Wrist and Hand Surgery:
Surgical Correction for Rheumatoid Arthritis in the Hand and Wrist

          Arthritis is chronic condition that often worsens to the point where oral medication is insufficient to control the associated pain and discomfort.  To maintain a fulfilling lifestyle and level of activity, it may be necessary to look at more invasive options for pain management.  One avenue of exploration may be a surgical approach where a qualified physician manipulates the internal structures of the hand or wrist.

“What can you expect to gain?”

          The most common reason for attempting surgery is the wish to alleviate pain that has failed all other less invasive treatment options.  Second, often there can be improved functional status after surgery.  Arthritis can be a debilitating disease due to both physical discomfort as well as actual deformity of the joint which can decrease mobility.  A surgical procedure may have the potential to increase the function of the joint and allow a person to regain the ability to do activities that they could not in their current state.  Finally, in some circumstances, there may be a cosmetic improvement as arthritis can often lead to joint deformity that is externally visible. 

“How do you know surgery is right for you?”

          The best thing you could do is to get informed about the options (such as reading this article)!  Each person is unique and the more knowledge you have, the easier it will be to discuss these issues with your doctor.

          Make sure you find a doctor that you feel comfortable talking to and that takes the time to answer all your questions.  The decision to have surgery is one that you and your physician should both agree is the best option.  By having good communication, you should have a clear understanding of reasonable expected benefits as well as potential complications. 

“Is surgery a quick fix?”

          The surgery itself will only be a small part of your total treatment plan.  Although the surgery itself will probably only take a few hours, you should expect a much longer recovery period as well as commitment to follow-up visits, rehabilitation, and physical therapy.  Unfortunately, there are no quick fixes.

“What types of surgery are available for arthritis of the hands and wrist?”

          Resection-

          This simply means the removal of something such as a bony structure.  Arthritic joints may have areas where the bones have abnormally grown and this causes pain with articulation (movement).  To relieve the discomfort associated with the extra material, the doctor may go in and simply remove the superfluous material.  Thus, without the intrusion of the extra bone there will be decreased pain and increased mobility in the joint.

          Arthroscopy-

          This is when a doctor uses a small camera to look inside a joint and allows him the ability to remove or alter any tissue in the joint that may be diseased.  Most often done in larger joints such as the knees, this relatively simple procedure is now being done on wrist joints.  The incision is very minimal and anesthesia can be kept at a minimum.  This translates into quick recovery times.

          Synovectomy-

          Removal of the synovium or tissue that surrounds the joint is another option.  If the synovium becomes diseased and causes pain, it can be surgically removed to relieve the symptoms.

          Arthrodesis-

          Arthrodesis or bone fusion is done on wrists, fingers, and thumbs.  This procedure essentially joins together the two sides of a joint so as to make the joint immobile.  The benefit of the procedure is pain relief although the movement of the joint will now be fixed causing limited range of motion.

            Arthoplasty-

            Another option is to rebuild the joint.  A diseased joint may become misaligned or the surface itself may be diseased.  Arthoplasty allows for the realignment and/or reshaping of the joint to alleviate pain and discomfort and increase function.  This term also includes joint replacement where synthetic or foreign material may be used to reconstruct the joint.

“Who should make the decision to have surgery?”

            Ultimately, if your doctor decides that your are a potential candidate for surgery, it is up to you to decide whether to go through with surgery.  No surgical procedure is without risks.  Both you and your doctor should play an active role in discussing the benefits and potential complications of any medical treatment option.

Gabor Pernyeszi, B.S. University of Connecticut School of Medicine, Farmington, CT

Bimalin Lahiris, M.D., St. Francis Hospital, Hartford, CT