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Arthritis of the Wrist

Bone, Muscle, & Joint
Diseases & Conditions
Contributed byKrish Tangella MD, MBAApr 18, 2018

What are the other Names for this Condition? (Also known as/Synonyms)

  • Degenerative Osteoarthritis of Wrist
  • Inflammation of the Wrist Joint
  • Wrist Arthritis

What is Arthritis of the Wrist? (Definition/Background Information)

  • Arthritis is a joint disorder characterized by an abnormal inflammation that affects one or more joints, within the body. Generally, arthritis increases with age. The majority of individuals who develop the condition begin experiencing pain and stiffness, in the affected joint or limb.
  • Arthritis of the Wrist affects the wrist joint; especially the cartilage, bone, soft tissue surrounding the joint, muscles, and tendon.
  • There are many causes of Arthritis of the Wrist. Major causes are: Degenerative osteoarthritis, post-traumatic arthritis, avascular necrosis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and gout (gouty arthritis).

There are several different types of arthritis. The most common types of Wrist Arthritis that may develop include:

  • Degenerative Osteoarthritis of Wrist: It is the most common type of arthritis. Osteoarthritis is characterized by a progressive degeneration of cartilage, bones,  or synovial membrane, within the joint, usually over a prolonged time period
  • Post-Traumatic Wrist Arthritis: It is a type of osteoarthritis. Post-Traumatic Wrist Arthritis is a progressive, degenerative disorder that may develop after a significantly traumatic injury to the wrist
  • Avascular Necrosis of Wrist: Avascular necrosis of Wrist occurs when blood flow to wrist joint is disrupted. This results in tissue damage (of both the bone and soft tissue surrounding the joints). Common causes of avascular necrosis include, chronic steroidal therapy, sickle cell disease, and trauma to the joint
  • Rheumatoid Arthritis involving Wrist: Rheumatoid arthritis is an autoimmune systemic inflammatory condition that may affect the lining of joints, surrounding tissues, or organs, within the body
  • Systemic Lupus Erythematosus causing Wrist Arthritis: Systemic lupus erythematosus is an autoimmune systemic inflammatory condition that occurs when an individual’s immune system creates antibodies that accidentally attack healthy tissues and organs within the body
  • Gout involving the Wrist Joint: A complex type of inflammatory arthritis, gouty arthritis is a medical condition caused by a high level of uric acid within the blood. A gout attack occurs with the abnormal formation of crystallized uric acid, resulting in inflammation of the joints. Gout generally affects small joints of the foot. Involvement of wrist joint by gout, is not common

Who gets Arthritis of the Wrist? (Age and Sex Distribution)

  • Individuals of all age, race, or ethnic groups, and belonging to any gender, may develop Arthritis of the Wrist
  • However, a high percentage of individuals who develop Wrist Degenerative Arthritis causing a debilitating and progressive disorder, are middle-aged and elderly adults
  • Young athletes, who sustain traumatic joint injuries while participating in rough or high-impact sports, may develop Post-Traumatic Wrist Arthritis
  • Wrist Degenerative Osteoarthritis and Systemic Lupus Erythematosus causing Wrist Arthritis is more common in females

What are the Risk Factors for Arthritis of the Wrist? (Predisposing Factors)

Risk factors associated with Arthritis of the Wrist include:

  • Age: Degenerative Osteoarthritis of the Wrist may develop in individuals of all ages, but is rarely diagnosed in individuals under the age of 40 years. However, since it is a gradually progressing disorder, the risk of developing this condition usually increases with age
  • Gender: Degenerative Osteoarthritis of the Wrist and rheumatoid arthritis are more likely to develop in women. However, men have an increased risk of developing gouty arthritis
  • Athletics: Individuals who sustain a wrist joint injury while participating in a rough or high-impact sports, such as football, basketball, soccer, wrestling, rugby, hockey, skiing, and snowboarding, are prone to developing Post-Traumatic Wrist Arthritis
  • Obesity: Excess body weight associated with obesity may cause abnormally increased pressure on the joints. This increases the risk for degenerative osteoarthritis, affecting the wrist
  • Family history: Some arthritic disorders, such as rheumatoid arthritis, have a genetic prevalence. Those having an immediate family member or a relative with a history of rheumatoid arthritis condition, may be at an increased risk
  • Smoking: Various studies have found that smoking is one of the key contributing factors for the development of rheumatoid arthritis
  • Certain occupations: Individuals with certain occupations (like carpenters and painters), which require a set of repetitive physical movement/motion for prolonged periods, have an increased risk of developing Degenerative Osteoarthritis of the Wrist

