Wrist Arthritis

What is Wrist Arthritis?

Arthritis is a condition that causes inflammation, or swelling, in the joints. If you have arthritis, you might experience symptoms like pain, swelling, redness, stiffness, and loss of movement in the affected joint. Arthritis in the wrist, in particular, can hamper various day-to-day activities. To prevent it from becoming a long-term disability, it’s important to understand what causes it, get it properly diagnosed, and pursue effective long-term treatments.

As the wrist is not a joint that supports body weight, but plays a significant role in many daily activities, it is susceptible to injuries and arthritis. About one in seven people, or 13.6% of the population in this country, suffer from wrist arthritis. Sometimes, people might ignore or not properly manage wrist arthritis. However, if healthcare professionals are more knowledgeable about this condition, they can manage it better, leading to improved health outcomes for people suffering from wrist arthritis.

What Causes Wrist Arthritis?

The American Academy of Orthopedic Surgeons tells us that there are mainly three types of arthritis that can cause wrist pain: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

1. Osteoarthritis is often the reason for wrist pain in older people, but it can occur at any age. Factors like getting older, family history, being overweight, the shape of your joint, and being female can increase your risk of getting it. In younger people, it usually comes about after an injury to the joint.

2. Rheumatoid arthritis is an inflammation-related condition that generally affects joints on both sides of the body equally. We don’t know exactly what causes rheumatoid arthritis, but it’s likely that many different factors are involved.

Post-traumatic arthritis develops as a result of trauma to the wrist, like injuries to the ligaments (tissues that connect bones to each other) or fractures (breaks) in the wrist bones. Even if treated well, damage to the bones from the injury can increase the risk of arthritis over time. It often affects people many years after their initial injury.

Other things that could cause wrist arthritis include infection (septic arthritis), arthritis caused by crystals in the joint, reactive arthritis (when the body’s immune system reacts to an infection), and diseases that affect the whole body, like sarcoid arthropathy (a type of arthritis caused by an immune system disorder), myelodysplastic (diseases where the body doesn’t produce enough healthy blood cells), and leukemic disorders (a kind of cancer that affects the blood and bone marrow).

Risk Factors and Frequency for Wrist Arthritis

The wrist might not carry body weight, but its daily use makes it prone to injuries and conditions like arthritis. It’s estimated that roughly one in seven people in the United States have wrist arthritis, which is about 13.6% of the population. There are also about 2.5 million people in the US with rheumatoid arthritis that affects their wrist, which represents almost 75% of all cases. Gout, another type of arthritis, affects the wrist in about 0.28% of people.

Signs and Symptoms of Wrist Arthritis

Wrist arthritis can cause pain in the entire joint. The type of pain experienced can vary based on the kind of arthritis a person has. For instance, with osteoarthritis, the joint hurts more when used and feels better when rested, while with rheumatoid arthritis, there’s typically stiffness that’s worse in the morning and eases as the day progresses. Rheumatoid arthritis also commonly affects both sides of the body. Swelling can also occur in arthritis and might be due to excessive fluid or growth of the synovial lining in the joint.

If the joints are red, warm, and swollen, this could indicate an inflammatory form of arthritis or even an infection. Limited range of motion and a sense of weakness might also be present. Symptoms such as fevers, chills, tiredness, sweating at night, and weight loss could indicate that the cause is a systemic condition such as a rheumatological disease, cancer, or septic arthritis.

Examination of the wrist involves looking at the joint, feeling it, assessing the range of motion, and conducting special tests. Some key signs of arthritis are swelling and deformities like abnormal movement or position of the joints. When touching the joint, the goal is to identify the specific part affected. To assess movement, the practitioner will test the wrists for flexibility, how much it can extend or bend, and its ability to deviate radially (towards the thumb side) or ulnarly (towards the little finger side).

Specific specialized tests like Tinel sign, Carpal compression test, Phalen test, Finkelstein test, etc., could also be used to rule out causes other than arthritis for wrist pain.
A full examination of the wrist also includes an examination of the elbow (the joint above) and hand joints (the joint below).

