Nonsurgical treatment may not work for some patients just because of how severe their arthritis is. Once that cartilage is gone, you can't really regrow it. Once the bones are rubbing against each other, it really is a pain generator. Some people are able to benefit quite a bit from nonsurgical steroid injections or bracing different kinds of treatments, but some people, those treatments don't prove effective, and surgery is really the best option.
Steroid injections are like a high dose anti-inflammatory directly to a certain area of the body. Like anti-inflammatories that you take orally, ibuprofen or naproxen, they deliver an anti-inflammatory effect. Those things you take orally go throughout your whole body and affect your kidney, your stomach, everywhere. Whereas corticosteroid or steroid injections are like a high dose, targeted therapy just to one joint of the body. When you give an injection in the knee for knee arthritis, you're getting a targeted therapy just there. Similarly, in the hand, if you give an injection for base of thumb arthritis, you give a small dose of steroid directly where you need it.
Determining the best surgical treatment for a patient with wrist arthritis can depend on what they want to do with their wrist. Some heavy duty laborer type patients need the stability and strength in their wrist, and they don't mind losing some motion. In that situation, we would probably lean more toward what we call a fusion procedure where we make the bones stable and actually act as one long bone. Whereas if someone isn't as heavy lifting type daily activities, they can save their motion and do alternative procedures where we take out the arthritic bone, but we don't fuse the two bones together.
