My wrists hurt… could it be arthritis and what should I do?

The wrist is a complicated joint.  It consists of the ends of two long bones: the radius and the ulna, two rows of carpal bones with each row containing 4 bones each, and the bottom ends of the hand bones- called the metacarpals.  The bones are connected to each other by a complicated series of ligaments.  

The entire wrist joint is enclosed within an envelope of tissue called the synovial capsule.  The bones within the wrist are covered with cartilage and a thin layer of joint fluid acts as a lubricant to permit smooth gliding.  Multiple tendons glide along the top and the bottom of the wrist.  These tendons originate in muscles and are connected to the bones within the hand to allow movement of the wrist up and don as well as side to side.

Arthritis causes inflammatory changes to develop within the wrist.  This leads to destruction of cartilage, inflammation of the synovial lining, and resultant weakening of ligaments and tendons. The types of arthritis that can affect the wrist include rheumatoid arthritis, psoriatic arthritis, osteoarthritis, gout, pseudogout, and a few others.

This inflammation causes pain, limited range of motion in the wrist, and a reduction in grip strength.  Sometimes if the swelling in the wrist becomes pronounced, there can be pressure on other structures such as nerves.  This can lead to conditions such as carpal tunnel syndrome which is due to pressure on the median nerve at the wrist.

The treatment requires a specific diagnosis.  Your rheumatologist will want to check blood tests, imaging procedures such as x-rays, ultrasound, and magnetic resonance imaging (MRI).  

The treatment will depend on the diagnosis.  However, certain measures may be helpful regardless of diagnosis.

Non-steroidal anti-inflammatory drugs (NSAIDS), splints to rest the wrist, and glucocorticoid injections may be helpful. Physical therapy may also be beneficial.

Arthroscopic debridement of the joint (going into the wrist with a small telescope and using small cutting tools to remove damaged and diseased tissue) is also an option.

For patients with severe disease, surgery may be needed.

Ulnar resection where the end of the long bone on the little finger side of the wrist is surgically shortened is sometimes done for arthritis.

Fusion is performed if the arthritis has advanced to the point where motion is gone but pain remains.  Fusion is exactly what it sounds like- fusion of all the bones to alleviate pain.

Joint replacement is done at a few select centers around the country.  Wrist implant surgery- as this is called- is best done in  patients who don’t place a lot of stress on the wrist.  Implants last about ten to fifteen years.