Wrist Osteoarthritis: Symptoms, Diagnosis, and Treatment

What is wrist osteoarthritis?

Wrist osteoarthritis is a condition caused by the wear and tear of the cartilage in one or more of the joints that make up the wrist. It can be post-traumatic, degenerative, or rheumatic.

Wrist osteoarthritis is a chronic condition that worsens over time. Treatment is based on palliative care to reduce or eliminate pain.

Symptoms of wrist osteoarthritis

What are the causes of wrist osteoarthritis?

Osteoarthritis is a pathology whose causes are not yet very clear. Certainly, some risk behaviors have been identified that can predispose the individual to suffer from this disease. In the case of wrist osteoarthritis, indeed, the people who suffer the most from this condition are those who perform manual activities such as: bricklayer, carpenter, masseur, employees who spend many hours on the keyboard and mouse of the PC, electricians, cooks, etc....

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Diagnosis of wrist osteoarthritis

Physical examination

During the physical examination, the doctor will ask the patient to indicate where the pain is felt, observe the appearance of the wrist (if it is red, swollen or has particular signs), test its articular mobility to identify any anomaly and, finally, check the force that the limb can apply. Based on the results of these observations, they will decide whether or not to continue the investigation with other diagnostic tests.

Diagnostic imaging

Diagnostic imaging refers to all examinations that result in the obtaining of an image useful in the search for the problem.

• X-ray examination is very useful for highlighting fractures and signs of osteoarthritis.
• The CT scan shows in detail the anomalies of the bones and joints. However, its execution exposes the patient to ionizing radiation, so its use must be evaluated on a case-by-case basis.
• Bone scintigraphy consists of injecting a radiopharmaceutical product which allows images of the anatomy and metabolic activity of the bones to be obtained. This is a very sensitive diagnostic test, but at the same time it is also non-specific.
• Magnetic resonance imaging (MRI) highlights the appearance of the bones and soft tissues present at the wrist level and, unlike the CT scan, does not involve exposure to ionizing radiation.

In order to identify the precise cause of wrist osteoarthritis, the doctor must subject the patient to a complete history and a precise objective examination and, if they deem it appropriate, to more specific checks, such as diagnostic imaging, arthroscopy, electroneurography and electromyography.

Only with a precise diagnosis is it possible to plan the most appropriate therapeutic treatment.  

Can wrist osteoarthritis be avoided?

Surgical treatment of wrist osteoarthritis

Surgical treatment of osteoarthritis becomes necessary when pain does not regress with rest or physiotherapy treatment.

In some cases, surgery also has a preventive purpose and serves to avoid the progression of osteoarthritis from certain bones to the entire carpus. Different chiropractic solutions are implemented, depending on the cause and the radiographic stage of the osteoarthritis. If the osteoarthritis only affects the first row of carpal bones, an intervention consisting of the surgical removal of this row or a partial fusion of the carpal bones can be performed leaving the semilunar bone in place.

These operations resolve most of the pain symptoms and generally allow the movement necessary for the use of the wrist to be preserved (movement generally limited even before the operation due to osteoarthritis).

Post-operative treatment involves immobilization in casts for about 30 days and abstention from heavy manual activities for at least 4 months.

On the other hand, in the case of osteoarthritis now affecting the entire carpus, a salvage operation is performed: total arthrodesis, which eliminates the flexion-extension movement of the wrist but restores strength in the absence of pain when using the hand.

In the presence of diffuse carpal osteoarthritis with pain but movement still preserved, it is possible to perform a "denervation of the carpal bones" operation. During this intervention, through 4 small surgical incisions, the branches of the peripheral nerves that transmit the sensation of pain to the wrist joints are interrupted, leaving the branches of the sensitivity of the skin of the hand intact. This operation eliminates the painful component of the disease, does not reduce the wrist joint and requires a few days of post-operative immobilization. It does not stop the progression of osteoarthritis, but does not prevent orthopedic surgery on the carpus at a later date.

Physiotherapy for hand and wrist osteoarthritis

The objective of physiotherapy for hand and wrist osteoarthritis is to reduce symptoms and improve hand and wrist function. To achieve this objective, the following are used synergistically:

• Manual techniques: traction mobilization and massage therapy, help relax tissues and treat movement dysfunctions that are often at the origin of an arthritic condition.
• Physical means: are applied to control inflammation and reduce pain.
• Ultrasound: sound waves are used to produce biological stimulation in the tissues.
• Exercises and self-postures: these are generally taught during therapy and are then performed daily at home. Through specific therapeutic exercises and the adoption of particular postures, the patient can more easily stabilize the progress made during the session and better manage their condition.
• Information: indicate to the patient the risk behaviors to limit, how to manage acute pain phases and when to use orthoses such as splints.