Arthritis of the Wrist

In arthritis, the cartilaginous layer of the affected joint is damaged or worn. This leads to inflammation with swelling and pain, especially with strenuous activity. The wrist joint consists of several bones, that form various joints to facilitate the overall mobility of the wrist. In arthritis of the wrist, individual joints alone or several joints at the same time may be affected. In most cases arthritis will develop in one portion of the joint and progress from there.

Causes

The main cause is often daily mechanical stress, due to which the cartilaginous lining in every joint can be worn off over the years. Other causes include inflammatory diseases of the rheumatoid group, metabolic disturbances (gout, etc.), or the consequences of trauma (fractures, ligamentous injuries), which result in dysfunction of the joint.

Symptoms

 Usually discomfort develops slowly over time. The primary symptom is pain, which in early stages increases with physical exertion, but later becomes constant. Transient swelling can also appear. The localization of the pain depends on the affected part of the wrist joint, which is most frequently at the side of the thumb. Over time range of motion can become restricted, on one hand because of pain and on the other mechanically due to arthritic deformities.

Diagnosis

The diagnosis is established based on patient history, clinical examination and radiographic findings. Sometimes, especially in the early stages, additional imaging such as CT or MRI scans can be helpful.

Therapeutic options

Because therapy is focused primarily on existing complaints and their causes, it is adjusted on the different stages of the disease.  

Minor disorders can be treated with anti-inflammatory pain medication. This reduces swelling and pain. In addition, cortisone injections into the joint can be performed. Patients with constant pain who do not respond to the above conservative treatment options need surgical therapy to reduce pain and improve hand function. Usually this can only be accomplished by at least partial loss of mobility. 

Depending on the affected parts of the joint, partial fusion or partial joint replacement methods are possible. If the entire wrist joint is affected (panarthrosis) complete fusion or – in specific cases – implantation of a full prosthesis is necessary. Your hand surgeon will advise you of the best suited method for your individual case.

Follow up care

This depends largely on the operation performed. In cases of partial or total fusion, the joint is immobilized in a plaster cast immediately after the surgery until consolidation of the bones. If prostheses are used mobilization is initiated as soon as possible. This takes place under the direction of the hand therapist, and occasionally with the aid of supportive splints.