Need advise have surgery scheduled in the am these are my two options surgery tomorrow at 10 am
Option 1
Wrist denervation: The idea behind this operation is to cut the nerves taking pain signals from the wrist to the brain so the pain is either not felt or felt much less whilst also NOT damaging the important nerves that provide sensation and movement to the wrist and hand. To remove all the nerve supply (denervate) to the wrist fully is not really feasible. We, like many other surgeons, just divide the 2 small end nerves that lie in the middle of the end of the forearm and take the majority of the pain signals from the wrist to the brain. These nerves are called the anterior and posterior interosseous nerves. This is not a very reliable operation so the Hand specialist will typically inject local anaesthetic around these nerves at a clinic visit to assess the likelihood of success. If there is little or no benefit then the operation is unlikely to work. If the injections work for at least several hours then the operation has about a 70% chance of success. I have had two injections in 2 days no success
Option 2
Wrist fusion: This is a reliable operation that has stood the test of time. Most patients are pleased but few are thrilled for although they have lost their pain (in most cases0 they have also lost wrist movement. Typically the wrist is fused slightly cocked back. The best position can be gauged in part by holding the wrist in plaster of Paris in advance. This allows the patient to gain a better idea of what it is like to have a fused wrist and what position is best for them. We find this a useful step in guiding patients about a fusion if they are unclear.
The operation is performed under a regional (making the whole arm numb) or general anaesthetic. Via a 12-14 cm incision over the back of the wrist the surgeon opens the wrist removes a little bone to optimise healing and fixes the position with a long narrow metal plate and 6-8 screws. This is designed to stay in long term but sometimes (c. 10%) requires removal. The deep tissues are closed and the skin stitched with absorbable stitches. The wrist is supported in a plaster of Paris back slab for comfort.
The time in hospital is usually one night's stay
Wrist denervation: The idea behind this operation is to cut the nerves taking pain signals from the wrist to the brain so the pain is either not felt or felt much less whilst also NOT damaging the important nerves that provide sensation and movement to the wrist and hand. To remove all the nerve supply (denervate) to the wrist fully is not really feasible. We, like many other surgeons, just divide the 2 small end nerves that lie in the middle of the end of the forearm and take the majority of the pain signals from the wrist to the brain. These nerves are called the anterior and posterior interosseous nerves. This is not a very reliable operation so the Hand specialist will typically inject local anaesthetic around these nerves at a clinic visit to assess the likelihood of success. If there is little or no benefit then the operation is unlikely to work. If the injections work for at least several hours then the operation has about a 70% chance of success. I have had two injections in 2 days no success
Option 2
Wrist fusion: This is a reliable operation that has stood the test of time. Most patients are pleased but few are thrilled for although they have lost their pain (in most cases0 they have also lost wrist movement. Typically the wrist is fused slightly cocked back. The best position can be gauged in part by holding the wrist in plaster of Paris in advance. This allows the patient to gain a better idea of what it is like to have a fused wrist and what position is best for them. We find this a useful step in guiding patients about a fusion if they are unclear.
The operation is performed under a regional (making the whole arm numb) or general anaesthetic. Via a 12-14 cm incision over the back of the wrist the surgeon opens the wrist removes a little bone to optimise healing and fixes the position with a long narrow metal plate and 6-8 screws. This is designed to stay in long term but sometimes (c. 10%) requires removal. The deep tissues are closed and the skin stitched with absorbable stitches. The wrist is supported in a plaster of Paris back slab for comfort.
The time in hospital is usually one night's stay