Saturday, 2 March 2013

Wrist Fusion Surgery

My wrist has a lot of damage that occurred before I was diagnosed. A few years after diagnosis I saw a surgeon who would have been happy to do a number of procedures to make my hands look and function better but I could not believe that it was necessary then.

25 years later...

Recently I was worried that I might have a ruptured tendon so I saw an orthopedic surgeon.  His opinion was that I had to have my wrist fused before he would do any other hand surgery. He said a replacement wrist joint was not an option for me, given the spotty success rate.  Since I had only about 10 degrees of movement in my wrist it sounded as though I would not lose much flexibility and my hand would be in a more functional position.

This is one view of how it looked before the surgery:

You can see that my hand above has an ulnar deviation. The whole hand is no longer straight. More often in RA it is the fingers that sway to the side. This is the way it looks now, after surgery:

Much better than before. Very strange how you don't really notice as things change over the years.  Finger deformities always seemed more obvious than the orientation of my hand. 

My operation was 5 weeks ago.  It was done as day surgery and it took  2 1/2 hours to complete.  I had a nerve block that numbed my whole arm.  When I saw my arm raised in the air after the nerve block and just before the operation I thought it belonged to someone else.  

After the operation they put a cast on from below the knuckles to above the elbow. That left me able to bend my arm a little.  You can't tell that from the picture because the cast is wrapped in a tensor bandage.  There is an open gap down the whole cast to accommodate swelling.  That purple arrow on my shoulder marks the correct arm for the surgery.  There were more markings under the cast.

The nerve block was very effective and I have moderate regrets I did not stay  conscious through the operation to hear the surgeon talk his surgical assistant through the process. However my curiosity wilted once they started.  I have heard the noise level in the OR is high and I know surgeons use power tools in their work. Remembering the noises was not on my bucket list.

Now that my wrist is fused it is supposed to be a pain free joint and stronger than it was.  It's early to say how that will work out but my fingers still move well. They were very bruised and swollen but that's normal after surgery.  Anything the surgeon touches seems to bruise and swell more dramatically now than it did when I was younger.

I am told that the incision is healing well and it is meticulously stitched - it will probably not be very noticeable. In the following picture you can barely see it.

                                               4 1/2 weeks after surgery

                                             just after stitches and cast were removed

I was glad to see this blog before my surgery. Reading someone's actual story of the process is more illuminating than reading the technical sites like Wheeless. I had read enough that there were no surprises after the surgery.

All in all my hand looks better in profile and straight on. After the cast was removed my elbow range of motion was diminished but with rehab exercises from the Occupational Therapist (OT) I have regained all of the motion of my elbow.

There is still some pain in my wrist as it heals, and I must wear a splint for the next month. The OT custom-makes them for each hand surgery patient.  The splint can be removed for washing and exercise.
                                     The Splint

I am doing a follow up post showing how it looks 4 months after, and also the X-rays of the hardware they actually use for the fusion. I can hardly believe what is under my skin.  You can see it here.


  1. Being the curious sort, I was awake for my forefoot surgery. I had a bit of a chat with the anaesthetist. Then he picked up the paper and I just listened to the sound of power tools.

    It's so true what you say about the changes being gradual over the years, so that they become unnoticeable.

    I'm glad that you're healing well.

  2. Maybe next time I'll stay awake like you did. I was curious enough to read the notes in my chart on the last visit and it sounded less complex than I imagined. But it will be quite a while before I jump in and do something else.

    Next is likely the knuckles with the thumb following after. Orthos are very methodical, I think.

    You don't hear power tools in your dreams?

  3. What a brave lady you are and a fabulous documentary account of events. When I 'll see you next, we will be shaking hands?

  4. For sure we'll be shaking hands Mara. The scar looks good already. It's just a little numb on top but they say the feeling will come back in time.

  5. You are really a brave lady. I hope you will have recovered properly now. Of course surgery is a best solution to treat wrist injury but we should also get physical therapy after surgery to recover rapidly. back and neck pain bergen county

    1. I had OT from a hand therapist but may talk to physio about it. The surgeon said I should exercise to strengthen the forearm since the wrist is still a bit sore soetimes, though there is really no joint

  6. I have rheumatoid arthritis in both wrists.I'm 44..To date nothing in the 2 years since I was diagnosed has worked.
    Had my 2nd MRI 5 weeks ago and rheumatologist said there had been even more severe destruction so that explained my heart stopping pain.
    I now can no longer bend my wrists without excruciating pain that makes me want to vomit so im in permanent braces but im still in pain because my wrists still move within the braces.
    My rheumatologist has said I need wrist fusion surgery on both wrists.
    Just wondering how people cope with personal hygiene ie toileting if you cant bend the wrist at all ????..
    My 2 thumbs when moved certain ways really hurt the wrists so does that mean my thumbs need fusing to ?..
    Thanks all.

    1. Hi Fleur, I have a friend who had some devices made by an occupational therapist therapist to help with that, and heard of another person too who has a device to help her.

      I have had both of my wrists fused and it is more difficult but still quite possible.

      There are different things that can be done for thumbs. When they do a fusion the surgeons try to make sure that the joint is in a functional position.

      Hopefully if your wrist are fused it will no longer hurt when your thumb moves in the way that bothers you now.

      I had my wrists done a year apart. It is hard on the body to have surgery so I have spaced my surgeries out. As a side benefit I can type faster with my wrists fused than I could before that happened