Wrist pain caused by arthritis is a common reason patients seek the care of a hand surgeon. While many patients have heard quite a bit about hip and knee arthritis, and may have friends and family who have had a hip or knee joint replacement, wrist arthritis and its treatment are less well understood outside the hand surgery community.
There are several different configurations and locations of arthritis which affect the treatment options. In this article we’ll discuss arthritis in the main wrist joint (radio-carpal). Other locations of arthritis, such as the base of the thumb (thumb carpo-metacarpal joint) and the distal ulna, deserve their own articles.
Arthritis at the radio-carpal joint presents as pain with gripping and movement. Range of motion frequently decreases as the arthritis worsens. Going into full extension when pushing up eventually becomes impossible. There is frequently swelling in the wrist often on the radial (thumb side) of the wrist. Sometimes this arthritis is caused by degeneration related to an old injury such as a scaphoid fracture or a rupture of a stabilizing structure called the scapholunate ligament. Rheumatoid arthritis, which is an auto-immune inflammation of the joints, will also frequently present in the wrist.
Treatment of wrist arthritis can be as simple as activity modification. A wrist brace can be tremendously helpful. Over-the-counter ibuprofen or prescription anti-inflammatory medication are frequently used. Steroid injections can provide substantial pain relief, sometimes for months.
If non-operative treatment doesn’t provide adequate pain relief, there are several surgical options. The specific procedure selected by a hand surgeon depends significantly on the patient’s use of the hand and their overall goals.
Wrist “denervation” refers to removing two nerves that go to the wrist capsule. It is a minimally invasive option with limited downtime. This may buy time until a more comprehensive reconstruction is needed.
The two most widely performed surgeries for wrist arthritis are proximal row carpectomy (removal of the arthritic bones) and mid-carpal fusion. These surgeries are based on the concept that removal of the arthritic scaphoid relieves pain, and that certain joints in the wrist predictably remain arthritis-free and can be relied on for motion. Carpectomy offers the benefit of not needing to wait for bone healing. A partial fusion, however, is required for certain specific X-ray findings. Carpectomy and partial fusion usually allow for half of a typical wrist flexion-extension arc of motion.
A total wrist fusion is a great option for those patients with severe arthritis and those who need maximum durability. Good candidates are manual laborers and individuals who use crutches or walkers to get around. A surgical plate is applied across the back of the wrist joint, locking it into a permanent but functional position. While rotation of the forearm is maintained, wrist flexion and extension are eliminated. Pain relief is typically excellent and most patients report adapting to their lack of wrist range of motion without too much difficulty.
Wrist replacement remains an area of research and advancement. It is performed much less commonly than replacement of the knee or hip. Replacement generally adds cost and complexity without much improvement in outcome over the surgeries discussed in the previous paragraphs. There are, however, a few specific instances where it can be the most appropriate treatment.
Dr. Elliot Robinson, the author of this article, is one of our fellowship-trained hand specialists at OrthoGeorgia. He specializes in the full spectrum of disorders of the hand, wrist, and elbow. He is board-certified by the American Board of Orthopaedic Surgery and holds a Certificate of Added Qualification in Surgery of the Hand, with a particular interest in sports injuries, post traumatic hand reconstruction, peripheral nerve surgery, elbow surgery, and reconstructive procedures for congenital hand differences. Dr. Robinson has authored multiple research papers on hand & upper extremity and has presented on a national level. He sees patients at our offices in Macon and Warner Robins.
Wrist arthritis can be debilitating. Pain relief and restoration of function can often be accomplished without surgery, but several surgical treatments are available when needed. A good outcome requires not only proper diagnosis and procedure selection, but also a thorough understanding of patient preferences and goals. At OrthoGeorgia, we are proud to provide our patients with a wide range of orthopaedic care services, from diagnosis of your injury or condition to surgery to bring you relief. We provide spine, hand, sports medicine, foot & ankle, and total joint care to those of all ages in Central Georgia. To schedule an appointment or to learn more about the care we provide in Macon, Macon Spine and Orthopaedic Center, Warner Robins, Kathleen, Milledgeville, and Dublin, please contact OrthoGeorgia today!
At OrthoGeorgia, we want to help you live a healthier and more comfortable life by giving those in Macon, Warner Robins, Kathleen, Milledgeville, Dublin, and the surrounding areas convenient access to the highest quality care. Whether you have been suffering from a sports injury or a common orthopaedic condition, we will determine the cause of your discomfort and craft a personalized treatment plan to bring you relief. To learn more about our services and our physicians, or to schedule an appointment at OrthoGeorgia, please contact us today.