Definition
Osteoarthritis of the wrist is a degenerative condition resulting in progressive wear of the wrist joints. It is also called arthrosis as opposed to arthritis, which implies the involvement of an inflammatory process.
Pathology
Osteoarthritis of the wrist is a complex pathology. It can affect numerous joints of the hand and forearm, which connect the radius and ulna with metacarpal bones and more distally to the phalanges or finger bones. In osteoarthritis, the articular cartilage covering the bone extremities becomes damaged mostly due to ageing, overuse and trauma. The cartilage is a specialised connective tissue that facilitates the movement between bones by reducing friction. The cartilage also absorbs shock and traumatic impacts to the joints.
Causes
Osteoarthritis of the wrist most often is caused by ageing and traumatic injury. It can also result from medical conditions such as chronic autoimmune inflammation (rheumatoid arthritis) or from the reduction of blood flow through the lunate carpal bone (Kienböck’s disease). Generally, the ageing process affects all joints due to wear and tear and osteoarthritis is more frequent in those patients with a family history of the disease. Wrist osteoarthritis can result from a previous injury following the repair of a fracture or as a consequence of small changes in the anatomy of the wrist bones that increase pressure on the joint cartilage, which gradually degenerates. The pathology can also arise from traumatic damage to the cartilage itself, leading to a rigid scar formation that impairs a smooth joint movement. This is named post-traumatic osteoarthritis.
Risk factors
There are a various risk factors leading to wrist osteoarthritis, the main ones being:
Aging
Overuse
Mechanical injury
Familiar predisposition
Additional medical factors:
Chronic inflammatory and autoimmune diseases (Rheumatoid arthritis, psoriasis, gout (accumulation of uric acid in the joint))
Kienböck’s disease
Septic arthritis (infection of the wrist joint)
Poor muscle training
Postmenopausal hormonal reduction
Diabetes
Symptoms
The main symptoms of wrist osteoarthritis are:
Swelling of the wrist
Fluid accumulation in the joint
Early stage: pain with movement that eases off with activity
Advanced stage: chronic pain without movement
Noise when moving the wrist (crepitus)
Stiffness of the joint
Reduced range of motion
Wrist weakness
Poor sleep quality due to pain
Widespread joint pathology (e.g. rheumatoid arthritis)
Diagnosis
The diagnosis of wrist osteoarthritis begins with a medical history. The examiner will discuss the occurrence of past injuries and familiar predisposition to autoimmune diseases and arthritis. During the physical examination the specialist will assess the condition of the wrist and other joints. Other aspects of the diagnosis include:
Definition of pain characteristics
Passive and active exercises to assess changes in the range of movement
Comparison of both wrists' anatomy and function
X-rays to visualise changes in bones and cartilage
Blood test to exclude other medical conditions (rheumatoid arthritis)
Treatment
Nonoperative treatment
In most cases wrist osteoarthritis is treated conservatively unless the pathology has severely compromised the anatomy of the joint or the pain has become unsustainable.
Antiinflammatory therapy with NSAIDs to reduce swelling, pain and permit the wrist movement Local steroid injection in more severe symptoms
Painkillers
Heat to provide comfort and reduce inflammation
Temporary immobilisation with a brace to reduce acute symptoms
Physical and occupational therapy to modify activities
Exercise to strengthen the wrist muscles and increase range of movement
Surgical treatment
In case of severe pain or advanced degeneration of the wrist joint affecting function and quality of life surgery is necessary. Numerous methods are available depending on aetiology causing osteoarthritis.
Wrist arthroscopy is an exploratory minimally invasive surgery to assess in situ the damage of bones, cartilage and ligaments. It can be used to repair small tears of soft tissue or to remove cartilage fragments following an injury.
Resection of arthritic bones mostly of the carpal bones reduces pain and maintains partial wrist function.
Arthrodesis consists in wrist joint fusion of the radius with the carpal bone by placing a plate along the wrist. The bones will grow together and flexion/extension of the wrist will no longer be possible. This surgery will resolve pain but is significantly debilitating.Wrist arthroplasty or joint replacement prosthesis is recommended in case of chronic rheumatoid arthritis where both sides are compromised and fusion is not an option.
Rehabilitation
After surgery initial rehabilitative care includes:
Arm elevation
Immobilisation with a cast or splint for 10-14 days or longer for 4-6 weeks
Ice pads
Antiinflammatory therapy with NSAIDs
Painkillers
Physiotherapy can begin at a suitable time as directed by the surgeon depending on the type of surgery or following conservative treatment with a cast or splint. A number of exercises guided by a physiotherapist or hand-therapist will aim to acquire flexibility, function and strength of the wrist such as:
Gentle hand exercises within a bowl of warm wax
Use of ice packs to the joints before and after motion
Massage
Joint mobilisation
Stretches
Electrotherapy
Taping / bracing
Return to activity plan
Prevention
To prevent severe damage of the arthritic wrist the patient is advised to avoid stress on the joint by modifying daily activities such as:
Gentle movements when twisting, pulling or pushing
Avoid carrying weights and bags
Exercise the muscles of the forearm and wrist to alleviate pressure on the wrist
Frequent motion of the wrist to reduce stiffness
Stretching exercises
Wear a wrist support when working with computers or returning to sport