Testing for Wrist Arthritis

To evaluate wrist arthritis, a careful review of your medical history is needed. Your doctor will ask about when your symptoms started, where exactly you feel the pain, what kind of pain it is, how long it lasts, and what makes it better or worse. If pain has been there for a long time, you may also be asked about any recent triggers that may have worsened the pain. Additionally, a thorough physical exam will be performed which will help your doctor decide what tests might be needed for further diagnosis.

A conventional X-ray of your wrist could be an essential part of these tests. This kind of imaging is the most commonly used and can identify problems like fractures, bone erosion, bone death, osteoarthritis, or nearby bone tumors. Some specific features of osteoarthritis that an X-ray can spot are bone growth around the edges of joints, narrowing of the space in between joints, hardening of the bone beneath the cartilage, and cysts. Another condition called pseudogout might be suspected if an unusual accumulation of calcium is observed within the joints.

Ultrasonography, which uses sound waves to create images, can also be used in some cases. It might not be very effective in capturing images of the deeper parts of the joints or the bones, and it greatly depends on the skills of the operator. However, it can assist in detecting structural changes related to osteoarthritis, such as bone growths, and the accumulation of crystals. It is also useful in identifying joint inflammation, fluid in the joint, and erosions.

In addition, certain blood tests can help in the diagnosis. For instance, an increase in white blood cells can indicate a possible infection. If an infection is suspected, samples from your blood, urine, or any other relevant sites may be cultured to identify the organism causing it. Tests for inflammatory markers like ESR or CRP which, though nonspecific, can suggest an infection or inflammation. If rheumatoid arthritis is suspected, tests for rheumatoid factor and anti-CCP antibodies might be needed. If gout, another form of arthritis, is suspected, a uric acid level test can be ordered. However, this isn’t always accurate as the levels can change during an actual episode of gout or because of other inflammatory conditions.

Lastly, if an infection in the joint is suspected, joint fluid analysis, also known as arthrocentesis, may be required. In this test, fluid from your joint is collected and examined for the presence of bacteria and crystals. This test can often accurately identify the cause of arthritis, especially if it’s an infection. Following the fluid sample collection, patients are usually started on antibiotics to control any suspected infections. The number of white blood cells in your joint fluid can also guide doctors in distinguishing between inflammatory and non-inflammatory causes of arthritis.

Treatment Options for Wrist Arthritis

The choice of treatment for wrist arthritis heavily depends on the type of arthritis you have.

For osteoarthritis, non-surgical options are often preferred. These might include taking pain relievers, avoiding activities that make the pain worse, or wearing wrist splints to stabilize the joints during the day and while performing certain activities. Physical therapy and locally applied corticosteroid injections can also help manage pain. Systemic steroids, which affect the whole body, aren’t recommend for this type of arthritis. Some pills on the market, like those containing hyaluronic acid and glucosamine, have been found to have a placebo effect, meaning they don’t actually affect the condition.

If you have rheumatoid arthritis (RA), treatment usually includes a type of medication called a disease-modifying antirheumatic drug (DMARD). These medications can slow down the progression of the disease. Anti-inflammatory treatments, such as corticosteroids and NSAIDs, might also be used temporarily to control disease activity, especially when starting new DMARDs or during disease flare-ups. Some commonly used DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Biologic agents, which target specific parts of the immune system, are also used for treating RA.

If non-surgical treatments aren’t effective in managing the pain, surgery might be considered. There are several types of surgeries available. One procedure called a proximal row carpectomy involves removing the three carpal bones close to the forearm to help ease pain and maintain wrist motion. Another procedure, known as fusion or arthrodesis, involves removing the damaged cartilage and fusing the wrist bones together. While this can limit range of motion, it could also eliminate pain. Finally, wrist replacement surgery might be an option. This involves removing the damaged wrist bones and cartilage and replacing them with plastic or metal joints. The goal is to restore function, improve range of motion, and relieve pain. However, results from wrist replacement surgeries may not be as satisfactory as those from knee or hip replacements.

