Osteoarthritis of the wrist

Osteoarthritis of the wrist is a degenerative pathology affecting the cartilage covering the ends of the bones in the wrist joint. Cartilage, like a shock-absorbing cushion, wears away over time or after trauma, resulting in direct contact between the bones. This causes pain, inflammation and sometimes deformation of the wrist. Osteoarthritis is linked to mechanical wear of the joint.

Osteoarthritis of the wrist is often caused by old fractures. When these wrist fractures fail to heal properly, they alter the alignment of the bones, leading to premature wear of the cartilage. This phenomenon is particularly marked in SLAC (Scapho-Lunate Advanced Collapse) and SNAC (Scaphoid Nonunion Advanced Collapse) syndromes, which result from poorly-healed sprains or fractures. These syndromes lead to instability and progressive degradation of the joint, causing pain and functional limitations.

Repetitive movements and excessive loads applied to the wrist, as in certain occupations or sports, can accelerate the onset of osteoarthritis. In addition, certain inflammatory diseases such as rheumatoid arthritis can also contribute to cartilage wear.

Symptoms of osteoarthritis of the wrist often begin with pain, especially during movement. This pain may be accompanied by morning stiffness, which improves with activity. As osteoarthritis progresses, pain becomes persistent, even at rest, and is accompanied by a loss of mobility. Daily movements may become difficult, and in advanced stages, visible deformities of the wrist may appear, sometimes associated with crackling during movement.

Diagnosis of osteoarthritis of the wrist is based on clinical examination and imaging studies. The hand surgeon examines the wrist for pain, deformities, loss of mobility and strength. X-rays of the wrist confirm osteoarthritis of the wrist and guide treatment choices.

An arthro-scanner (or arthro-MRI) may be required to obtain more detailed images of the cartilage lesions and assess the extent of the damage.

Treatment of osteoarthritis of the wrist depends on the severity of symptoms and the impact on the patient’s quality of life. Two main approaches are proposed: conservative medical treatment and surgery.

Conservative medical treatment is often the first approach for wrist osteoarthritis, and aims to relieve pain. Custom-made splints and occupational therapy are used to relieve pain and help the patient with daily activities. Corticosteroid infiltrations can provide temporary relief.

When conservative treatments no longer suffice, or when osteoarthritis is too advanced, surgery may be required. Partial wrist arthrodesis, in which several wrist bones are fused together, is common to eliminate pain by stabilizing the joint, although it limits mobility. Arthroplasty, which replaces the joint with a prosthesis, can offer improved mobility, with results varying from patient to patient. Other procedures, such as denervation, total arthrodesis or bone resection, may be considered to maintain some joint function while reducing pain.