Osteoarthritis of the Wrist

The wrist is a very complicated structure designed specially to enable it to move in the different ways that it does.

It is made up of two long bones in the forearm (the radius & ulna) and eight smaller bones at the bottom of the hand (the carpal bones). These bones are joined through a complex structure of ligaments and tendons inside the wrist joint itself.

What Osteoarthritis?

Osteoarthritis (OA) is a degenerative joint disease which causes the cartilage surrounding your bones to wear away. Cartilage is tough but flexible and surrounds the ends of your bones allowing them to move over one another forming a joint. When the cartilage wears away bone rubs on bone which gives rise to a painful inflamed joint.

Why does is occur?

Osteoarthritis is a common degenerative disease affecting joints. Anyone can get it but there are a number of factors that may increase the risk of osteoarthritis:

• Age :tends to affect people aged 40+ as muscles become weaker and joints gradually wear over time
• Gender : Osteoarthritis is more common in females than males (particularly in the hands and knees)
• Weight: being over-weight puts more stress on your joints and can increase your chance of developing arthritis
• Family: some forms of osteoarthritis run strongly in families and can be linked to genetics
• Previous injury: an injury such as a fracture or operation on a joint can lead to osteoarthritis in a joint. E.g. Scaphoid fractures/ scaphoid ligament injuries
• Similarly some hard repetitive activities or physically demanding jobs can increase the risk of the condition
• Other joint diseases: such as rheumatoid arthritis / gout can increase the risk of developing osteoarthritis

What are the symptoms?

The main symptoms of OA in the wrist are:

• Pain in and around the wrist
• Swelling
• Stiffness
• Weakness in the hand and wrist
• Limited movement
• Altered positioning of the wrist

What tests might be done?

You may need to have X-Rays of your wrist to allow the doctor to see which areas are affected by arthritis.

Sometimes CT scans (also known as CAT scans) may be undertaken to give the doctor a more in-depth view of the wrist to diagnose the problem.

Blood tests may be required to rule out any other cause for wrist pain such as rheumatoid arthritis.

What is the treatment?

Non surgical Treatment

• Medication: such as non steroidal anti-inflammatories such as ibuprofen can help with swelling/ inflammation and pain killers can help alleviate pain.
• Splinting: Sometimes splints can be used to protect and support the joint to help alleviate some of the pain.
• Joint protection advice/ aids: Sometimes advice on how to protect your joints throughout every day tasks can help to alleviate pain.
• Steroid Injections: Localised injections directly into the affected joint to help reduce inflammation and pain.

Surgical Treatment

In cases where the above has not worked the following may be considered:
4 corner fusion: This can be performed in less severe/advanced cases of osteoarthritis where only part of the wrist is affected. Screws and plates are used to fuse/hold together some of the carpal bones in the wrist which can help to alleviate pain in the wrist but does restrict the amount of movement in the wrist permanently.

There is a 20% chance of pain continuing with 4 corner fusion.

Total Wrist fusion: This is performed in severe cases of osteoarthritis. A plate is put across the radius and two rows of carpal bones to fuse/ hold them altogether. ALL movement at the wrist is lost following this procedure but is very reliable at alleviating pain by preventing any movement.

The patient will still have full movement of their fingers and thumb.
Grip strength may be slightly affected.

Joint Replacement:

On occasions joints in the wrist can be replaced for prosthetic ones but this is dependent on the quality of other bones/ joints involved.