Wrist Arthritis

What Is Wrist Arthritis?

Arthritis is the loss of smooth cartilage that normally covers bone surfaces where they come together to form joints. Cartilage is the shiny, slippery material that allows bones to glide smoothly against each other with minimal friction. The wrist is made up of many bones working together. The forearm has two long bones, the radius and ulna. Below these sit two rows of small carpal bones, eight in total. All of these bones need healthy cartilage to work together properly.

When cartilage wears away, the bones lose their smooth surfaces and begin to rub directly against each other. This causes pain, swelling, and stiffness. Wrist arthritis can develop in different areas. Radiocarpal arthritis occurs where the small wrist bones meet the radius. Midcarpal arthritis involves the articulation between the two rows of small wrist bones. Distal radioulnar arthritis affects where the radius meets the ulna at the wrist, causing pain with forearm rotation. Sometimes multiple areas are involved at once.

Symptoms

Pain is the most common symptom of wrist arthritis. The pain is typically located over the arthritic joint and worsens with use. Activities that load the wrist, such as pushing up from a chair, doing pushups, carrying groceries, or using tools, can be particularly uncomfortable. The wrist may ache at rest when arthritis is severe, and pain can interfere with sleep.

Stiffness is another hallmark symptom. You may notice decreased motion compared to your other wrist, making it harder to bend the wrist fully forward or backward. This can affect your ability to perform activities that require wrist flexibility. Swelling over the arthritic joint may be visible or palpable. The wrist can feel weak or give out during activities.

With mild arthritis, symptoms may come and go over weeks or months, often related to activity level. As arthritis progresses, symptoms tend to become more constant and severe. Some people develop visible bony prominences or bumps around the arthritic joints as bone spurs form. Grinding or clicking sensations can occur with wrist movement.

Causes & Risk Factors

Wrist arthritis has several potential causes. Degenerative or wear and tear arthritis is one of the most common types. Like arthritis in other joints, wrist arthritis can develop over time as cartilage gradually breaks down. This is often a natural aging process rather than the result of any particular activity. There's not necessarily a reason why it develops in one person and not another, and it's not always preventable.

Post-traumatic arthritis develops after injuries to the wrist. Broken bones can create uneven joint surfaces that wear out more quickly than smooth ones, similar to how a rocky road is harder on car tires than a smooth highway. Distal radius fractures and scaphoid fractures are common injuries that can lead to arthritis, especially if the bones don't heal in perfect alignment. Ligament injuries that allow abnormal motion between bones can also lead to accelerated cartilage wear.

Inflammatory or autoimmune arthritis occurs when the body's immune system mistakenly attacks its own cartilage. Rheumatoid arthritis is the most common type of inflammatory arthritis affecting the wrist, but there are many others including psoriatic arthritis and lupus. These conditions are usually managed with medications prescribed by rheumatologists or primary care physicians to slow progression and prevent arthritis from developing in multiple joints throughout the body.

Diagnosis

Your hand surgeon diagnoses wrist arthritis through a combination of your history, physical examination, and imaging studies. The examination looks for areas of tenderness, swelling, and decreased motion. Specific maneuvers stress different areas of the wrist to identify which joints are arthritic. Your surgeon will assess how the arthritis affects your ability to perform daily activities and understand your goals for treatment.

X-rays are the primary imaging study for diagnosing wrist arthritis. They show loss of cartilage by revealing that bones are closer together than normal where cartilage is missing. X-rays also show bone spurs, cysts, and other changes characteristic of arthritis. Sometimes special X-ray views or comparison images of both wrists help clarify the diagnosis.

CT scans or MRI studies are not usually needed to diagnose wrist arthritis but may be helpful for surgical planning to better understand the pattern of arthritis or to evaluate ligaments. With a clear understanding of your symptoms, examination findings, activity level, work requirements, and hobbies, your hand surgeon can discuss the best treatment approach for your situation.

Treatment Options

Treatment usually begins with conservative measures. Rest from aggravating activities, over-the-counter anti-inflammatory medications, and activity modifications can provide significant relief for mild to moderate arthritis. Wearing a wrist splint, particularly during activities that stress the wrist, can reduce pain and provide support. The splint limits motion of the arthritic joint while allowing you to continue using your hand.

Cortisone injections can provide temporary relief, especially when inflammation is present. These injections deliver powerful anti-inflammatory medication directly into the arthritic joint. The relief can last weeks to months and may be repeated if effective. Physical therapy or hand therapy can help maintain motion and teach you techniques to protect your wrist during activities.

When conservative treatment no longer provides adequate relief and arthritis significantly limits your function or quality of life, surgery may be appropriate. Several surgical options exist depending on the location and severity of arthritis, your age, activity level, and expectations. The decision about which surgery is right for you is made together with your surgeon after discussing the benefits and limitations of each option.

Surgical options range from relatively minor procedures to more involved reconstructions. Denervation involves removing the nerves that transmit pain from the arthritic joint, providing relief while preserving motion. This is not permanent for everyone, as nerves can sometimes grow back. More definitive procedures include removing one or more arthritic wrist bones, fusing selected bones together to eliminate painful motion while preserving some wrist movement, or complete wrist fusion which eliminates all wrist motion but provides stability and pain relief. Total wrist replacement is available for select patients, though it has limitations and is not suitable for everyone.

Surgery: What to Expect

Wrist arthritis surgery is performed as an outpatient procedure under local anesthesia, with sedation available for select cases if needed. The duration depends on which procedure is performed, ranging from 30 minutes for denervation to two to three hours for more complex reconstructions or joint replacements.

After surgery, your wrist is placed in a splint or cast. The immobilization period varies based on the procedure, from a few weeks for denervation to three months for fusion procedures. Your surgeon will provide specific instructions about wound care, activity restrictions, and what to expect during recovery. Pain is usually well controlled with medication in the days and weeks after surgery.

Recovery

Recovery varies dramatically depending on which surgical procedure was performed. Denervation has a relatively quick recovery, with return to activities in a few weeks. Fusion procedures require months of immobilization while bones heal together, followed by several more months of gradual strengthening. Total wrist replacement requires careful rehabilitation to protect the implant.

You'll receive a home exercise program appropriate for your procedure. Initially, exercises focus on maintaining motion in fingers and thumb while protecting the wrist. As healing allows, wrist exercises are gradually introduced. Most people can manage their recovery with these home exercises, though formal hand therapy sessions may be beneficial for regaining motion and strength after complex procedures or if complications develop.

The goals of surgery are to reduce pain and improve function, not necessarily to restore the wrist to normal. Some procedures trade motion for stability and pain relief. Your surgeon will discuss realistic expectations based on your specific situation. Most people experience significant improvement in pain and quality of life after wrist arthritis surgery, though the recovery process requires patience and commitment to rehabilitation.

When to See a Specialist

If you have wrist pain and stiffness that's interfering with your daily activities, work, or hobbies, it's worth getting evaluated. While many cases can be managed with conservative treatment, understanding your diagnosis and options can help you make informed decisions about your care. Don't wait until pain becomes unbearable to seek evaluation.

Dr. Lackey specializes in treating wrist arthritis with both non-surgical and surgical approaches. An evaluation can determine the extent of your arthritis and develop a treatment plan tailored to your needs and goals.