Understanding Wrist Arthritis
What is wrist arthritis?
Wrist arthritis refers to the inflammation and pain in the joint of the bones in the wrist. The wrist joint is complex, made up of eight small bones (carpal bones) and numerous ligaments, all working together to allow a wide range of motion. Osteoarthritis is the most common form of wrist arthritis, often known as “wear and tear” arthritis, although it is not typically caused by excessive use of the wrist. Instead, it is mainly due to the natural aging process and genetics. Additionally, wrist arthritis can develop after an injury to the joint, a condition referred to as “secondary osteoarthritis.”
What causes wrist arthritis?
The primary cause of osteoarthritis in the wrist is aging and genetic factors. This type of arthritis may affect a specific area of the wrist, particularly the joint between the scaphoid, trapezium, and trapezoid bones. Secondary osteoarthritis can occur following wrist trauma, often years after an injury such as a fracture of the radius or scaphoid bone, or ligament damage. Inflammatory conditions like rheumatoid arthritis can also lead to wrist arthritis.
What are the symptoms?
Many people with wrist osteoarthritis may not experience symptoms, and the condition is sometimes found incidentally when an X-ray is taken for another issue. When symptoms do occur, they typically include pain, swelling, and stiffness in the wrist. The severity of these symptoms can vary, with many individuals able to manage their daily activities without the need for treatment. Symptoms may worsen after a minor injury, leading to flare-ups of arthritis pain.
What is the natural history?
In most cases, osteoarthritis remains stable over time, with little to no change on X-rays taken over a couple of years. Symptoms often improve with changes in activity to avoid exacerbating them. However, in some patients, pain may become persistent, and over time, dexterity and grip strength may decline. Some individuals may experience long-term stiffness and reduced movement, but most can manage these changes well.
How is the diagnosis made?
After a physical examination, X-rays are usually used to assess the extent of damage in the wrist joint. However, the findings on the X-ray do not always align with the symptoms. Some individuals may have severe arthritis visible on X-rays but report only mild discomfort. X-rays typically show a narrowing of the joint space due to the loss of smooth cartilage, and the bones may rub against each other. This can lead to inflammation within the joint, which may cause pain.
X-ray of a wrist showing severe arthritis
What are the treatment options?
Non-operative treatments:
Pain is the body’s natural warning system to alert us to potential harm. Although osteoarthritis often causes gradual deterioration, the pain tends to diminish over time. Using the wrist normally does not worsen the condition, as the progression of arthritis is primarily influenced by aging and genetics. For many people, pain resolves on its own, and no treatment is necessary. If pain interferes with daily activities, the following methods can help manage symptoms:
- Splints: Immobilising the wrist with a splint can sometimes provide relief and comfort.
- Physiotherapy: Maintaining wrist mobility through physiotherapy can help delay the onset of stiffness.
- Painkillers: While painkillers can be effective for short-term relief, regular use is not recommended due to potential side effects, such as stomach ulcers or cardiac issues. Stronger painkillers can be addictive and should be avoided.
- Steroid Injections: Steroid injections can help reduce inflammation and provide short-term pain relief, but they are not a long-term solution.
What operations can help?
- Wrist Denervation: This procedure involves cutting the nerves that supply the lining of the wrist joint. It does not affect the important sensory or motor nerves that control wrist and hand movement.
- Proximal Row Carpectomy: In this surgery, three bones of the wrist (scaphoid, lunate, and triquetrum) are removed, allowing the capitate bone to move freely with the radius. This procedure is only suitable for specific cases of arthritis.
- Fusion Surgery: Fusion involves removing the joint and fusing the two bones together to heal as a single piece. While this surgery sacrifices some wrist movement, it is effective for relieving pain and offers predictable results in about 85% of cases.
- Wrist Replacement: This newer surgical option involves replacing the damaged joint with an artificial one. Wrist replacement has shown promising medium-term results, but long-term outcomes are still being studied.
In most cases, surgery is considered only if non-surgical treatments do not provide adequate relief. The decision to pursue surgical options should be made carefully weighing up the risks and benefits.
