Arthritis of the Wrist

Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. How well the hand and wrist interact depends on the integrity and function of the ligaments, tendons, muscles, joints and bones.

Arthritis of the wrist can affect upper extremity function, causing disruptions at home and work and negatively impacting quality of life.

The human hand itself is very complex and delicate in structure.

At some time in life, you may experience hand and wrist pain due to arthritis and there are hundreds of kinds of arthritis, most wrist pain is caused by just two types: osteoarthritis and rheumatoid arthritis.

Osteoarthritis can develop due to normal “wear-and-tear” in the wrist, particularly in people who have a family history of arthritis. It may also develop as a result of a traumatic injury, such as a broken wrist bone or a wrist sprain.

Osteoarthritis of the wrist can also develop from Kienböck’s disease. In Kienböck’s disease, the blood supply to one of the small bones of the hand near the wrist (the lunate) is interrupted. If the blood supply to a bone stops, the bone can die. Over time, this can lead to osteoarthritis.

The exact cause of RA (Rheumatoid arthritis) is not known. There may be a genetic reason — some people may be more likely to develop the disease because of family heredity. However, doctors suspect that it takes a chemical or environmental “trigger” to activate the disease in people who genetically inherit RA.

Pain

Early symptoms of arthritis of the hand include joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping. The pain may not be present immediately, but may show up hours later or even the following day. Morning pain and stiffness are typical.

As the cartilage wears away and there is less material to provide shock absorption, the symptoms occur more frequently. In advanced disease, the joint pain may wake you up at night.

Pain might be made worse with use and relieved by rest. Many people with arthritis complain of increased joint pain with rainy weather. Activities that once were easy, such as opening a jar or starting the car, become difficult due to pain. To prevent pain at the arthritic joint, you might change the way you use your hand.

Swelling

Thumb extension deformity. This patient has lost mobility at the base of the thumb due to arthritis. The next joint closer to the tip of the thumb has become more mobile than normal to make up for the arthritic joint. Normally, the thumb does not come to a right angle with the rest of the hand.

When the affected joint is subject to greater stress than it can bear, it may swell in an attempt to prevent further joint use.
Changes in Surrounding Joints
In patients with advanced thumb base arthritis, the neighboring joints may become more mobile than normal.

Warmth

The arthritic joint may feel warm to touch. This is due to the body’s inflammatory response.

Nonsurgical Treatment

In general, early treatment is nonsurgical and designed to help relieve pain and swelling.

Several therapies can be used to treat arthritis, including:

• Modifying your activities. Limiting or stopping the activities that make the pain worse is the first step in relieving symptoms.
• Immobilization. Keeping the wrist still and protected for a short time in a splint can help relieve symptoms.
• Medication. Taking non-steroidal anti-inflammatory medications, such as aspirin or ibuprofen, can reduce both pain and swelling.
• Exercise. Following a prescribed exercise program. Specific exercises can improve the range of motion in your wrist.
• Steroid injection. Cortisone is a powerful anti-inflammatory medicine that can be injected into the wrist joint.

When rheumatoid arthritis symptoms are not adequately controlled by the above therapies, additional medications with varying risks and benefits may be prescribed by your doctor. Specific medicines called disease-modifying anti-rheumatic drugs are designed to stop the immune system from destroying the joints. The appropriate use of these medications is directed by a rheumatologist.

Surgical Treatment

When nonsurgical treatments are no longer effective, resulting in progressive loss of hand and wrist function, surgery is an option. The goal of surgery is to relieve pain and to preserve or improve hand function.

Surgical options include:

• Removing the arthritic bones. In this procedure, three carpal bones are removed. This procedure, called a proximal row carpectomy, will relieve pain while maintaining partial wrist motion.
• Fusion. When motion is the source of pain, carpal bones can be fused together to make one, solid bone. A fusion can be partial, in which just some of the carpal bones are fused together. This eliminates pain and retains some wrist motion. When the arthritis is extensive, a complete fusion may be necessary. In this procedure, all of the carpal bones are fused together, as well as the radius. This completely eliminates wrist motion, but does not affect forearm rotation.
• Joint replacement. This surgery removes the damaged joint and replaces it with an artificial device (prosthesis). This surgery may help retain or recover wrist movement.