What is it?

Osteoarthritis (OA) refers to a process of degradation and degeneration of the cartilage lining a joint, and subsequent changes in the bone adjacent to that joint. The wrist joint is a complex joint made up of the radiocarpal joint (between the radius and the proximal row of carpal bones) and the midcarpal joint (between the proximal and distal rows of carpal bones). This complex joint often becomes arthritic as a result of a previous, often unrecognized injury, in which case we term this "secondary osteoarthritis". Examples of such injuries include:

• Rupture of the scapholunate ligament
• A scaphoid fracture that has not healed
• A fracture of the distal radius which has led to joint surface damage

The degeneration of the joint can occur within a few years of the index injury, so can even affect young patients in their 20’s or 30’s.

There are other specific joints within the wrist that more often become arthritic through gradual degeneration (“primary osteoarthritis”). Fortunately this is relatively uncommon. Examples include the scapho-trapezio-trapezoid (STT) joint, and the pisotriquetral joint.

What are the symptoms?

OA of the wrist causes pain, particularly on use, sometimes with stiffness and reduction in grip strength. There may be a background of aching discomfort. The amount this will affect someone will depend to a great extent on his or her occupation – those with heavier manual jobs being more affected. Naturally some hobbies can also be affected, particularly sports.

How is it diagnosed?

The diagnosis can usually be confirmed by taking X-rays of the wrist. Rarely more specialized imaging techniques are required, such as MRI scans or SPECT scans.

How is it treated?

Treatment of this condition usually progresses from less invasive to more invasive techniques, depending on the level of symptoms and the response of those symptoms to treatment:

• The use of anti-inflammatory and pain killing medication, and activity modification
• The use of splints to support the wrist and reduce pain. These can be provided 'off the shelf' or can be custom-made by a hand therapist
• Injection of steroid into the specific involved joint. This technique usually yields a temporary improvement in symptoms, for up to 6 months. Mr. Gidwani will generally use this on up to two occasions. It is more useful for cases of primary osteoarthritis
• Surgery is useful when these measures have not helped. The exact procedure that is appropriate will depend on a number of factors, such as the patient’s age, occupation, wrist range of motion, and the extent of degeneration of the joint that has already occurred. Mr. Gidwani will be able to discuss the pros and cons of the different available procedures with you during your consultations