Elbow & Wrist Surgery
The elbow and wrist are complex joints and like the shoulder are vital for upper limb function.
The most commonly seen complaints are arthritis and traumatic conditions.
Elbow
Osteoarthritis of the elbow is more common in men. It can be related to previous trauma. Similar to other joints this causes pain and stiffness. Osteoarthritis of the elbow can often lead to small loose bodies in the joint, which can cause pain and create a catching sensation.
Treatment for Osteoarthritis of the elbow initially is non-operative, with activity modification, physiotherapy, and simple pain medication and anti-inflammatories.
Surgical management can include arthroscopic (keyhole) surgery of the elbow to remove loose bone and cartilage fragments, and remove bone spurs. This does not reverse the underlying arthritis, but can provide symptomatic relief.
Elbow replacement surgery is less common than similar procedures on the shoulder/hip/knee. This is generally reserved for older and lower demand patients, and more commonly those with rheumatoid arthritis.
Wrist Arthritis
Wrist arthritis is most commonly related to previous wrist trauma. This trauma can often be relatively trivial, but can lead to ligamentous injury, or undiagnosed fractures in the small carpal bones. Subsequently people can develop significant arthritis of the wrist.
Following non-operative management, the most common surgical treatment of wrist arthritis is either partial or total wrist fusion. A fusion procedure involves joining or fusing bones together. This reduces the pain caused by the movement of arthritic joints, but does result in a reduction in the movement of the joint.
Triangular Fibrocartilage Complex (TFCC) Tear
The TFCC is a complex group of cartilage and ligament structures located on the little finger (ulnar) side of the wrist. It helps with stability and support of the wrist, as well as having a role as a shock absorber.
TFCC tears can be a cause of ongoing wrist pain.
TFCC tears usually come in one of two forms:
Type 1 (traumatic) tears - related to a specific injury.
Type 2 (chronic or degenerative) tears - related to long term wear and tear.
TFCC tears are usually suspected following careful examination of the wrist. Plain x-rays help to rule out any fractures or arthritic changes of the wrist. An MRI is the most reliable test to confirm the diagnosis.
Treatment depends on the type and severity of the tear.
Non-operative treatment can involve splints or braces, anti-inflammatories, and a cortisone injection.
Some cases require surgical intervention. This is commonly performed with arthroscopic (keyhole) surgery to assess and treat the tear. The tear may be surgically repaired or a debasement procedure may be used to clean-up the tear.
In some circumstances, patients may have a ‘long ulna’ which results in abutment between the end of the ulna and the carpal (wrist) bones. In this situation a procedure can be carried out to shorten the ulna, in addition to treating the TFCC.