Wrist Arthritis

Wrist Arthritis

What are the symptoms of arthritis?

The symptoms of arthritis can be:
• Joint pain
• Joint inflammation
• Redness and heat of the skin around the joint
• Decreased ability to move the joint
• Joint stiffness, especially in the morning

What are the causes of arthritis?

This pathology can be a consequence of:
• Bone fracture
• Autoimmune disease
• Infection by bacteria or viruses
• Joint wear
• Crystals (such as uric acid or calcium pyrophosphate dihydrate)

Can arthritis be prevented?

Joint damage can be prevented with timely and adequate diagnosis and treatment. Also, if someone has a family history, it is important to talk with the doctor, even if s/he does not have any symptoms. It is also recommended to avoid repetitive and excessive movements to prevent osteoarthritis.

What is the treatment for arthritis?

The treatment aims to alleviate the symptoms and prevent the disease from getting worse. The treatment can be covered by several aspects:
Lifestyle changes: this is the preferred treatment since exercises help to reduce pain and fatigue, relieve stiffness and improve muscle and bone strength. The doctor can also recommend physiotherapy. Other measures may include sleeping 8-10 hours a day, not staying in the same position for a long time, eating a healthy diet, avoiding alcohol and tobacco, among others.
Medicine: can be added to the changes in lifestyle.
Surgery: is performed if the other treatment methods have not worked. The main intervention is arthroplasty, which consists of replacing the affected joint with an artificial one.

Why wrist arthritis does it occur?

Arthritis can occur in a wrist as a consequence of a fracture that may have gone into the joint and healed with a step, causing localised wear and tear. Arthritis can occur as a generalised wear and tear process with increasing age. Arthritis can occur as a consequence of inflammatory joint diseases such as rheumatoid arthritis or psoriatic arthritis.

Management

Patients often complain of pain and a decreased range of movement in the wrist. Painful actions include lifting and bending the wrist. These can be quite painful. Restricted range of movements can affect patients with the inability to perform common day-to-day tasks.
Plain x-rays often confirm the diagnosis, but further imaging such as a CT scan or MRI scan may visualise the joint space more carefully. 

Non-operative treatment
Options could include splinting to keep the wrist still or x-ray guided cortico-steroid injections.

The goal of treatment is to reduce pain and improve function. Some of the treatment options include:
1. Lifestyle modifications: Just a simple case of altering your activities slightly can reduce pain considerably.
2. Wrist and finger splints: Splinting can provide support and allow you to perform simple activities without pain.
3. Hand therapy: Seeing a therapist for help with exercises is important. You can buy cheap but effective hand devices that will help keep the joint moving and improve strength in fingers and wrist.
4. Medication: Topical cream applied frequently onto the sore wrist or finger joints provide excellent pain relief. Creams include ibuprofen or flexiseq.
5. Injection therapy: a cortisone shot in hand can help reduce pain and improve mobility for a few months.
6. There is early evidence that PRP injections can work in wrist arthritis.

Operative Intervention Options
Wrist denervation
Proximal row carpectomy vs
Partial wrist fusion vs 
Total wrist fusion vs 
Total wrist replacement
  
These procedures are designed for patients that have failed conservative measures, including rest, splints and injections. They have been performed for severe pain and discomfort, often the result of osteoarthritis. In such situations, the first question we need to ask is whether the patient requires wrist flexion and extension or are they happy to have a wrist fused, abolishing this movement. Initial impressions are the most patients do not want a total wrist fusion and an inability to flex and extend the wrist. 
 
However, after careful consideration and often speaking to other patients who have had the procedure, or discussions with a hand therapist, they realise that there are very few activities they will be unable to perform. The upper limb can accommodate a wrist fusion and get the hand into mots places providing there is a supply elbow and shoulder.
 
Wrist flexion and extension are required by some professions, and these would include plastering, plumbing and being an electrician. 
 
The majority of other activities of daily living activities are well accommodated with a total wrist fusion. If, after the above discussions, the patient is still adamant they wish to have flexion and extension at the wrist maintained, the options are a proximal row carpectomy, a partial wrist fusion or total wrist replacement.

What is wrist denervation?

Surgical denervation of the wrist is a useful palliative procedure for chronic wrist pain when reconstructive procedures are not feasible or desirable.

Wrist denervation aims to stop nerves that are transmitting pain, such as the anterior and posterior interosseous nerves (near the wrist joint) and the articular branches of the superficial radial nerve. The procedure can allow for long-lasting pain relief and better function of the wrist.

Which conditions might require wrist denervation?

Degenerative arthritis is a condition that leads to the painful limitations of wrist motion and indicates that wrist denervation is necessary.

Other indicators include scaphoid non-union, painful carpal instabilityligament injury and Kienbock’s disease.

What is the surgical procedure used during wrist denervation?

Wilhelm’s wrist denervation is a surgical procedure used to cut tiny branches of the sensory nerves to the wrist and hand. Cutting these nerve pathways means that pain signals to the brain can be stopped. The motor nerves are not disturbed, so there is no loss of motion or strength.

The operation takes around 45 minutes and involves four small incisions on both the front and back of the wrist and hand. The incisions are closed with wire sutures, and a dorsal plaster splint is applied. 

Following surgery, grip, strength, wrist motion and pain improves.
  
proximal row carpectomy involves removing the scaphoid, lunate and triquetrum bones. The capitate bone then moves down and articulates with the lunate facet of the distal radius. This gives a more ball and starts socket type joint. The advantage of this particular procedure is that there is no metalwork inserted into the joint, there is no risk of non-union and early mobilisation after 2 to 4 weeks.

Wrist Fusion

A wrist fusion can be a very effective operation for controlling pain in an arthritic wrist. Arthritis can arise as a consequence of a number of conditions, including trauma, generalised wear and tear arthritis, inflammatory arthritis, such as those caused by rheumatoid arthritis or psoriasis. Arthritis is a disease process whose end product is the destruction of the articular cartilage of the joints. The articular cartilage is the slippery substance found at the end of bones. These allow the two bones in a joint to move with each other without any friction. In arthritis, the cartilage is destroyed, and the bone is exposed, and it rubs against the opposite exposed bone surfaces, causing significant pain.

There are two main types of fixation for wrist fusions. The first is a contoured plate that is held across the back of the wrist joint, with screws into the bone to secure fixation. The surgeon will carefully remove the remaining articular cartilage from the wrist joint to allow the bone to completely solidify underneath the plate. The second type of fixation is a pin that is passed across the wrist joint (usually down through the middle knuckle joint). This second type of fixation is often performed for patients with rheumatoid arthritis.

Wrist replacements are becoming increasingly common. These are performed when patients have got regular pain and misery from an arthritic joint. The vast majority of wrist replacements are performed in patients with rheumatoid arthritis or psoriatic arthritis, but increasing numbers have been performed in patients with osteoarthritis. 
Generally speaking, the modern generation of wrist replacements includes a two-piece component, one of which is metal and one of which is a special type of plastic.