Arthritis In Wrist

As with other types of arthritis, there is no fundamental treatment for wrist arthritis. However, there are treatment options that can relieve the symptoms of the disease. Other treatment options can slow its progression.

If they receive timely and proper medical advice, many people suffering from wrist arthritis are able to keep the symptoms under control and lead active and relatively normal lives.

Wrist Anatomy

The wrist is a complex joint that is actually the intersection of 10 bones:

• Two forearm bones – the radius and the ulna;
• Eight small bones (the carpal bones) arranged in two rows of four each at the base of each hand.

To help the wrist bones to glide smoothly over each other inside the joint, a healthy bone is covered with a slick cartilage. The cartilage serves as a cushion between the bones as we move our hands and wrists in various ways.

Types of Wrist Arthritis

There are two primary kinds of arthritis that affect the wrist – osteoarthritis and rheumatoid arthritis. A further kind is post traumatic arthritis.

Osteoarthritis

Osteoarthritis is a wear and tear disease that damages the bones in the wrist and gradually destroys the smooth cartilage that covers the ends of healthy bones. This causes the bones to rub directly against each other, causing the pain and stiffness noted above, as well as long term joint damage. Wrist osteoarthritis tends to appear on one side i.e. either the left or right wrist only.

Rheumatoid Arthritis

Rheumatoid arthritis is another common form of wrist arthritis and is an auto immune condition that causes the body’s immune system to malfunction and start attacking the lining of joints (the wrist joint in this case). Most cases of rheumatoid arthritis of the wrist tend to appear simultaneously in both the left and right wrists.

Posttraumatic Arthritis

This type of arthritis develops after a traumatic injury to the wrist that either:

• Directly damages the bone cartilage, or
• Changes the relative positions of the wrist bones in such a way that there is more wear and tear as they rub against each other.

Posttraumatic arthritis can develop years after the causative injury and may appear even though the initial injury has received proper treatment.

Symptoms Of Wrist Arthritis

Although wrist arthritis may be present in a patient, it may not cause symptoms in all cases. In addition, if it is present, the symptoms can vary widely from one patient to another. Even in a particular patient, wrist arthritis symptoms can vary in severity from one day to another.

Having said this, the typical symptoms of arthritis in the wrist (when present) are the following:

• Wrist pain;
• Wrist swelling;
• Stiffness of the wrist joint, or reduced range of motion;
• Wrist weakness.

If you are experiencing some or all of these symptoms, we suggest that you talk to your doctor with a view to a formal diagnosis being made. As with many other health conditions, early awareness of the presence of wrist arthritis is one of the keys to successfully managing the condition.

Diagnosis

To make a formal diagnosis of the cause of a patient’s wrist pain and stiffness, a doctor will likely review the patient’s medical history, looking in particular for previous wrist injuries.

The doctor will also probably ask the patient to describe the symptoms in detail, how they vary over the day and what (if anything) makes the pain worse.

The next likely step will be a physical examination of the patient’s hand and wrist to check for things like loss of range of motion, joint instability or swelling. Finger and thumb mobility, as well as nerve function, will also be evaluated. The goal here will be to eliminate other conditions for which the symptoms may be very similar such as carpal tunnel syndrome (which is caused by damage to the median nerve at the wrist). A distinguishing feature of this condition, however, is that the patient usually has pain, pins and needles and/or other sensory disturbance in the part of the hand corresponding to the area supplied by the median nerve. In addition, there can be wasting of the muscles of that part of the hand as well. This wasting, in turn, can lead to weakness of the grip in that affected hand.

If the doctor is still not fully certain, the following tests may be requested:

• X rays to determine the location and severity of the arthritis. X rays can also help the doctor determine the type of arthritis the patient may have;
• Blood tests to further help the doctor determine the type of arthritis the patient has. Rheumatoid and other inflammatory forms of arthritis produce changes in blood composition that can be revealed by blood tests. For example, gout (although it doesn’t commonly occur in the wrist) tends to be associated with unusually high levels of uric acid. However, uric acid levels are not always high. Osteoarthritis does not usually cause abnormalities in blood tests. Therefore, blood tests are not usually helpful in making a diagnosis of this type of arthritis.

Treatment of Wrist Arthritis

As mentioned earlier, there is no fundamental cure for wrist arthritis that will reverse the underlying cause. Since the joint changes are irreversible, the disease cannot be eradicated once it has developed.

However, doctors can suggest a range of measures to reduce the severity of its symptoms and to slow the progression of the condition.

There are both non-surgical and surgical treatment options.

Non Surgical Treatment

Doctors will initially try to manage wrist arthritis using non-surgical approaches. These may include:

• Activity modification, i.e. restricting participation in activities that worsen the symptoms;
• Immobilization of  the wrist joint by means of a wrist splint can reduce the pain caused by bones rubbing against each other. Over-the-counter non-steroidal anti-inflammatory drugs can help to relieve pain and inflammation;
• A physical therapist can devise a program of wrist exercises to help the patient to regain wrist range of motion and strength;
• Steroid injections into the wrist joint can be used to combat inflammatory forms of arthritis. However, these effects are unlikely to be permanent. The pain relief can last anywhere from six weeks to six months;
• Hot & cold therapies can be used alternately to reduce pain and improve the blood supply to the wrist joint.

Surgical Options

If the conservative treatments described above do not succeed in relieving wrist arthritis symptoms, doctors may then suggest a range of surgical treatments for consideration. The shared goal of surgical treatment options is to eliminate or reduce bone on bone contact within the wrist.

These options may include:

• Proximal row carpectomy, which involves removal of 3 carpal bones from the row closer to the forearm;
• Fusing some or all of the wrist bones together to prevent them from rubbing against each other. This procedure is called arthrodesis. However, this procedure will inevitably result in loss of wrist function;
• Complete wrist replacement, which involves first removing damaged cartilage and bone from the wrist. The surgeon then inserts new metal or joint surfaces in their place. This is analogous to knee replacement surgery. It leaves the patient with more wrist movement than does partial or complete wrist bone fusion.