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Arthritis of the Wrist? (Etiology)

Many different contributing factors exist, since there are several different types of arthritis. Some causes that may be associated with Arthritis of the Wrist include:

  • Sports-related injury: Post-Traumatic Wrist Arthritis may develop in individuals who sustain a joint injury, while participating in rough or high-impact sports, such as football, basketball, soccer, wrestling, rugby, hockey, skiing, and snowboarding
  • Certain occupations: Individuals with certain occupations that require a set of repetitive physical movement/motion for prolonged periods, such as carpenters and painters, may be affected by Degenerative Osteoarthritis of the Wrist
  • Family history: Some arthritic disorders, such as rheumatoid arthritis, have a genetic prevalence. Those having an immediate family member or a relative with a history of this condition, may be at risk
  • Obesity: Excess body weight associated with obesity, may cause abnormally increased pressure on the joints
  • Kienböck's disease: Kienböck's disease is a rare, progressive, and debilitating condition caused by the interruption of blood flow to the lunate bone (one of the wrist bones). It may result in the development of osteoarthritis

In all of the above cases, the cartilage tissue covering the joint is damaged, either due to inflammation (such as rheumatoid arthritis), or due to repeated stress/trauma (such as degenerative osteoarthritis). The thinning of cartilage causes bone-on-bone contact in the joints. Once the bones are rubbing on each other, it causes pain, stiffness, and abnormally restricted joint movement.

What are the Signs and Symptoms of Arthritis of the Wrist?

Arthritis is a gradual progressive disorder that usually worsens over time. Common signs and symptoms associated with Wrist Arthritis include: 

  • Noticeable pain and tenderness (pain on touch)
  • Swelling of tissue (due to inflammation) around the wrist joint
  • Stiffness, decreased range of motion of the wrist joint
  • Formation of cysts around the affected wrist joints
  • Wrist joint deformity
  • Noticeable redness due to an inflammatory response of the body

How is Arthritis of the Wrist Diagnosed?

Diagnostic methods that a physician may use to help diagnose Arthritis of the Wrist include:

  • Physical examination: A thorough physical examination of the wrist may be undertaken by the physician. In addition to this, a complete medical history will aid in arriving at the correct cause of Wrist Arthritis
  • X-rays: X-rays are utilized to visualize images of the wrist. It can also help the physician rule out other possible causes of wrist discomfort
  • Blood test: A blood sample is drawn from an artery or vein using a needle and taken to a laboratory for analysis. Blood tests such as complete blood count (CBC), rheumatoid factor (RF) levels, cultures of the joint fluid, lupus blood tests (SLE panel), help the healthcare provider arrive at a cause for Wrist Arthritis
  • Fine needle aspiration (FNA) of joint fluid analysis: Occasionally, fluid may accumulate around a joint, which results in pain and disability. Analysis of this joint will provide clues regarding the cause of joint fluid accumulation
  • Ultrasound imaging: An ultrasound imaging equipment uses high-frequency sound waves to generate a more detailed image of the wrist
  • MRI and CT scan of the wrist joint: This helps assess the damage to the joint and surrounding tissue
  • Arthroscopy: During this procedure a surgeon inserts a thin tube attached to a camera (a fibro-optic camera) into the joint, via a small incision on the skin of the joint. Visualizing the joint via a camera helps the healthcare provider arrive at a cause of Wrist Arthritis. Arthroscopy is considered to be a minimally invasive diagnostic tool

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Arthritis of the Wrist?

Arthritis is a progressive condition that gradually worsens over a long period of time. The complications from Wrist Arthritis include:

  • Chronic pain and stiffness of the wrist joint, which may prevent individuals from performing their routine daily activities
  • Some cases may cause permanent disability (frozen joints)

How is Arthritis of the Wrist Treated?

The treatment measures depend on the cause of Wrist Arthritis and these are grouped as non-surgical and surgical treatment methods. A healthcare provider may start with non-surgical treatment methods before adopting surgical procedures and techniques. However, in some cases, the healthcare provider may elect to use surgical treatment methods, if the symptoms or the condition, cannot be managed with conservative non-surgical methods.

