inside one of the incisions with an arthroscope (a tiny tube with a camera lens and a light source) and repair and/or evaluate the area by going in through the other incisions with small surgical instruments. After the surgery, the incisions are closed with stitches and a dressing is applied to keep the wounds clean. Some physicians may also provide patients with a splint to stabilize the wrist joint and promote healing.
DIAGNOSING WRIST CONDITIONS
The wrist is made up of small bones, joints, tendons and ligaments, and connects the hand to the forearm. Wrist pain is quite common and a wide range of injuries and conditions can affect the area. Repetitive motions (like typing, racquet sports or sewing) can put stress on the wrist and are often the cause of discomfort. Wrist pain that is accompanied by bruising, clicking, swelling, misshapen joints and/or a lack of mobility can be a sign of an injury. To identify the cause of your wrist pain, your doctor will ask you about your symptoms, do a physical examination, and may order diagnostic testing like x-rays or an MRI.
WHO NEEDS WRIST ARTHROSCOPY?
As with most orthopedic conditions, there are conservative and surgical treatment options. Many orthopedic patients with wrist injuries or wrist pain will respond well to conservative treatments like rest, over the counter pain medication, or physical therapy. However, if these measures fail, wrist arthroscopy is an effective way to assess and treat wrist pain and conditions. Some of the reasons a patient may undergo arthroscopic wrist surgery include:
- To evaluate their pain or examine the integrity of the wrist ligaments, cartilage, and bones.
- To assess and treat ligament and cartilage tears, and assist in complex fracture management.
- To remove loose bones or cartilage (loose bodies).
- Adhesion removal (areas of built up scar tissue that can limit movement and cause pain).
- Removal of ganglion cysts.
ADVANTAGES OF WRIST ARTHROSCOPY
As a minimally invasive procedure, wrist arthroscopy is less painful than regular surgery, which makes it a great option to help restore wrist function. Tasks that were challenging prior to surgery should become easier and less painful after recovery. The advantages of arthroscopic surgery over traditional surgery include:
- Smaller surgical incisions which result in less scarring and a lower infection rate
- Less trauma to ligaments, muscles, and tissues
- Less pain and a quicker recovery period
- Earlier mobilization following surgery
- A shorter hospital or outpatient stay– many patients go home the day of their procedure
How fast a patient recovers from wrist arthroscopy depends on what types of injuries or conditions were being treated. Recovery time can range from several days to several weeks or months. After wrist arthroscopy, your orthopedic physician will likely wrap your wrist in a protective bandage, sling or splint. Time spent in a splint will vary from patient to patient depending on their rate of recovery. Your physician may also prescribe the RICE regimen for the first two or three days following surgery: rest, ice (not to exceed 20 minutes at a time), compression, and elevation (keeping the wrist above heart level to reduce swelling and pain). Your physician may also instruct you to keep your surgical incisions covered, clean and dry following the procedure. This means you may not be able to shower until the surgical dressings are removed and replaced with a waterproof covering. Keep in mind that post-operative bleeding is not unusual. However, if the amount of bleeding seems concerning it’s important that you call your orthopedic physician in a timely manner.
Following arthroscopic wrist surgery certain tasks may be unsafe or painful to execute. Such tasks may include:
- Bathing- It is important to keep your dressing or splint dry. You may shower by wrapping the wound dressing in plastic.
- Work- After surgery you may need to wear an arm sling. This may make it difficult to use the computer, write or perform other work-related tasks.
- Exercise- Outside of your prescribed therapy regimen, do not use the operative wrist for any activities involving pushing, pulling, twisting or lifting until your doctor gives you clearance to do so.
PHYSICAL THERAPY FOR WRIST ARTHROSCOPY RECOVERY
Many surgeons have their patients take part in formal physical, occupational and/or hand therapy after any type of arthroscopic wrist procedure. Typically, the more complex the surgery is, the longer the rehabilitation process will be. Although specific physical therapy regimens vary from patient to patient, most therapists will initially prescribe wrist strengthening exercises, range of motion (ROM), grip and pinch exercises, and exercises to reduce pain, stiffness and swelling. Over time, goals of physical therapy will expand to include returning to physical activity and job demands. The therapist will continue to be a resource, but the patient will need to perform their wrist exercises at home to complete the rehabilitation process.