There are over one hundred kinds of wrist arthritis. The two most common types are osteoarthritis and rheumatoid arthritis. Rheumatoid arthritis causes joint lining, or synovium, swelling and joint space narrowing. It progressively destroys the bones and soft tissues of both wrists and other joints of the body.
Osteoarthritis affects the cushioning cartilage on the ends of wrist bone, which enables them to move smoothly. Osteoarthritis occurs when the cartilage is damaged as a result of previous injury to the wrist, or normal wear and tear process as we age. As the cartilage is destroyed, the bones begin to rub against each other and cause pain, stiffness and weakness.
In rheumatoid wrist arthritis, patients often experience swelling, tenderness, limited motion, decreased grip strength and pain in the knuckle joints, or metacarpophalangeal (MCP) joints. Wrist osteoarthritis is accompanied by swelling, pain, limited range of motion, and weakness. In both, rheumatoid and osteoarthritis, joint swelling may compress the nerves that travel through the wrist, which can lead to neuropathy such as carpal tunnel syndrome.
A detailed history including medical conditions, activities that aggravate wrist use, and any prior injuries, is important. During a physical examination, your doctor will look for tenderness and swelling, limited range of motion as well as identify positions which cause pain to your wrist joints. X-ray will be taken to evaluate the extent of joint damage and to check for any evidence of fractures. By the time wrist arthritis can be seen on x-rays, there has been significant damage to the wrist joint surface. Some forms of rheumatoid arthritis can be confirmed by a blood test.
Treatment options depend on the severity of wrist arthritis symptoms and patient’s overall medical health.
Pain and swelling control: For the early stages of wrist arthritis, over-the-counter pain and anti-inflammatory medications help to reduce or alleviate pain and swelling. Additional therapies for patients with rheumatoid arthritis include antimalarial drugs, antimetabolites, gold, and immunosuppressive drugs.
Physical Therapy: Physical therapy and activity modifications serve to strengthen the musculature and reduce stress on the joint cartilage. Avoiding aggravating activities and having periods of rest after these activities may be helpful. Applying heat or cold, splinting, and gentle exercises may be recommended.
Steroid injections: Steroid injections typically provide significant pain relief although temporary. They can be used until symptoms progress enough to require surgical treatment.
Surgical treatment is recommended when the conservative, non-surgical intervention fails to adequately control patient’s symptoms. Surgical options include removing the arthritic bones, joint fusion, which makes the joint solid and prevents movement at the wrist, and joint replacement.