Arthritis In Wrist

The wrist joint is a complex joint that provides support to the hand and related structures. It enables you to grip, grab items and lift weights. Wrist pain is frequently seen in certain occupational groups. Manual labourers and players that carry out hectic hand motions have a high prevalence of wrist pain.

Arthritis of the wrist is a debilitating condition that takes away power from your hands. It was revealed in a 2022 study that chronic inflammatory disease, i.e., arthritis in the wrist, affects about every 1 in 7 adults.

The prevalence of wrist arthritis was found to be 13.5%. The anatomical structure and position of the wrist joints predispose them to degenerative arthritis and trauma.

Wrist pain is the main presenting symptom, but patients also report thumb pain (and referred pain to the neighbouring hand structures). Usually, the wrist and thumb joints are affected together.

Anatomy Of The Wrist Joint

Before discussing the impact of arthritis on the wrist, we must know about the anatomy of the wrist joint to understand the complexities of the affected joint.

The wrist joint, also known as the radiocarpal joint, is a fusion of multiple small joints. Wrist joint forms by merging small carpal bones, metacarpal bones and bones of the forearm.

The distal ends of the two forearm bones (radius and ulna) join with eight small carpal bones, further connected to the 5 metacarpal bones, forming the hand.

Based on the bones involved wrist arthritis can be divided into:

Radiocarpal Arthritis-Occurs at the junction of forearm bones and carpal bones.

Midcarpal Arthritis- Occurs in any of the eight carpal bones.

Distal Radioulnar Arthritis-Occurs at the junction of the radius and ulna (forearm bones).

Arthritis in the wrist can affect any wrist bones, and there are different types of inflammatory arthritis of the wrist. The most common types of wrist arthritis include:

Osteoarthritis (Degenerative Arthritis In The Wrist)

Osteoarthritis is a highly prevalent degenerative disease of the joints. It can affect different large and small joints. The most commonly affected joints include the knees, neck, hand and wrist, and lower back. It is the most common form of arthritis.

Osteoarthritis presents as chronic joint pain. Arthritis Age-related joint damage is the main cause of joint disintegration. The disease is characterized by damage to the smooth cartilage of the wrist joint.

Researchers have highlighted damage to other soft tissues, such as tendons, ligaments and synovium. The breakdown of soft and hard tissues is accompanied by swelling, chronic wrist pain and loss of motion.

Over the years, the articular cartilage wears off, and the bones gradually wear off, forming bone spurs. Studies show that joint damage from wrist osteoarthritis can present as mild swelling to considerable discomfort.

Clinicians have found a genetic predisposition for the disease. Repetitive stress and overuse also contribute to the development of wrist osteoarthritis. Over time the joint surface gets eroded and is replaced by abnormal bony lumps or spurs known as osteophytes.

Rheumatoid Arthritis (Autoimmune disease)

Another inflammatory condition of the wrist that can lead to chronic hand or wrist pain is rheumatoid arthritis. Unlike osteoarthritis, RA in the wrist arises due to immune system disturbances.

Your immune system is the body’s defence system which fights foreign intruders (pathogens) and infection-causing micro-organisms. Sometimes, this system gets diseased and attacks its own tissues. This leads to pain and inflammation.

This autoimmune disease can also affect other joints, such as the knee joints, forearm bones (joint), thumb joints, etc. It may also involve carpal bones, metacarpal and interphalangeal joints.

According to a study, autoimmune inflammatory arthritis diseases preferentially attack synovial joints such as the wrist. RA patients are more likely to end up with severe, debilitating wrist arthritis over time.

Many aged RA patients with wrist arthritis suffer from daily activities due to an inability to bend the wrist. Studies show that wrist arthritis is present in up to 50% of rheumatoid arthritis patients.

Hand and wrist symptoms appear early in the disease; thus, they can be evident initial symptoms. The disease begins by destroying the articular cartilage and progresses to pathological joint spaces.

Hand radiographs of patients reveal a narrowing of the joint. This narrowing of the joint adds to pain due to constriction of the neighbouring nerves.

Patients of autoimmune inflammatory arthritis experience periods of high disease activity (exacerbations) known as flare ups. RA patients experience more pain during a flare-up.

Psoriatic Arthritis (PsA)

Psoriasis is an inflammatory skin condition. When arthritis develops due to this skin condition, it is termed psoriatic arthritis.

