Arthritis in the wrist area can involve any of several wrist bones but can generally be divided into three areas: the radio-carpal joint, the mid-carpal joint, or the radio-ulnar joint. When the term ‘arthritis of the wrist’ is used without further clarification, it usually refers to osteoarthritis involving the radio-carpal joint, mid-carpal joint, or both. Arthritis of the radio-ulnar joint is usually referred to by its acronym- DRUJ arthritis. The type, location, and severity of the arthritis determines the treatment plan.
Wrist Arthritis The wrist can be thought of as two rows of wrist bones. Arthritis can involved one or the other, or both at the same time. Early on, it can be subtle. Swelling, pain, limited motion, and weakness are common. These symptoms are usually limited to the wrist itself. Remote injury, including fractures or sprain, may be related. Upon examination, the wrist is usually tender to deep pressure, and limited in motion. X-rays may show narrowing of the space between the two bones, bone spurs, and cysts, signifying loss of the cartilage layer on the surface of the bones.
If nonsurgical treatment is not effective, we may consider surgery. As with all surgeries, there are some risks and possible complications. Depending on the degree of damage, the patient’s age and functional demands, we have to consider several options. There is usually a trade of between stiffness and reliability. The most secure option is fusion, but it comes with price tag- the patient will have to sacrifice what is left of his wrist motion. If the extent of the damage is not extensive, we may be able to save some motion by choosing other options such as limited fusion or carpectomy. The least reliable option, usually reserved for patients with high demand for motion but low demand for strength and stability, a wrist replacement may be a good option.Initial treatment of arthritis of the shoulder is nonsurgical. Splinting are usually very helpful. Typically I offer my patients a steroid injection and anti-inflammatory medicines. Activity modification, and icing or heating are helpful as well. Physical therapy usually has limited benefit.
DRUJ Arthritis is less common than wrist arthritis. It involves the area where the two long forearm ones meet at the wrist. DRUJ arthritis is usually related to previous fracture or dislocation. It is one of the more difficult arthritic conditions of the wrist to treat. Pain is usually made worse with forearm rotation such as with turning a key. Injections are less effective. Activity modification and anti-inflammatories are helpful. Surgery can be helpful, but is not perfect. There are several options available, but none is highly reliable.