Wrist pathologies
Osteoarthritis of the wrist
Summary
Diagnosis
Treatments
It's the degree of damage, the extent of nerve compression, that determines the best course of treatment.
Different treatments are proposed for each stage of the disease.
Surgical treatment
Arthroscopy
Wrist arthroscopy can be used to assess lesions, clean the joint and remove excess inflammatory synovium.
This treatment is often only temporary, but in moderate forms it can provide lasting symptomatic relief. It is sometimes combined with platelet-rich plasma injections.
The procedure is performed on an outpatient basis under anaesthesia of the entire arm using a plexus block.
Partial arthrodesis
Partial arthrodesis of the wrist can be performed. When osteoarthritis has progressed in part of the joint, it is possible to remove certain carpal bones that no longer have cartilage, but the remaining bones must be fused together to stabilize the joint. This is called partial carpal arthrodesis.
This surgery is performed on an outpatient basis, although in some cases an overnight hospital stay may be necessary. The entire arm is anesthetized using a plexus block.
Resection of the first row of the carpus
Resection of the first row of the carpus is also a frequently used option.
The scaphoid, semi-lunate and pyramidal bones are removed. A new joint is thus created between the head of the central bone, known as the greater bone, and the radius.
Prostheses
Thereare partial prostheses to cover, for example, the head of the large bone when its cartilage has been altered, after resection of the first row of carpal bones.
There are also total wrist prostheses, which replace the entire joint.
This surgery is performed on an outpatient basis, although in some cases an overnight hospital stay may be necessary. The entire arm is anesthetized using a plexus block.
Other types of partial prosthesis exist, but I have a preference for and extensive expertise in the resurfacing prosthesis of the head of the large bone.
Total arthrodesis
Total arthrodesis is a definitive operation in which the whole wrist is completely locked, usually by a plate with screws. I only perform it when there is no other solution, or when another method has failed and cannot be reversed.
In all cases, it's through discussion with your surgeon that you'll find the solution that seems best suited to you. He or she will be able to explain the different options available to you, depending on the degree of your osteoarthritis, to help you make the best choice for relieving your symptoms and preserving your function.
Standard post-operative care
After wrist arthroscopy, steri-strips are used to close the small openings made to pass the camera and instruments through the wrist. Nursing care lasts around ten days.
After partial carpal arthrodesis, absorbable sutures close the skin. Nursing care is required every two to three days for 15 days, and if the sutures do not fall out on their own, a nurse will remove them.
After partial carpal arthrodesis, absorbable sutures close the skin. Nursing care is required every two to three days for 15 days, and if the sutures do not fall out on their own, a nurse will remove them.
Immobilization in a custom-made, ideally thermoformed plastic splint, will be maintained for three weeks at all times and for a further three weeks, with the patient starting to mobilize early on.
After a total wrist prosthesis, absorbable sutures close the skin. Nursing care is required every two to three days for 15 days, and if the sutures do not fall out on their own, a nurse will remove them.
The patient is immobilized in a custom-made, ideally thermoformed plastic splint, which is kept on for three weeks, but can be removed during the day to begin self-education.
Possible complications
Infections are rare in hand and wrist surgery. Post-operative care must be carried out regularly by an attentive nurse, who should be on the lookout for abnormal inflammation.
Algodystrophies are always a possibility in this complex surgery.
In the case of partial arthrodesis, the bones may not fuse together, a condition known as pseudarthrodesis, which may require further bone grafting.
Dislocation of partial prostheses is exceptional.
In the case of total prostheses, loosening will lead to replacement of the prosthesis in the same way as for the limb or knee.
As a general rule, when a joint remains, i.e. excluding cases of total prosthesis,osteoarthritis can continue to progress and lead to another operation.
In brief
Type of anesthesia
Whole arm by plexus block
Type of hospitalization
Often outpatient, sometimes overnight hospitalization
Average downtime
Between 3 and 6 weeks, depending on the method used
Average recovery time
Between 6 weeks and 6 months, depending on the operation performed
Quervain's tendonitis
Summary
Diagnosis
Treatments
Medical treatment
Medical treatment may involve anti-inflammatory drugs and a rest orthosis.
In recent and moderate forms, cortisone infiltrations can also be performed, which I recommend under local anaesthetic and ultrasound monitoring, for the patient's comfort and the reliability of the procedure.
If medical treatment fails, or the tendons become blocked, surgery may be required.
Surgical treatment
Surgery involves freeing the tendons trapped in this first extensor compartment.
Dr. Couturier performs an enlargement of the groove, combined with a synovectomy to remove the excess synovial membrane. The procedure is usually performed on an outpatient basis.
Dr Couturier performs this procedure preferably under WALANT anaesthesia, with a small local opening. This makes it possible to check actively during the procedure (you move your thumb yourself) that the tendons are correctly released.
Standard post-operative care
The skin is sutured with absorbable sutures, and a nurse will provide regular care and remove the sutures if they don't fall off by themselves after 15 days.
Dr Couturier does not immobilize patients after the operation, allowing immediate use of the hand without exertion for three weeks.
A small haematoma often appears on the wrist or forearm, sometimes at the base of the thumb.
Pain can take a long time to disappear. The tendon must be healed and remodeled before it is no longer sensitive.
It's not uncommon to experience a disturbance of sensitivity on the back of the hand between the thumb and index finger for a few weeks. This is because the terminal branches of the radial nerve are located just above the first extensor compartment. These are moved aside during the operation, but as this nerve is very sensitive, there may be a disturbance of sensitivity locally.
Normal activity can usually be resumed after three weeks.
Possible complications
The main complication is a neuroma (small swelling on a nerve) on one of the terminal branches of the radial nerve.
Recurrence of this disease is possible despite surgery.
In brief
Type of anesthesia
WALANT
Type of hospitalization
Ambulatory,
Average downtime
No strict immobilization
Average recovery time
3 to 6 weeks (to resume strength activities)
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