Wrist osteoarthritis

What is osteoarthritis of the wrist?

Osteoarthritis refers to a non-inflammatory degeneration of the joint cartilage, which is a physiological sign of aging. However, it can be aggravated by external factors. In wrist osteoarthritis, the joint surfaces of the two forearm bones, the ulna and radius, as well as the carpal bones that together form the wrist, are affected.

Typical symptoms of wrist osteoarthritis

The main symptom of wrist osteoarthritis involves pain in the affected joint.

This pain only occurs in certain conditions during the initial stages:

• movement of the wrist after prolonged rest

• after prolonged or heavy strain

• during maximum wrist movement in any direction (maximum flexion, extension or lateral inclination)

In addition, there may be instability in the joint or an increased cracking or rubbing noise during movement.

With advanced osteoarthritis, pain in the wrist is permanent, also at night. Restricted movement and morning stiffness also occur, and the muscles around the wrist can become stiff.

If temporary inflammation of the wrist also occurs, this is referred to as activated osteoarthritis. Here, the joint is usually red, overheated and swollen. The pain and functional limitations can worsen during these episodes.

Cause: How does wrist osteoarthritis develop?

Osteoarthritis is a normal ageing process. This is why wrist osteoarthritis often occurs without a specific cause. Nevertheless, there are various risk factors that encourage the development of osteoarthritis and can trigger wrist osteoarthritis at a younger age.

• Heavy one-sided strain on the wrist

• Bone fractures or torn ligaments around the wrist

• Misalignment of the wrist

• Rheumatic joint diseases

• Metabolic diseases (e.g. gout)

• Immobilization

• Genetic disposition

Diagnosis: How does a doctor diagnose wrist osteoarthritis?

Arthritic changes can be detected using imaging techniques. The extent of these visible changes does not always correlate with the patient's complaints and symptoms, though, so treatment is based more on how the patient feels. However, diagnostics are still very important to exclude other diseases with similar symptoms.

The wrist can be visualized using various imaging techniques including X-ray, ultrasound or MRI. An MRI (magnetic resonance imaging) is the most accurate, but also most complex and expensive examination.

In the case of wrist osteoarthritis, there are signs of osteoarthritis that the doctor can detect. This includes a narrowing of the joint space and the presence of bony protrusions on the joint surfaces. Other radiographic changes, such as an excessive growth of the joint capsule or inflammation of the tendons, tend to speak more against osteoarthritis and in favor of rheumatoid arthritis, of which the symptoms are similar.

If imaging is inconclusive, additional blood tests can be performed to distinguish between wrist osteoarthritis and arthritis. In cases of arthritis, elevated inflammation markers and possibly rheumatoid factors can be found in the blood, whereas no abnormalities are present with osteoarthritis.

Osteoarthritis of the wrist: treatment and surgical procedure

There are various conservative options for treating wrist osteoarthritis. They do not provide a cure but are used to alleviate the symptoms.

• Taking anti-inflammatory and pain-relieving medication

• Physical therapy (e.g. cold, heat, electrical stimulation)

• Splinting of the wrist

• Injections of hyaluronic acid (Hyaluronic acid is an important component of joint fluid, binds water, and nourishes the non-vascularized joint cartilage. By injecting hyaluronic acid into the joint, cartilage degradation caused by osteoarthritis can be slowed down).

It is also recommended to strengthen the muscles of the hand and forearm to reduce the strain on the joint. By regularly training mobility, the range of movement can be preserved for longer. However, patients should avoid excessive strain, as this can encourage osteoarthritis.

If the symptoms are not controlled adequately with conservative treatment measures, wrist osteoarthritis should be treated surgically.

Denervation

In a minor surgical procedure, the nerve branches that transmit pain signals from the wrist to the brain can be exposed and severed. This can significantly alleviate osteoarthritis-related pain for several years. While the pain may not disappear completely, wrist mobility is preserved, and the sense of touch remains intact.

Resection of the proximal row of carpal bones

If the osteoarthritis is triggered by an unhealed fracture of one of the carpal bones and is limited to this part of the joint only, it is possible to achieve an improvement in symptoms for many years by removing the first row of carpal bones. However, mobility is somewhat limited after the operation.

Wrist endoprosthesis

An endoprosthesis can be used in cases of advanced wrist osteoarthritis. The bone parts that form the joint are removed and completely replaced with a prosthesis that is anchored in the remaining bone parts. The patient can be completely pain-free with only slightly reduced mobility.

The prosthesis can become loose after several years. In this case, another operation is required - a prosthesis replacement or permanent stiffening of the wrist.

Midcarpal partial arthrodesis

For certain causes of wrist arthrosis, for example following a fracture of the scaphoid bone (a carpal bone) or certain torn ligaments, a partial fusion of the wrist is a suitable treatment option. If the scaphoid bone is the cause, it is removed. The remaining carpal bones are firmly joined together using bone tissue taken from the iliac crest and additionally stabilized with metal pins or a small plate. This surgery can significantly improve or even eliminate pain. However, the mobility of the wrist is subsequently reduced to a third to half of that of a healthy wrist.

Wrist arthrodesis

An arthrodesis is the complete immobilization of a joint. In this case, all the bones of the wrist are fused together so that movement is no longer possible. This usually results in pain relief, even with strain. Finger movements and forearm rotations are still possible without any problems.

Chances of recovery and prognosis with wrist osteoarthritis

Without surgery, wrist osteoarthritis progresses with increasing pain until the joint becomes stiff.

Good results can, however, be achieved with the various surgical techniques. Prognosis depends on the quality of the remaining bones, which are stiffened together or used as anchors for the prosthesis. A smoker statistically has a lower chance of favorable bone healing after surgery than a non-smoker.

Which doctors and clinics specialize in wrist osteoarthritis?

The symptomatic therapy of wrist osteoarthritis can be provided by the general practitioner who as a primary care provider has experience with such a common disease. However, the specialist for this condition and the right contact for more interventional treatments is an orthopedic surgeon.

If you are planning an operation, it is recommended that you visit a hand surgery clinic. Hand surgery is an additional qualification that can be acquired by a specialist in orthopedics or another surgical specialty through appropriate further training.

Anyone in need of a doctor would expect the best possible medical care for themselves. Therefore, patients are looking for the most suitable clinic for their needs. Since this is not an objective decision and a respectable doctor would refrain from claiming to be the best, patients must trust the experience of a doctor.

We can help you find an appropriate expert for your condition. All the doctors and clinics listed have undergone extensive review and have been verified by us for their outstanding expertise in the field of wrist osteoarthritis. They are looking forward to and are ready to address your questions and treatment requests.