Wrist arthritis is diagnosed based on patient’s medical history, clinical examination and appropriate investigations.

Patients may complain of wrist pain, swelling and stiffness. They may start developing difficulty with daily activities like gripping or carrying things in their hand. They develop wrist deformity as well in the advanced stages.

Clinically patients have deformed, swollen and tender wrists. The wrist movements are painfully limited and are associated with a grinding feeling. Patients may also show swelling and deformities of their fingers if they have Rheumatoid arthritis. Some patients may have tingling and numbness due to carpal tunnel syndrome caused by bony spurs rubbing on the median nerve.

X-rays of the wrist in different planes helps to confirm the arthritis and the severity of the deformities. Blood tests are be done to confirm presence of inflammatory arthritis like RA.

Wrist arthritis can be managed conservatively or surgically.

Conservative management consists of:

Lifestyle modifications – Avoid carrying, pushing or lifting heavy objects with the affected hand.

Wrist splint – supports the wrist and avoid movements. This gives rest to the wrist and also pain relief. Helps in performing simple daily activities but it does not halt the progression of arthritis.

Warm fomentation – is done twice a day for 5 to 10 minutes. Then a painkiller gel is gentle applied

Anti-inflammatory medications help to reduce pain and improve functional abilities in early to moderate stages of arthritis.

Wrist injections – like a steroid or platelet rich plasma are used for controlling pain and inflammation. Can give temporary relief lasting for 3 to 6 months.

Patients with wrist arthritis due to RA are ideally managed medically by a rheumatologist. Once their symptoms or deformities worsen despite treatment, they get referred to an orthopaedic surgeon for surgical management

Surgery for wrist arthritis is advised for:

• patients with advanced stages arthritis with bony deformities &
• patients who fail to respond to conservative treatments

The surgical options are wrist fusion, wrist replacement or proximal row carpectomy.

Wrist Fusion: Used for advanced stages arthritis of the wrist.

In some cases, where the wrist arthritis is advanced but limited to a smaller area of the joint, a limited wrist fusion amongst the small affected wrist bones can be performed. A ‘four corner fusion’ is performed when arthritis is limited to the small bones of the wrist and results due to an old wrist trauma or fracture.

In patients with more severe arthritis affecting a wider area of the joint including the lower ends of the forearm bones, a total wrist fusion is performed.

During wrist fusion the remaining cartilage from surfaces to be fused is removed, the bones are held in a functional position and then stabilised with long wires or specialised fusion plates and screws. The wrist in then protected for 6 weeks in a plaster cast or wrist splint. The wrist fusion can take 8 to 12 weeks for complete fusion.

The fused wrist gives lasting pain relief but at the cost of losing wrist mobility.

But it does give a strong wrist which allows patients to get back to heavy manual work as well.

Total Wrist Replacement:

This option is best suited for low demand patients with severe arthritis.

Not ideally suited for younger and high demand patients as their active lifestyle puts extra stress on the implants. The implants may wear out or loosen early in such active patients.

Wrist replacement surgery does offer the ability to have pain-free movements after surgery in the select group of patients.

Proximal Row Carpectomy:

Surgical procedure performed for removal of 3 small bones of the wrist. This removes the worn-out joint surfaces. PRC is an option for patients who wish to maintain their wrist mobility and are too young to undergo wrist replacement surgery. Useful also for patients who are smokers and have a high chance of bony non-union with fusion surgery.