In surveys, psoriatic arthritis was found to have an annual incidence of 6 per 100,000, while the prevalence was 1-2 per 1000 in the general population. According to a meta-analysis, the prevalence of PsA in psoriasis patients was 20-25% (1 in every 4 patients).

It is also an autoimmune disease characterized by an immune system attack on different joints following a psoriasis infection. Patients complain of scaly and inflamed skin with joint presentations.

Wrists, elbows, hips and spine are the preferred targets. Moreover, this type of wrist arthritis can affect the entheses, i.e., soft tissues in the joints (ligaments and tendons).

Early symptoms of wrist arthritis include hand or wrist pain. You may also experience pain in the fingers, as multiple joints can be involved simultaneously. Morning stiffness, anxiety and fatigue are the most common features of the disease.

Post-Traumatic Arthritis In The Wrist

This type of arthritis develops as a response to injury. Post-traumatic arthritis develops as a response to direct injury or trauma to the wrist joint.

Post-traumatic arthritis is present in about 12% of all osteoarthritis cases. It is characterized by inflammation in the wrist joint.

The condition usually does not need surgical intervention to correct. Symptomatic management can help control symptoms until the disease subsides. However, in some cases, it might turn into chronic joint pain.

Post-traumatic arthritis of the wrist develops after serious bone injuries like dislocation of a bone or fracture. The most commonly affected joints are the most commonly used joints, i.e., ankles, hips and knees. It is not uncommon to find arthritis in the wrists.

Roadside/car traffic accidents and sports injuries are major contributors to the disease. The trauma to bones gradually wears down the cartilage in the joint, leading to symptoms.

Ligament injuries can also trigger wrist arthritis. You can prevent arthritis by staying careful while driving and playing.

Gouty Arthritis

Excessive uric acid in the blood can get deposited in the joints leading to arthritis. Gout rarely affects the wrist joint but can cause wrist arthritis.

Wrist Arthritis Vs Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome is a chronic wrist pain condition that resembles wrist arthritis. CTS causes pain, tingling and numbness in and wrist and thumb region. But unlike arthritis, carpal tunnel syndrome arises due to the compression of the median nerve.

Inflammation of the tendons or any other swelling narrows the pathway (carpal tunnel in the wrist) and compresses the nerves leading to nerve symptoms. People involved in hectic hand activities are at an increased risk of CTS.

In advanced cases, hand weakness makes gripping objects almost impossible. Timely diagnosis and treatment are necessary.

Signs And Symptoms

As there are different types of wrist arthritis, there is a wide variety of symptoms that wrist arthritis patients can experience.

Wrist Pain

The most significant of the common symptoms of wrist arthritis. The intensity of wrist pain can vary depending on the severity and the type of arthritis.

Patients with osteoarthritis of the wrist experience chronic pain in the wrist and the hand. The intensity ranges from mild to severe. However, autoimmune disorders like rheumatoid arthritis and psoriatic arthritis patients have exacerbations of wrist pain during flare-ups.

Prolonged wrist OA leads to the formation of osteophytes which can impinge the nerves, leading to neuropathic pain and symptoms (burning, tingling, numbness, etc.).

OA pain worsens at night while wrist pain from RA and PsA worsens in the morning. RA can also involve the tendons of the joint, causing tenosynovitis. Thus, patients can also experience tendon pain.

Initial symptoms of wrist arthritis may include having difficulty turning a door knob or twisting open a jar lid.

Swelling And Redness

Swelling and redness are part and parcel of any arthritis. In many cases, inflammation of the joint and the neighbouring structures can be seen on the skin. The redness, warmth and swelling indicate the underlying inflammation.

Loss Of Motion (Reduced Range Of Motion)

One of the most common features of arthritis is reduced range of motion. The pain and inflammation directly affect the mobility of the joint. All types of wrist arthritis are known to reduce the range of motion. Knee OA is notorious for hurting mobility.

Functional disability is an evident feature of RA. Per a systematic review, hand therapy exercises are good for improving the reduced range of motion. The reduction in range of motion interferes with daily activities. Altered wrist motion decreases the quality of life.

Anxiety And Fatigue

Persistent pain is a source of anxiety but fatigue and anxiety are present in almost all types of wrist arthritis. Post traumatic wrist arthritis patients, along with the common arthritis forms, are frequently faced with the issue of anxiety and excessive fatigue.

