What causes arthritis of the wrist?

• Trauma: Intra-articular fractures will also damage the cartilage lining of the joints.
• Wear and tear arthritis due to aging process.
• Rheumatoid arthritis and other types of inflammatory arthritis.

What are the symptoms?

• Deformity and swelling.
• Pain with motion.
• Stiffness.

How to diagnose it?

Clinical examination will show:

• Tenderness around the joint
• Deformity or angulation
• Limited range of motion

Tests:

• X-ray of the involved joint will show various degrees of joint destruction
• Blood tests

Functional treatment

NSAIDs, corticosteroids; drugs and splinting are the mainstay of conservative therapy.

Surgery

Joint fusion or replacement can be considered depending on the affected joint and lifestyle.

Several selective joint fusions can alleviate pain while preserving motion.

Different types of partial wrist fusions include

• Four corner fusion with resection of the scaphoid.
• STT fusion (between scaphoid, trapezium and trapezoid)
• Capito-lunate fusion (between capitate and lunate)
• Scaph-capitate fusion (between scaphoid and capitate)
• Radio-scapho-lunate fusion (between radius, scaphoid and lunate)

We will always favour motion-preserving procedures but in very advanced stages, only a formal wrist fusion will treat the pain.

Wrist arthroplasties include proximal row carpectomy, partial joint resections (such as distal scaphoid resection to treat STT arthritis).

Arthroscopic procedures are evolving significantly and new implants are being developed to improve the possibilities of minimally invasive wrist surgery.

Theses sophisticated surgical procedures require period of postoperative immobilization, to allow bones and joints to heal.

Possible complications include pain, bone non-union, stiffness, nerve or tendon injuries and the need for additional procedures, such as :

• Capitolunate fusion
• Four corner fusion
• Partial wrist fusion
• Total wrist fusion