What operations can help?
There are different types of operation which can produce pain relief in an arthritic joint:
Operations for Wrist and Hand OA
A. Joint replacement surgery for the fingers
Some of the knuckle joints can be replaced with a plastic hinge joint, which will remove pain from the arthritis but will also completely alter the way the hand works. Joint replacements tend to wear out within a few years in the hand and are often associated with loss of grip strength. Complications from joint replacements include infection, loosening or breakage of the joint, dislocation and other risks outlined in the ‘General information on having an operation on your wrist or hand’ section.
B. Joint fusion surgery
Fusion is the term used when the joint in removed and the bones on either side of the joint are pinned together so that they heal over with bone. This type of surgery is for pain relief only as you will lose all movement in the fused joint. Complications include infection, failure of the bone to fuse, and irritation from the pins holding the bones in place.
Operations for Wrist and Hand OA
Trapeziectomy
The most common procedure is a trapeziectomy. This involves removing one of the bone that is most worn and causing pain. The outcome of this operation is not guaranteed, and you may require a four to six week period in a cast after the operation. It is also quite usual for pain to be felt for some time after the surgery. It can take a while for things to settle down and it can take several months for you to feel the full overall benefit of the procedure. Surgery like this is generally only considered after you have tried and tested all of the other ‘simpler’ measures outlined in the workbook which often help avoid the need for surgery.
Operations for De Quervain’s Tenosynovitis
Decompression of the tendon tunnel
Via a small incision at the thumb side of the wrist and protecting the nerve branches just under the skin, the surgeon widens the tendon tunnel by slitting its roof. The tunnel roof forms again as the split heals, but it is wider and the tendons have sufficient room to move without pain. Pain relief is usually rapid although the scar may be sore and unsightly for several weeks. During the procedure the nerve branches are gently moved to see the tunnel, therefore, temporary numbness can occur on the back of the hand or thumb. As with all surgery there is a risk of stiffness in the joints involved and infection (less than one out of 100 cases).
The anaesthetic may be local (injected under the skin at the site of operation), regional (injected in the armpit to numb the entire arm) or a general anaesthetic (when you are put to sleep).
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