WRISTS Worth SAVING
Article by Ann Butenas
Mitchell Solano, MD -A Kansas City orthopedic surgeon sheds light on wrist arthritis and why patients have more options today than ever before.
For many people, wrist pain is something they quietly endure, chalking it up to aging or overuse and hoping it eventually resolves on its own. But Mitchell Solano, MD, a board-eligible orthopedic surgeon with Rockhill Orthopaedic Specialists, wants patients to know that relief is well within reach. With advanced fellowship training in hand, wrist, and elbow surgery from Brown University, Dr. Solano brings a distinctive level of expertise to the Kansas City area. A Lee’s Summit native, he and his wife chose to return home to raise their three boys in the community where they both grew up.
Q: What drew you to hand and wrist surgery?
Dr. Solano: I didn’t initially know I wanted to become a hand surgeon, but during residency I had outstanding exposure to hand trauma and was fortunate to train under exceptional mentors who inspired me to pursue the specialty. My interest in wrist arthritis and wrist replacement surgery further developed during my fellowship training at Brown University, where I trained with one of the world’s leading experts and innovators in total wrist arthroplasty.
Q: What are the most common causes of wrist pain, and how do you determine what’s actually going on?
Dr. Solano: Wrist pain can stem from a variety of causes. Common conditions include tendinitis from overuse, arthritis related to chronic wear and tear or prior injury, ligament injuries, and fractures. A detailed history, physical examination, and radiographs are often enough to determine the cause. In certain cases, advanced imaging such as MRI or CT scans may be necessary to better evaluate the soft tissues and joint surfaces.
Arthritis can affect patients of all ages. Osteoarthritis is more common later in life as joints naturally wear over time, while post-traumatic arthritis can occur much earlier following a prior injury such as a fracture or ligament injury. There are also inflammatory forms of arthritis, including rheumatoid arthritis and gout, that can affect the wrist joint.
Q: At what point should someone stop managing the pain on their own and see a specialist?
Dr. Solano: Many people try to live with arthritis symptoms for years. I generally recommend seeking evaluation when the pain begins affecting quality of life, daily activities, work, hobbies, or overall functional goals. Early evaluation can help patients better understand both conservative and surgical treatment options before symptoms become more limiting.
Q: What non-surgical treatments do you typically recommend first?
Dr. Solano: Surgery is generally considered a last resort, as many patients can achieve meaningful relief with conservative treatment. Initial management often includes bracing, anti-inflammatory medications, and activity modification. Steroid injections are another effective option and can sometimes provide relief lasting a year or longer. When these measures no longer provide durable relief and symptoms significantly impact quality of life, surgery may then become part of the discussion. If patients find certain lifestyle changes helpful in managing symptoms, I encourage them to continue those practices.
Q: How do you explain the difference between wrist fusion and wrist replacement to patients?
Dr. Solano: Both procedures can provide excellent pain relief. The major distinction is that wrist replacement preserves motion, while wrist fusion permanently joins the bones of the wrist together so the joint no longer moves. Fusion is the traditional gold standard for end-stage wrist arthritis. Wrist replacement removes the damaged joint surfaces and replaces them with metal and plastic components like a hip or knee replacement, with the goal of preserving some wrist motion. The choice between the two is largely guided by imaging findings, the specific pattern of arthritis, and a patient’s lifestyle and activity level. The decision ultimately depends on the patient’s goals, lifestyle demands, and expectations following surgery.
Q: Who is an ideal candidate for total wrist replacement, and what does recovery involve?
Dr. Solano: Ideal candidates are typically patients with advanced wrist arthritis who are seeking pain relief while maintaining functional wrist motion. Patient activity level, bone quality, overall health, and functional goals all play an important role in determining candidacy. Those with more labor-intensive lifestyles may consider wrist fusion a more durable option in some cases.
Recovery involves a period of immobilization followed by progressive therapy to reduce swelling, restore motion, and improve function. Hand therapy plays an important role in that process, and patient participation and compliance are key factors in achieving the best possible outcome.
Q: How long do wrist implants last, and what happens if one eventually fails?
Dr. Solano: The 10-year implant survivorship rate varies between 70% and 90%, depending on the study and type of implant. A 2020 study published in the Journal of Hand Surgery evaluated wrist replacement implants placed between 2005 and 2009 and demonstrated 92% survivorship at 10 years. Implant technology continues to evolve, and newer-generation implants may provide even greater longevity moving forward. If revision becomes necessary, revision components exist, or one may consider wrist fusion if arthroplasty fails.
Q: What excites you most about where this field is headed?
Dr. Solano: I am encouraged by the continued advancements in implant design and surgical technology. As these innovations evolve, they have the potential to further improve outcomes and quality of life for patients living with wrist arthritis.
Mitchell Solano, MD, is a board-eligible orthopedic surgeon with Rockhill Orthopaedic Specialists, with advanced fellowship training in hand, wrist, and elbow surgery. To learn more or schedule a consultation, visit RockhillOrtho.com.
