Wrist joint osteoarthritis

Osteoarthritis is the name given to age-related arthritis which causes the affected joint to become painful and stiff. The process of osteoarthritis involves wearing or thinning of the smooth cartilage joint surfaces as well as stiffening to the soft tissue surrounding the joint. These aspects combine to produce swelling, inflammation and pain. Several factors normally combine to cause symptoms of osteoarthritis.

• Previous joint damage (from trauma or other conditions such as such as gout and rheumatoid arthritis)
• Age (risk increases with age)
• Family history (genetics)

As it is not a weight-bearing joint, significant wrist osteoarthritis often only develops in individuals who have sustained previous trauma to the joint or who have been involved with occupations or recreational use of the wrist involving sustained, heavy loads being placed through the joint.

Most commonly, the pain is felt on the top and side/s of the wrist joint. Some individuals may suffer with referred pain radiating in to the top of the hand. Fortunately, the presence of wrist OA does not always cause pain so it is quite possible to live pain free despite reasonably advanced arthritis. In addition, the wrist undergoes a ‘wear and repair cycle’ so pain can improve with appropriate treatment.

Pain with weight bearing through the wrists and hands as well as movements involving rotation of the forearm and wrists such as turning a key in a lock are often the main aggravating activities. If wrist osteoarthritis becomes more severe the movements of the wrist may become increasingly stiff.

Wrist osteoarthritis can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination. The main feature on examination is often a reduced range of movement. X-rays are not routinely required but may be requested if symptoms are severe enough that surgery is being considered.

Non-surgical management

In the majority of cases, the symptoms of wrist OA can be managed effectively by non-invasive measures as described below.

Wrist splint

Wearing a wrist splint intermittently when performing certain tasks may reduce stresses on the wrist joint and reduce subsequent pain.

Exercises

Regular exercises to maintain flexibility and strength to the affected wrist joint:

[Contrast bathing video] https://youtu.be/5g3yKlVViIo [Wrist extension prayer stretch] https://youtu.be/Db1_y7GpEP0

5×30 second holds, 2x per day

Using painkillers when needed

Over-the-counter analgesia is available through pharmacies when needed. Paracetamol is most commonly prescribed. Anti-inflammatories, such as Ibuprofen are also used, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice. There is a good booklet on the Arthritis Research UK website with information about the various drug options.

Corticosteroid injection therapy

For individuals with moderate wrist osteoarthritis who continue to suffer disabling symptoms in spite a course of non-surgical management (outlined above), a corticosteroid injection can be offered as the next line of treatment. You can read more about local corticosteroid injections here.

Surgical management

Wrist arthrodesis (fusion) and in rare circumstances wrist replacement surgery can be considered for individuals who:

• Have X-rays confirming advanced osteoarthritis of the wrist joint
• Have trialled a course of non-surgical management without success
• Have consistent, disabling pain significantly function and impairing quality of life

Further information about Osteoarthritis – Arthritis Research UK