Arthritis Treatment: What to Do About Wrist Arthritis

The wrist is a complicated joint. Rather than just two bones that interact, the wrist consists of eight small bones all of which interact with each other as well as the two arm bones- the radius and ulna- as well as the bones of the hand.

The wrist bones- called "carpals" are arranged in two rows and are held in place with an intricate system of ligaments.

The wrist has a number of functions. It moves the hand, stabilizes the hand, and enhances the mechanics of the hand in relation to the forearm.

Wrist arthritis results in both severe pain and restriction of movement. Swelling and deformity are other features of wrist arthritis.

A number of conditions can cause wrist arthritis. The most common is rheumatoid arthritis. However, crustal induced arthritis such as gout and pseudogout, psoriatic arthritis, and osteoarthritis can also be implicated.

Since the wrist is supposed to stabilize the hand, the resultant pain and deformity from arthritis may result in loss of function with weakness of hand grip.

History and physical exam start the process of diagnosis. Laboratory tests are also useful. While x-rays can detect damage, the findings are late. Magnetic resonance imaging is better for finding early changes.

The general axiom is that initiation of treatment for the underlying disease is needed along with local treatment for the wrist.

Non-surgical measures for wrist arthritis are aimed at pain relief. Splinting can be instituted during acute flares. However, prolonged can lead to wrist stiffness and weakness.

Non-steroidal anti-inflammatory drugs (NSAIDS) can help reduce swelling and pain.

Steroid injection may be beneficial. Injection should be accompanied by temporary splinting. The results can vary depending on the severity of the underlying problem.

In patients who don't respond to conservative measures, surgery may need to be considered. A number of considerations enter into the decision making process. These include: type of arthritis, the extent of involvement, functional requirements, and patient expectations.

Surgical options include:

• Arthroscopy (using a small telescope to examine the inside of the wrist and perform minor surgical procedures such as repairs of ligament tears)
• Synovectomy (removal of inflamed joint tissue; particularly useful for rheumatoid arthritis)
• Ulnar resection (removing the end of the ulna bone which helps stabilize the wrist biomechanically)
• Arthrodesis (fusion)

All of these treatments have their place depending on the extent of disease. Wrist replacements are improving all the time but are still inadequate.