wrist arthritis
Arthritis is inflammation of a joint, and can occur anywhere in the body. Wrist arthritis can produce pain, weakness and stiffness. In normal healthy joints, the bones are lined by smooth cartilage. When this cartilage wears thin, normal motion of the joint can become painful, and motion can decrease. Cartilage can wear out more quickly due to genetics, over-use, or prior injuries.
Causes
Oftentimes wrist arthritis develops many years after an injury to the wrist. The injury may have damaged a bone or ligament, which disrupts the normal mechanics of the wrist. While initially thought to be “just a sprain”, the injury can disrupt the normal alignment of the wrist and produce arthritis over the subsequent years.
One cause of wrist arthritis is due to a broken scaphoid bone that was not correctly diagnosed or treated at the time of injury. A scaphoid fracture that does not heal can result in a pattern of arthritis called SNAC (scaphoid non-union advanced collapse) wrist.
Wrist arthritis can also develop after a torn ligament in the wrist, typically seen when the connection between the scaphoid and lunate bones is disrupted. This results in a SLAC (scapho-lunate advanced collapse) wrist arthritis pattern.
Arthritis can also develop due to genetics, or inflammatory conditions such as rheumatoid or psoriatric arthritis. Sometimes the cause is not known.
Symptoms
Patients with wrist arthritis experience pain throughout the wrist, stiffness, decreased motion, weakness and swelling.
Diagnosis
Wrist arthritis can be diagnosed by talking with your doctor and having them examine your wrist. X-rays can be useful to see the severity of the cartilage loss, and oftentimes will show narrowing of space between the bones, changes in alignment, and development of bone spurs (osteophytes).
Non-surgical Treatment
Splinting: a wrist splint limits painful motion of the wrist, and can help stabilize and protect the wrist during activities.
Ice: cold therapy can be helpful after activities; the cool temperature can be an effective analgesic to decrease pain, and can help with swelling.
Heat: running the wrist under warm water, or using paraffin/wax baths can increase blood flow to the area, which can decrease stiffness and help with discomfort.
Anti-inflammatories: NSAIDs such as ibuprofen or naproxen decrease inflammation, swelling and pain. Sometimes topical gels, such as diclofenac, can be helpful and may have fewer side effects.
Cortisone injection: a corticosteroid is a very strong anti-inflammatory that can be injected directly into the wrist joint. It is quick acting, and can notably reduce pain. The duration of symptom relieve depends on the individual and the severity of their arthritis, but it may last several months.
Surgery
Surgery for wrist arthritis depends on the pattern of arthritis and the specific bones of the joint that are involved.
A wrist deneveration is a procedure where several nerves that carry pain signals from the wrist to the brain are removed. This does not affect strength or sensation of the hand, wrist or forearm. Only the portion of the nerve sending pain signals is removed, typically a ~2cm segment. This “disconnects” the wrist from brain, and is a minimally invasive way of trying to improve pain.
Other procedures, such as a radial styloidectomy or proximal row carpectomy can be used to remove arthritic portions of the wrist while trying to maintain some motion.
In early stages of wrist arthritis, a proximal row carpectomy or wrist fusion can sometimes be avoided. In this patient with early SLAC (scapho-lunate advanced collapse) degenerative changes, a radial styloidectomy was performed with a wrist denervation. This removed the large bone spur at the end of the radial styloid, and resulted in significant improvement in pain and motion.
Left: Wrist osteoarthritis seen on X-ray. This pattern of arthritis is known as a SLAC (scapho-lunate advanced collapse) wrist. This is due to a torn ligament between the scaphoid and lunate bones. Middle: Surgical treatment involves removing a row of arthritic bones from the wrist. This is called a “proximal row carpectomy”. The bones marked with an “x” are removed. The remaining, non-arthritic bones, slide into the space created and make a new wrist joint. Right: Same patient after a proximal row carpectomy was performed, with excellent clinical results and near complete improvement in pain.
A partial or complete wrist arthrodesis involves “fusing” several bones together. By eliminating motion across arthritic joints, pain can be notably improved. The recovery can be longer after these procedures, as it can take months for the bones to fuse together.
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.