Do I have Arthritis in my wrist?
Arthritis affects millions of Americans annually. Although arthritis can affect any joint, this disease can be particularly debilitating when it affects the wrist.
Risk factors: The most common type of arthritis is osteoarthritis, which is typically not associated with any other medical illness. The risk of developing this disease increases with age. It is also more common in females, in obese patients, and with prior history of wrist injury. Patients who have had a prior wrist fracture, dislocation, or ligament injury are at higher risk of developing osteoarthritis in the future. This risk is even higher if the previous injury was not treated. Patients who have a history of other diseases such as rheumatoid arthritis, lupus, or psoriatic arthritis are also at increased risk. Finally, there is also likely a genetic component as well to developing osteoarthritis.
Symptoms: The most common symptom patients present with is pain. The pain usually starts slowly but then becomes more frequent and more intense. The pain is often described as achy and is typically worse at the end of the day. Loss of range of motion often accompanies the pain. Patients also report that the affected joint is swollen or deformed. As the pain worsens, patients will often limit the use of the affected limb, which can result in secondary weakness. In some cases, there can be advanced joint deformity but with limited pain.
Physical Examination: Patients with worsening arthritis in the wrist demonstrate swelling, stiffness, and progressive deformity of the joint. There can also be clicking or other noises in the joint. The exam is tailored to find out which bones of the wrist are affected and what the cause may be.
Diagnostic Tests: X-ray examination of the wrist is used to determine the areas of joint damage and how far along the arthritis is. X-rays can also show old injuries/fractures which may have led to the pain. A CT scan or MRI may be necessary in patients who have less obvious signs of arthritis or to look for ligamentous injuries. In addition, blood tests may be ordered in cases where rheumatoid arthritis, gout, or other systemic illness is suspected. Rarely, a sample of joint fluid may be necessary in cases of suspected infection.
Nonsurgical Treatment Options: There are several nonsurgical treatments for arthritis of the wrist. Early on, the symptoms can be treated with splinting, physical therapy, activity modifications, oral anti-inflammatory medications, and selective steroid injections. The injections can relieve symptoms for up to 6 months and can be repeated several times. Patients who are found to have other diseases such as rheumatoid arthritis are treated with medications geared toward reducing inflammation from the disease process. Patients can enjoy good function and pain relief for many years without requiring surgery.
Surgical Treatment: Patients who have exhausted nonsurgical treatments are candidates for surgical reconstruction of the wrist. Surgery is geared towards halting the progression of the arthritis. The mainstays of surgical treatment include selective fusion (arthrodesis) of wrist bones, selective removal of wrist bones around the arthritic areas, or repair of previously undetected injuries. These procedures usually result in good pain relief, but at the expense of some range of motion. In advanced cases, complete fusion (arthrodesis) of the wrist bones becomes necessary to relieve pain. Complete wrist joint replacement (arthroplasty) can also be performed in selective cases.
- Risk factors: increased age, female sex, obesity, history of old wrist injuries, and family history of arthritis.
- Symptoms: Progressive pain, swelling, stiffness, weakness and joint deformity.
Physical Examination: the wrist may be stiff, swollen, tender, and deformed. Patients are also found to have clicking or clunking in the wrist.
- Diagnostic Tests: X-rays are the initial test of choice. Additional tests which may be necessary include CT scan or MRI of the wrist. Blood tests may be ordered in cases where other diseases are suspected.
- Nonsurgical Treatment: Oral anti-inflammatory medications, splinting, physical therapy, activity modification and steroid injections. Patients can live many years without having to undergo surgery.
- Surgical Treatments: Surgery is geared toward halting the progress of the arthritis. Surgical options include selective removal of wrist bones or selective fusion (arthrodesis) of wrist bones. In advanced cases, complete fusion or wrist joint replacement can be performed.