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What is Wrist Arthritis?
The wrist is composed of 8 carpal bones and its essentially like one big joint as it moves in cooridation with the two forearm bones. Most of these bones are covered in cartilage. What this means is that all of this wrist motion can cause the cartilage to wear away and allow for arthritis to develop. Wrist arthritis is a chronic condition where the cartilage of the wrist bones wears away. As we get older its normal for us to loose cartilage from daily wear and tear, but its definitely less common in our wrists than in our knees or hips (that’s because those joints bear our weight every day) and its usually caused by an abnormal alignment in our wrist architecture as a result of some old injury that was never treated. The most common cause for wrist arthritis is the result of a ligament tear called the Scapho-lunate ligament. This is a critical ligament for holding two of the wrist bones together and when it tears these two bones separate (“See Scapho-lunate dissociation”) and over time all of the bones become unbalanced as they try to compensate for this ligament tear. The name for this wrist instability is a “SLAC” wrist (aka scapholunate advanced collapse). The second most common cause is arthritis to develop between the scaphoid bone, the the trapezium and trapezoid bones. Arthritis can also occur after the wrist bone (the scaphoid) breaks and does not heal correctly, and the bone takes on a new shape that doesn’t fit into the normal joint position. This is called a scaphoid nonunion advanced collapse. If you notice a pattern here, the last three causes of wrist arthritis all involve the scaphoid bone which is one of the 8 wrist bone, but really a major player in wrist motion because it connects the thumb to the rest of the wrist. Another cause for the development of arthritis is a DRUJ injury after a distal radius fracture. While most instances are associated with an old injury, sometimes the arthritis just comes on its own.
How is Wrist Arthitis diagnosed?
The diagnosis is made with a good history of the patients complaint and x-rays. Looking at x-rays you can see which of the many wrist bones are involved in the arthritis and then determine how far along the arthris is. After a SL dissocation wrist, radiocarpal joint arthritis develops first, then capitolunate arthritis develops, then STT arthritis. Usually the radiolunate joint is spared from degeneration. In a SNAC wrist the arthritis develops in the same way. However in RA, the whole wrist shifts palmar and deviates radially, while the ulna shifts backwards b/c the DRUJ is disrupted.
How is Wrist Arthritis treated?
Treatment is often started with activity modification, splinting, anti-inflammatories, and steroid injections.
Like most arthritic conditions, the nonsurgical approach is first recommended.
Altering activities to decrease strain across the wrist in combination with a wrist splint to stabilize the joint, and taking anti-inflammatory medications can really help with pain relief for many years.
The surgeries to treat wrist arthritis are effective at treating pain but are complex procedures and should only be considered when non-surgerical treatments are not effective. There are multiple surgical techniques for treatment including 1) a proximal row carpectomy; 2) partial carpal fusion (four corner fusion) or a 3) complete carpal fusion. These surgeries, in various techniques, remove arthritic bones, or fuse two bones together thereby effectively removing the arthritic joint which was causing pain. Patients will lose some strength and/or wrist motion depending on which procedure is utilized.
What is the long term outcome?
The patients do well when treatment is approached with stepwise progression to more invasive therapy.