End Small Joint Pain With a Minimally Invasive Procedure—a Philly Doctor explains

Photo credit: Getty Images

Many people with arthritis in their fingers, hands and wrists just power through the pain and discomfort because they aren’t aware there are solutions.  

But advanced, minimally invasive techniques are now available for patients with wrist and small joint issues, especially those suffering from arthritis. These patients can have access to cutting-edge surgical options that can delay or avoid joint replacement, reduce pain and restore independence—often with minimal downtime. 

“Small joint arthroscopy is pushing the envelope in hand and wrist surgery in a way that my colleagues who operate on large joints like knees, shoulders and hips have been doing for a long time,” says Dr. Meredith Osterman, a hand surgeon at Philadelphia Hand to Shoulder Center in their Glen Mills and Havertown offices. 

With small joint arthroscopy, surgeons make small incisions and insert tiny cameras to look inside the joints of the fingers, hand or wrist. It’s particularly beneficial for the wrist, which can be difficult to visualize with an MRI or ultrasound, as the anatomical structures often overlap. 

“The small camera allows us to look inside and understand the underlying issue and treat the injury in a very minimally invasive way,” Dr. Osterman says. “The benefit is you can diagnose and treat all in the same procedure, which is huge for patients.” 

In addition to treating arthritis, the technology can also aid in the treatment of injuries like torn ligaments and tendonitis as well as with joint replacement. “We can look inside the joint in real time, while the patient is moving their wrist and moving their fingers,” she says. “We can watch it what’s going on. It’s very dynamic.” 

Building on Tradition 

Osterman’s father, Dr. A. Lee Osterman, current president of Philadelphia Hand to Shoulder Center, was a pioneering hand surgeon of wrist arthroscopy in the United States in the 1980s. “At the Philadelphia Hand to Shoulder Center, we were at the forefront of this technology,” Dr. Osterman says. “Where I’ve pushed the boundary is taking it into the joints like the thumb and fingers using smaller and smaller instruments.” 

She used the example of a recent patient with a swollen wrist. Ten years ago, the wrist would have been opened up with a large incision. But in this case, she made a few incisions and went in arthroscopically to take cultures to determine whether the cause was infection or inflammation. “It was just four little poke holes, so there is less recovery and less wound issues,” she says.  

This reduction in recovery time makes a big difference to patients. Larger reconstructions like fixing a ligament or replacing a joint arthroscopically take the same time to heal, but there’s no added recovery or discomfort of waiting for the muscle and skin to heal. It amounts to less scarring as well.  

Beyond Small Joint Arthroscopy 

Arthritis is a common problem for older adults or for those with previous traumatic or sports injuries. Arthritic joints hurt because of bone-on-bone contact. The treatment is typically either a replacement of the joint or the wrist, or a fusion of the joint to stop movement and prevent discomfort.  

Surgeons prefer to preserve the joints by replacing them, usually with plastic or metal. But Philadelphia Hand to Shoulder Center is offering new, cutting-edge biological alternatives.  

“We’re pushing the envelope by replacing the joints with biological tissue,” Dr. Osterman says. This can include meniscus from the knee or cadaver tissue to replace joints. “It’s more anatomical, more of a natural joint that can have a longer shelf life and a more normal feeling for patients in terms of the mechanics. It can also be a faster recovery because there’s not a piece of metal or plastic in there.”  

These treatments are not just innovative but tailored to restore function while preserving as much natural joint integrity as possible.  

Another minimally invasive option offered at the center is de-enervation. “We go into the joint arthroscopically and clean out the arthritis and numb up the nerves that give feeling to the joint,” she said. “It doesn’t change the mechanics, it just reduces the pain. There is no downtime, patients don’t have to wait for anything to recover, so that’s an alternative for patients who want to try a quick fix.” 

Surgery isn’t the only treatment available at Philadelphia Hand to Shoulder—and fear of it shouldn’t stop people from seeking care to alleviate their pain.  

“People are sometimes scared to see a surgeon for fear that surgery is the only option,” she said. “But don’t suffer. There are a lot of non-operative alternatives for patients with arthritis, and connecting with a surgeon early opens up more surgical options that can help earlier in the process.” Alternative therapies include splinting, medications and cortisone injections. 

Ultimately, there are many minimally invasive options offered at Philadelphia Hand to Shoulder Center that allow patients to return to the activities they love with restored motion and reduced pain. 

For more information on the minimally invasive procedures at Philadelphia Hand to Shoulder, or to schedule an appointment, visit hand2shouldercenter.com