Apart from the causes mentioned earlier, other conditions to consider that might cause similar symptoms include Lyme arthritis, sarcoid arthropathy, peripheral spondyloarthritis, and unusual infections like mycobacteria and fungi.

In addition to wrist arthritis, there are several other possible causes of wrist pain, including:

Surrounding conditions: Inflammation of the tendons (Tenosynovitis), including De Quervain’s tenosynovitis, and pigmented villonodular tenosynovitis, along with acute calcific inflammation surrounding the joint (peri-arthritis)
Bone issues: Fractures, cancers, infections, and bone death (osteonecrosis) such as in Kienbock’s disease (avascular necrosis of the lunate bone) and Preiser disease (scaphoid bone)
Neurological conditions: Nerve trapping conditions, particularly carpal tunnel syndrome and ulnar nerve entrapment in the Guyon canal
Vascular conditions: Scleroderma and issues related to occupational vibration
Referred Pain: Issues with the cervical spine and reflex sympathetic osteodystrophy

What to expect with Wrist Arthritis

The future outlook for wrist arthritis heavily depends on its root cause. For example, wrist arthritis due to wear-and-tear damage (osteoarthritis) or a repetitive use injury may respond well to non-surgical treatments or surgery. However, if the arthritis is caused by an overactive immune system, the outlook might not be as positive, depending largely on how aggressive the disease is and how well the inflammation can be controlled with medication.

Poorly managed wrist pain could lead to a gradual worsening of the condition and increased pain in older adults, which may result in a lower quality of life due to decreased physical function.

Possible Complications When Diagnosed with Wrist Arthritis

Wrist arthritis can lead to various complications, primarily stemming from the different surgical options used to treat the condition. One such complication could be persistent wrist pain resulting from the incomplete healing or scar tissue after wrist fusion surgery. Like all surgeries associated with bone and joint conditions, there are risks involved. You might face complications such as infection of the fake joint or prosthetic, damage to your nerves or blood vessels during the procedure, or failure or loosening of the implanted device.

Common Risks:

Persistent pain after wrist fusion surgery
Prosthetic infection
Nerve or blood vessel damage during procedure
Implant failure or loosening

Preventing Wrist Arthritis

In today’s technology-driven era, the frequent use of hand-held devices and laptops may increase the risk of developing wrist osteoarthritis, a condition that damages the cushioning cartilage of your wrist joint. To help prevent this, it’s essential to use recommended posture habits and make changes to your workstation’s layout.

For those already dealing with autoimmune diseases – conditions where your immune system mistakenly attacks your body – it’s crucial to manage the illness aggressively to stop it from causing irreversible harm to the joints. Following your medication routine accurately plays a significant role in keeping the ailment under control.

If a wrist injury has already caused joint damage, it’s worth noting that some research suggests that injections of corticosteroids – a type of powerful anti-inflammatory medication – directly into the problematic joint can help prevent the development of osteoarthritis following an injury.

Frequently asked questions

Wrist arthritis is a condition that causes inflammation and swelling in the joints of the wrist. It can result in symptoms such as pain, swelling, redness, stiffness, and loss of movement in the affected joint.

Roughly one in seven people in the United States have wrist arthritis, which is about 13.6% of the population.

Signs and symptoms of wrist arthritis include: - Pain in the entire joint - Varying types of pain depending on the type of arthritis (e.g., osteoarthritis or rheumatoid arthritis) - Joint pain that worsens with use and improves with rest in osteoarthritis - Morning stiffness that eases as the day progresses in rheumatoid arthritis - Stiffness that affects both sides of the body in rheumatoid arthritis - Swelling in the wrist joint - Limited range of motion - Weakness in the wrist - Redness, warmth, and swelling in the joints, which could indicate an inflammatory form of arthritis or infection - Symptoms such as fevers, chills, tiredness, sweating at night, and weight loss, which could indicate a systemic condition like a rheumatological disease, cancer, or septic arthritis During an examination of the wrist, healthcare practitioners will look for specific signs, including: - Swelling and deformities in the joints - Abnormal movement or position of the joints - Assessing the range of motion and flexibility of the wrist - Testing the wrist's ability to extend, bend, and deviate radially or ulnarly Specialized tests like the Tinel sign, Carpal compression test, Phalen test, Finkelstein test, etc., may also be used to rule out causes other than arthritis for wrist pain. Additionally, a full examination of the wrist includes assessing the elbow joint above and the hand joints below.