Nonsurgical treatment measures that may help relieve pain and improve the range of motion of the wrist joint include:

  • Rest: Any activity that aggravates the wrist condition further should be avoided. The physician usually advises to refrain from all such activities, until the symptoms stop
  • Heat and ice: Applying a damp heated towel or ice to the wrist joint, can help reduce pain and swelling
  • Splint or brace: Some type of padded splint or cast may be used to help keep the wrist joint in a stable position, especially while sleeping
  • Non-steroidal anti-inflammatory medication: Oral medications, such as ibuprofen and naproxen, can help decrease pain and swelling in the wrist
  • Corticosteroids: Oral steroidal medications, such as prednisone, may help decrease inflammation and increase motion range of the wrist
  • Viscosupplementation therapy: The normally present fluid (synovial fluid) within a joint contains a material called hyaluronic acid. When a joint is affected by osteoarthritis, there is a reduction of hyaluronic acid level within the joint. This decreased acid level reduces the fluid’s ability to lubricate the joint. Viscosupplementation is a common and minimally invasive technique that is used in treating osteoarthritis. During this procedure, small doses of hyaluronic acid are injected into the wrist joint, to increase its lubrication and thereby relieve pain
  • Physical therapy: After the signs and symptoms have decreased, it is important to begin some light motion exercises. Physical therapy may help restore strength, as well as flexibility, in the muscles
  • Injection of steroids into the joints: Steroid injection into the joint helps in temporary relief of symptoms (such as pain), and in improving the range of motion. It is important to note that steroidal injections only give temporary relief and prolonged episodes of such injections, may injure the joints in the long run

Surgical treatment measures include:

  • Proximal row carpectomy: Proximal row carpectomy is a surgical intervention technique that involves the removal of three carpal bones in the wrist.  The purpose of this procedure is to relieve pain and maintain/improve function of the wrist
  • Joint fusion: In a joint fusion, the arthritic part within the wrist joint is removed and the two adjoining bones are fused together. The purpose of this procedure is to relieve pain, stabilize the joint, and regain some range of motion with the wrist
  • Total wrist arthroplasty: In total wrist arthroplasty the wrist joint is completely removed. It is then replaced by a metal and plastic prosthetic implant. This surgical procedure is recommended, if the entire wrist joint is acutely affected by the inflammatory and degenerative joint disorder

How can Arthritis of the Wrist be Prevented?

Common recommendations to help prevent Arthritis of the Wrist are:

  • Healthy body weight: Maintaining a healthy body weight can help reduce abnormal pressure within the joints, which may decrease the risk of arthritis
  • Healthy diet: Individuals who consume a healthy diet regularly, may decrease their chances of developing Wrist Arthritis 
  • Use protective gear: Individuals who participate in high-risk sports activities (like football), should wear appropriate safety equipment to help prevent the possibility of injuring their wrists, or other joints
  • Regular stretching exercise helps decrease the incidence of development of Arthritis of the Wrist

What is the Prognosis of Arthritis of the Wrist? (Outcomes/Resolutions)

  • The long term prognosis with arthritis depends on the specific type of inflammatory and degenerative disorder an individual develops, and the severity of the condition
  • If the cause of Wrist Arthritis is detected early, and proper, aggressive treatment provided; then, the quality of life can be substantially improved. This also helps avoid any serious complications from arising in the wrist joint
  • Degenerative Osteoarthritis of the Wrist is a debilitating disorder. A high percentage of individuals who develop this disorder may experience a gradual degeneration of their wrist joint, during their lifetime

Additional and Relevant Useful Information for Arthritis of the Wrist:

Fine needle aspiration (FNA) of joint fluid analysis procedure:

  • A needle is inserted within the joint space and the accumulated fluid aspirated with a syringe, which is then sent to a laboratory for analysis
  • The tests a laboratory may perform would include:  Analysis of the type of cells present in the fluid, chemical composition of the fluid, and examination of the fluid under the microscope, for the presence of crystals
  • If an infection is suspected as the cause for fluid accumulation at the joint, then a joint fluid culture may be performed, to remove fluid from the joint

One must be careful while adopting unproven and non-evidence based claims, such as copper bracelets and magnets, for treating joint disorders. Your healthcare provider is the best source for advice, on new methods of treatment.

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Krish Tangella MD, MBA

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