Arthritis of the Wrist

Arthritis of the Wrist

What is it?

Arthritis causes damage to the normal cartilage that covers the ends of bones where joints are formed. There are two broad types of arthritis.

1. Osteoarthritis, more commonly known as wear and tear arthritis. This is caused by use of the joint or sometimes by an injury. Injury to one of the ligaments in the wrist can lead to particular patterns of arthritis as a result of a change in the wrist mechanics. Osteoarthritis occurs when the cartilage initially splits and becomes rough and thin. Later on it wears through completely and the bone ends rub together. This may be felt as a grating sensation. The wrist joints are commonly affected with this type of arthritis.

2. Inflammatory arthritis, an example of this is rheumatoid arthritis. The body’s own immune system damages the joints and surrounding tissues including ligaments and tendons. There is typically more swelling and stiffness in the mornings with an inflammatory arthritis


What are the symptoms?

Most patients will present with pain, stiffness and a variable amount of swelling. Later on deformities may develop. There will be a reduction in how much you are able to do with your hand. You may have to give up hobbies or sports because of pain, stiffness and lack of grip.


Diagnosis can often be made from the clinical history (the account of events and symptoms from the patient) and the clinical examination. Patients will usually need further investigations in terms of X-rays and some will require special scans – ultrasound, CT or MRI.
If an inflammatory arthritis is suspected you will require a series of blood tests and would require an opinion from a special doctor called a Rheumatologist.

Treatment Options

In Osteoarthritis the mainstay of treatment is activity modification, analgesics, anti-inflammatory medication, Hand Therapy and sometimes splints. These treatments are very useful in the early stages of the arthritis.
Steroid Injection – can be useful in selected cases and may give several weeks/months relief of symptoms. One or occasionally two injections are advised because of the risk of cartilage damage with further injections.
There are a number of surgical options for painful wrist arthritis that is not controlled by painkillers and/or splints. Your surgeon will assess the severity of your symptoms and arthritis and discuss with you which treatment is most appropriate.

Treatment options

Wrist denervation

This operation involves removing the small nerves that supply sensation to the wrist joint. This will have no detrimental effect to the sensation to the hand/fingers. This procedure can provide benefit, relieving pain, in patients for several years.

Partial wrist fusion

In some cases, where only part of the wrist is arthritic, only part of the wrist is fused together. Some of the wrist bones are also removed. This operation maintains some of the wrist movement (approximately half). This operation is however only appropriate in a small number of people.

Proximal Row Carpectomy

This operation involves removing the nearside row of the wrist bones. This is again only appropriate for some patients in which the other articular surfaces are healthy. Again this procedure will maintain some wrist movement.

Wrist Fusion

Wrist fusion (or arthrodesis) is an operation in which the moving surfaces of the wrist are removed in order to fuse those joints together. This will be helped by packing bone graft around the joints. A specially designed plate and screws (or occasionally a metal pin) will be used to stabilise the bones while they heal. The bone graft is taken from either the wrist area or the pelvis/hip bone. Taking bone from the hip region does not harm the bone or nearby joints, but can be quite sore for a few days.

Wrist Replacement

Wrist replacement surgery is generally reserved for patients with Inflammatory arthritis such as Rheumatoid and Psoriatic arthritis. (see Wrist Replacement)

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