Wrist Arthritis

There are many forms of wrist arthritis. It occurs either from a more generalized disease process like rheumatoid or may occur following trauma such as an unrecognized scaphoid fracture (the so called Scaphoid Non-union Advanced Collapse or SNAC wrist) or a scapholunate ligament injury (the ScaphoLunate Advanced Collapse or SLAC wrist). Alternatively, there may be primary osteoarthritis that affects various joints within the wrist that cause pain, stiffness and swelling.

As with arthritis in other joints, once the cartilage has eroded away there is no way of regenerating it, so surgical strategies are directed at retaining movement in the wrist and controlling pain.



  • Management
Management

Non-operative

Non-operative management of wrist arthritis is directed at pain control and may include a wrist splint and anti-inflammatory medication. This is sometimes accompanied with a steroid and local anaesthetic injection into the wrist joint, to alleviate severe symptoms. This however only gives temporary relief. The management to provide long lasting relief is surgical.

Operative

Surgical management of the arthritis depends on the stage of disease and which joints are affected. Often the proximal bones of the wrist are affected and may need to be partly removed, with selective fusions of the remaining bones to maximize functional articulations.

In some case the whole proximal row of bones is removed (a proximal row carpectomy) or in advanced disease a wrist replacement or fusion may need to be considered. Themistocles Gluck (what a great name!) performed the first total wrist replacement over 100 years ago and wrist replacement surgery has advanced significantly since then. In elderly patients with advanced wrist arthritis, wrist replacement is a reliable option to alleviate pain and maintain the motion required for activities of daily living. Indeed, patients that have a wrist fusion on one side and a wrist replacement on the other, uniformly prefer the replacement to the fusion.

In younger patients, often with higher activity demands, a fusion remains the procedure of choice as it is robust and stable.

Conditions Managed



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