Arthritis / osteoarthritis

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What is hand and wrist arthritis?

Arthritis can affect the wrists and hands, particularly at the base of the thumb joint. The condition develops when the cartilage that cushions the joints starts to wear away, causing the bones to rub together. The result is pain, swelling and a loss of movement. Wrist and thumb arthritis becomes more common as we age, although people of any age can be affected.

What causes hand and wrist arthritis?

  • One of the most common causes of wrist arthritis is rheumatoid arthritis, which is a disease that affects the entire body. It causes inflammation in the joints that can become so severe that it destroys cartilage and bone. Wrist arthritis can also be due to a previous injury of the wrist. If a wrist fracture extends into the surface of the joint, the normally smooth cartilage can become uneven and prone to arthritis. Injuries to the small bones and ligaments in the hand and wrist can affect normal movement or lead to instability and wearing away of the cartilage.
  • Thumb arthritis affects the carpometacarpal joint, which is where the metacarpal bone attaches to the trapezium (carpal) bone of the wrist. It is also common with ageing and can be linked to obesity. Like wrist arthritis, it can develop as the result of a previous injury to the thumb joint and it may be linked to certain hereditary conditions such as joint ligament laxity. As arthritis progresses in the base of the thumb, extra bone spurs develop and the ligaments become lax resulting in deformity, pain and loss of strength and function. Rheumatoid arthritis can affect the carpometacarpal joint, although osteoarthritis is the most common cause.

What are the symptoms of hand and wrist arthritis?

  • Arthritis in the wrist causes: pain and swelling in the wrists and can lead to problems gripping. If bony spurs have developed as the cartilage wears away, it can cause irritation to the nerves around the joint and may cause carpal tunnel syndrome. Rheumatoid arthritis may cause inflammation of the wrist joint and tendons causing the tendons to rupture. As rheumatoid arthritis progresses, deformity of the wrist can occur, which in turn can lead to deformities of the fingers.
  • The symptoms of thumb arthritis include: pain at the base of the thumb, particularly when you grip, pinch or use your thumb to apply force. You may also have swelling and stiffness, loss of movement and decreased strength in your thumb. In some cases, the thumb may appear deformed with an enlarged joint at its base.

How is hand and wrist arthritis diagnosed?

Your consultant will carry out a physical examination to assess your wrist and hand for pain, swelling and loss of movement. Depending which parts of the wrists are affected (the joints or the tendons), the swelling may be in a different place. You may be asked to twist and flex your wrists to ascertain whether the pain is in your wrists or thumbs. An X-ray will confirm the diagnosis and can identify bone spurs and worn down cartilage. You may also be given a blood test to determine whether you have rheumatoid arthritis or osteoarthritis. An ultrasound sometimes will help to confirm tendon irritation or joint inflammation.

How is hand and wrist arthritis treated?

The treatment for wrist arthritis will depend on the severity and location of the arthritis. In the first instance, you may be able to relieve some of the symptoms by avoiding certain movements and wearing a wrist splint to support the joint. Heat can help to alleviate some of the pain associated with the condition and you may be offered anti-inflammatories or injections of cortisone into the joint to reduce inflammation.

If the condition is severe you may be offered hand and wrist surgery. Surgical procedures include:

  • Wrist fusion: By joining the bones of the forearm to the bones of the wrist and hand, the wrist is prevented from moving which helps to eliminate pain. However, there will inevitably be some loss of movement.
  • Proximal row carpectomy removes three of the small bones of the wrist joint, including the arthritic bone. The advantage is that this preserves more movement than wrist fusion but it is only possible for some forms of wrist arthritis.
  • Joint replacement surgery: Wrist replacements are less common and less predictable than hip or knee replacements but they are performed in some circumstances.

In the case of thumb arthritis there is a range of medication you can take, including topical medications which are applied to the skin over the joint, anti-inflammatories and painkillers. Wearing a thumb splint can be helpful to support and rest the joint and limit movement. Injections of corticosteroids directly into the joint can help to reduce inflammation and relieve pain. Hand therapists may be very helpful in providing exercises and guidance on improving the function of your thumb.

If the condition is severe you may be offered hand and wrist surgery. Surgical procedures include:

  • Joint fusion: By permanently fusing bones in the affected joint, the thumb will be able to bear weight without pain but there will be a loss of movement.
  • Osteotomy: This involves repositioning the bones in the thumb joint to correct deformities.
  • Trepeziectomy: The arthritic bone in your thumb joint is removed to alleviate pain.
  • Joint replacement surgery: The affected joint is replaced with an artificial implant.