Hand & Wrist Arthritis

Wrist Arthritis

Wrist arthritis commonly occurs post traumatically or from chronic and repetitive wear. Symptoms generally occur as pain and swelling in the wrist, along with decreased range of motion, ultimately effecting the patient’s overall function. The exact type and degree of wrist arthritis is best diagnosed with radiographs which can help pinpoint the joint surfaces and bones that are most involved. Management begins conservatively with bracing, NSAIDs and cortisone injections. If the pain persists despite conservative management, the patient may be a candidate for surgery. Surgical intervention consists of fusing specific joints in the wrist or hand. Removing certain carpal bones may be indicated as part of the procedure to eliminate the associated pain. A total wrist fusion, a partial wrist fusion, a four corner fusion or a proximal row carpectomy are some of the options available depending on the exact location and severity of the arthritis. Our orthopaedic hand specialists will determine which, if any, procedure would be best to treat your wrist for your lifestyle and needs.

SNAC Wrist
Scaphoid nonunion advanced collapse (“SNAC wrist”) occurs after sustaining a scaphoid fracture that goes undiagnosed or does not heal. Patients may present with a history of an old injury with complaints of wrist pain, stiffness and weakness. Diagnosis is often made with radiographs that show a scaphoid nonunion and the progression of the collapse. Treatment of this condition begins conservatively with bracing and cortisone injections, but definitive treatment requires surgery.

SLAC Wrist
Scaphoid lunate advanced collapse (“SLAC wrist”) usually occurs as the result of a chronic scapholunate ligament injury. Loss of stability between these carpal bones causes the scaphoid to go into a flexed position and the lunate to be extended. Over time, these abnormal forces and instability lead to arthritic changes between the radiocarpal and midcarpal joints. Patients may present with a history of an old injury and complaints of wrist pain, stiffness, and weakness. Diagnosis is often made with radiographs that will show scapholunate widening, radiocarpal and/or midcarpal arthritis, and a DISI (dorsal intercalated segment instability) deformity.

Thumb Arthritis

Basal joint arthritis is a degenerative process that takes place at the base of the thumb. It usually begins with intermittent pain in the thumb with repetitive or forceful motions. Patients may initially complain of pain with trying to open a tight jar or carrying a heavy load. As the arthritis progresses they may notice pain with opening doors, turning car keys, and may also feel a grinding sensation with thumb motion. Generally, the disease process starts gradually beginning with intermittent symptoms that may become more frequent over time. Basal joint arthritis can affect one or both hands, but many times symptoms will be noticed earlier on in the dominant hand. This type of arthritis can be addressed in many ways depending on the severity and dysfunction the patient is experiencing. We will discuss the treatment options in further detail, but first we want you to gain a simple understanding of the disease process.

Cartilage is a smooth rubber-like tissue that cushions joint surfaces. Arthritis occurs when cartilage in a joint wears down. Eventually, the two bone surfaces are rubbing against each other when the joint moves. In basal joint arthritis, the base of the first metacarpal bone and the trapezium, a small carpal (wrist) bone beneath the thumb, begin to rub against each other. This rubbing is the source of the pain which may be felt as an aching, stabbing, or intermittent. Over time the space that was once between those bone disappears and they are resting against one another. Your thumb may feel weak and have decreased range of motion. This condition usually develops over time, but in some cases it may first be noticed after trauma or injury.Basal Joint Arthritis

Basal joint arthritis can be diagnosed through careful examination of the hands and thumbs. X-rays are helpful in obtaining a definitive diagnosis and gives your doctor a better idea of how far the arthritis has progressed. X-rays will clearly show that the space between the two bones has deteriorated and may reveal bone spurs as a result. Our offices are equipped with fluoroscopy machines that allow us to take low dose radiation images of the hand during your appointment.

Treatment of basal joint arthritis depends on the patient, the severity of symptoms, and the stage of the disease process. Usually, initial treatment is conservative and consists of bracing and cortisone injections. Cortisone injections are given into the joint and help to decrease inflammation and pain in the area. Many times patients will have long term relief following an injection, but in more advanced cases the relief may not last as long or at all. Our doctors will image your hand through fluoroscopy while doing the injection to ensure the cortisone is injected into the exact location of your arthritis. If symptoms persist or worsen over time you may be a candidate for surgery.

Surgery usually involves removing a small carpal bone called the trapezium that sits at the base of your thumb and is the source of pain in basal joint arthritis. Removal of this bone does not alter the mobility or function of the thumb but does alleviate your pain. Once that bone is removed, the thumb metacarpal will be suspended in a variety of ways that may involve a tendon transfer, pinning or a tight rope suspension. All of these are appropriate options, although some may allow for earlier motion than others. Your doctor will discuss the surgery they think is right for you.

Physical therapy will be a large part of your rehabilitation process regardless of the specific type of surgery done. Hand therapists in particular are specifically trained in this type of rehabilitation. They will design a therapy program that is tailored to your needs and goals. They may also make a custom splint that can be worn during the beginning stages of recovery if advised by your doctor. Certified hand therapists have a wide array of skills, tools, and modalities that are specific to regaining fine motor skills, hand strength, and dexterity.

Thumb arthritis can be extremely painful and cause serious dysfunction for patients. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any thumb or hand issues and receive superior care from our doctors and staff.