What is Arthritis?
Arthritis is a condition in which a joint undergoes inflammation. This condition could be temporary (short-termed) and chronic (long-termed). It could also be a sequela of joint infection or trauma (intra articular fracture, i.e. bone break that extends into the joint surface). Lastly it can also be a part of autoimmune process, such as rheumatoid arthritis or lupus.
The Impact of Arthritis
With arthritis, cartilage continues to wear down. Cartilage is the smooth “cushioning” tissue that lines joints. Continuous cartilage damage frequently results in persistent pain and reduced range of motion (‘stiff’). The involved joint is also swollen, warm and maybe tender to touch. Furthermore, as cartilage is destroyed by the arthritic process, the joint space will eventually be obliterated (see figures 1 and 2).
Figure 1. The above radiograph shows normal wrist joint. Note that the joint space between scaphoid bone and distal radius is still well-preserved (yellow circle)
Figure 2. The above radiograph shows an arthritic wrist. The joint space between scaphoid and distal radius (yellow circle) is very narrow or obliterated.
Figure 3. This radiograph shows partial wrist fusion, in which two screws are fusing scaphoid and lunate bones to the distal radius. Also note that the ulnar head has been partially removed (yellow circle).
What is Osteoarthritis?
The most common form of arthritis in the wrist is osteoarthritis that also known as degenerative arthritis. Some factors contribute to the development of osteoarthritis. Age is a risk factor – the older one becomes, the longer the joint has been exposed to wear-and-tear. Mechanical derangement of the joint is an important factor as well.
A joint that loses its stability and alignment certainly loses its normal biomechanics. In a normal joint, there is even and physiological distribution of forces across the joint surface. In a joint that has been deranged, distribution of forces is altered. Some areas of the cartilage must then sustain forces beyond its physiological capacity, therefore a subject to damage.
Wrist arthritis can also result from infection, inflammatory conditions that can occur anywhere in the body such as rheumatoid arthritis, lupus and gout arthritis. Rheumatoid arthritis will be discussed in a separate section.
Symptoms of Osteoarthritis
Symptoms of arthritis from any cause can include:
- Pain in the involved joint.
- Loss of motion in the joint (stiffness)
- Grinding sensation that occurs during motion
- Swollen joint and tenderness
What are the first-line treatments for wrist osteoarthritis?
Treatment for wrist osteoarthritis should begin with non-surgical methods. Simple measures such as rest or activity modification may relieve pain. Splinting also helps, as splinting ‘forces’ the joint to rest. Over-the-counter medications (paracetamol, ibuprofen, mefenamic acid) also help in relieving pain. Physical therapy plays an important role in the management of arthritis.
Surgical management of wrist arthritis
Surgery is considered when non-surgical treatments above fail to relieve pain, or when resulting deformity interferes with wrist function. There are several different aims of surgery in the management of wrist arthritis:
- Surgery may aim to reconstruct or replace the joint. Although we cannot replace damaged cartilage with new, healthy cartilage, we can replace it with materials that function like cartilage. These materials give lining to the joint, replacing the damaged cartilage, so that the bones of the joint do not grind against one another. The materials can be prosthetic joint (such as the one used for total knee replacement), or biological materials, such as the patient’s own expendable tendon.
- Surgery may aim to fuse the joint. Fusion or arthrodesis obliterates the joint space, fusing 2 or more bones into one single (bigger) bone. Following this procedure, the fused joint no longer yields motion, which is a downfall, but it is very effective and reliable in eliminating pain.
- Surgery may also aim to simply remove the involved joint. In certain forms of wrist arthritis, some of the small bones in the wrist joint are removed to create more space that enables to preserve motion (see figure 3).