Hand And Wrist Deformities

Chronic arthritis can cause permanent deformation of the joints and cause disability. Irreversible synovitis caused by rheumatoid arthritis in the wrist and hand can lead to different deformities:

The most commonly observed deformities include Boutonniere deformity, Swan-neck deformity, Z deformity (Hitchhiker’s thumb) and Vaughan-Jackson deformity.

Causes And Risk Factors

There is a genetic predisposition for most arthritis types. OA has a well-known genetic factor, while the exact cause of auto-immune arthritis is unknown.

Diagnosis Of Arthritis Of The Wrist

Physical Exam

Diagnosis of wrist arthritis depends on complete medical history, physical examination and blood tests. A physical exam of the wrist joint reveals swelling and tenderness.

Blood Tests And Radiographing Imaging

Blood tests are important in diagnosing auto-immune disorders. RA factor is a distinguishing diagnosing point for rheumatoid arthritis. Blood tests and radiographs are combined for accurate diagnosis.

X rays have been used conventionally to diagnose hard tissue disorders. Hand and wrist X-rays are advised to check for cartilage breakdown and bone disintegration.

Treating Wrist Arthritis

Wrist arthritis is a chronic condition that needs to be treated in the long term. The main aim of any treatment is to reduce pain and inflammation. For symptomatic management, patients can follow simple home remedies to ease pain and doctor-guided medications.

Home Remedies

Rest And Ice Application

Physical stress aggravates inflammatory conditions, so rest is crucial to reduce inflammation. Though arthritis is a hard tissue disorder, soft tissues like tendons and ligaments can also get involved.

Cold application on the same joint can help relieve pain. Some people prefer alternating hot and cold therapy.

Wrist Splint And Brace

You can wear wrist splints and braces to relieve pressure from the joint. Arthritis gloves help reduce hand or wrist pain. Arthritis gloves are recommended for patients with undifferentiated inflammatory arthritis.

Non-Surgical Management

An alternative way to help with arthritis: Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat arthritis.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the joints and help arthritis.

As prolotherapy is helping to treat the root cause of arthritis, it is deemed to be a permanent fix, preventing the symptoms from returning.

Medications And Steroid Injections

Symptomatic management involves alleviating symptoms. Non-steroidal anti-inflammatory drugs reduce pain and inflammation.

Disease modifying antirheumatic drugs are given to halt autoimmune diseases like RA and PsA. A steroid injection in the joint can relieve pain and instantly alleviate symptoms of inflammation.

Physical Therapy

A visit to the physical therapist improves the blood supply to the joint. Patients can help relieve pain and improve mobility with physiotherapy. Therapists can also improve symptoms by applying kinesiology tapes to the joints.

According to a randomized controlled trial, kinesio taping improves the range of motion and functionality in wrist arthritis patients. Patients are advised to maintain a healthy weight to improve the symptoms further.

Surgical Treatment

Orthopaedic surgeons recommend surgery only when conservative treatment fails. There are different surgical treatments available:

Wrist Denervation Surgery- nerves of the wrist joint are disconnected.

Proximal row carpectomy- carpal bones are removed to accommodate other bones and reduce friction.

Total Arthroplasty (Wrist Joint Replacement)- damaged wrist bones are replaced with prostheses (artificial implants).

Joint replacement surgeries and total wrist replacement surgeries are indicated in extreme cases of joint degeneration.

FAQs

1. What does arthritis of the wrist feel like?It starts with pain in the wrist and reduced range of motion. Later the disease progresses to muscle weakness and deformation of the joint.
2. How do you treat arthritic wrists?Symptomatic management involves rest, ice application, NSAIDs and steroid injections. DMARDs (leflunomide, methotrexate) are given to halt the progression of the disease.
3. Does wrist arthritis go away?Most arthritis are chronic condition and do not go away on their own. Post traumatic wrist arthritis is a time-bound condition and goes away sometime after the trauma/accident.
4. At what age do you get arthritis in your wrists?Osteoarthritis develops in old age (above 50 years). However, PsA and RA of the wrist are diagnosed at a younger age. RA usually develops between ages 30 and 60.
5. What causes arthritis flare-ups in the wrist?Stress, weather changes, excess physical activity and smoking, are the most common flare-ups of wrist arthritis.