There are mainly three types of arthritis that can cause wrist pain: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Other causes of wrist arthritis include infection, arthritis caused by crystals in the joint, reactive arthritis, and diseases that affect the whole body.

The doctor needs to rule out the following conditions when diagnosing Wrist Arthritis: 1. Inflammation of the tendons (Tenosynovitis), including De Quervain's tenosynovitis, and pigmented villonodular tenosynovitis, along with acute calcific inflammation surrounding the joint (peri-arthritis) 2. Fractures, cancers, infections, and bone death (osteonecrosis) such as in Kienbock's disease (avascular necrosis of the lunate bone) and Preiser disease (scaphoid bone) 3. Nerve trapping conditions, particularly carpal tunnel syndrome and ulnar nerve entrapment in the Guyon canal 4. Scleroderma and issues related to occupational vibration 5. Issues with the cervical spine and reflex sympathetic osteodystrophy

The types of tests that may be needed for diagnosing wrist arthritis include: 1. Conventional X-ray: This imaging test can identify fractures, bone erosion, bone death, osteoarthritis, and bone tumors. It can also detect specific features of osteoarthritis, such as bone growth around joints, narrowing of joint spaces, hardening of bone beneath cartilage, and cysts. Unusual accumulation of calcium within joints may suggest pseudogout. 2. Ultrasonography: This test uses sound waves to create images and can assist in detecting structural changes related to osteoarthritis, such as bone growths and crystal accumulation. It can also identify joint inflammation, fluid in the joint, and erosions. However, its effectiveness depends on the skills of the operator. 3. Blood tests: These tests can help in the diagnosis of wrist arthritis. An increase in white blood cells may indicate a possible infection. Tests for inflammatory markers like ESR or CRP can suggest infection or inflammation. Tests for rheumatoid factor and anti-CCP antibodies may be needed if rheumatoid arthritis is suspected. A uric acid level test can be ordered if gout is suspected. 4. Joint fluid analysis (arthrocentesis): This test involves collecting and examining fluid from the joint for the presence of bacteria and crystals. It can accurately identify the cause of arthritis, especially if it's an infection. The number of white blood cells in the joint fluid can help distinguish between inflammatory and non-inflammatory causes of arthritis.

The treatment for wrist arthritis depends on the type of arthritis. For osteoarthritis, non-surgical options such as pain relievers, wrist splints, physical therapy, and locally applied corticosteroid injections are often preferred. Systemic steroids and certain pills have not been found to be effective. For rheumatoid arthritis, treatment usually includes disease-modifying antirheumatic drugs (DMARDs) to slow down the progression of the disease. Anti-inflammatory treatments like corticosteroids and NSAIDs may also be used temporarily. If non-surgical treatments are not effective, surgery options include proximal row carpectomy, fusion or arthrodesis, and wrist replacement surgery.

The side effects when treating Wrist Arthritis can include: - Persistent pain after wrist fusion surgery - Prosthetic infection - Nerve or blood vessel damage during the procedure - Implant failure or loosening

The prognosis for wrist arthritis depends on its root cause. Wrist arthritis caused by wear-and-tear damage or repetitive use injury may respond well to non-surgical treatments or surgery. However, if the arthritis is caused by an overactive immune system, the outlook might not be as positive and depends on the aggressiveness of the disease and how well inflammation can be controlled with medication.

You should see an orthopedic surgeon or a rheumatologist for wrist arthritis.

Arthritis Osteoarthritis Post-Traumatic Arthritis Rheumatoid Arthritis