Wrist Arthritis

Understanding Wrist Arthritis

Wrist arthritis commonly occurs post traumatically or from inflammatory or osteoarthritis. Symptoms are generally wrist swelling and pain along with decreased range of motion affecting function. The exact type 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. A surgery done to fuse specific joints in the wrist or hand and possibly to remove certain carpal bones may be necessary 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 specialists will determine which if any procedure would be best to treat your wrist for your lifestyle and needs.

SNAC

Scaphoid nonunion advanced collapse occurs after sustaining a scaphoid fracture that goes undiagnosed or does not heal. After some time the scaphoid nonunion causes collapse of the scaphoid and radiocarpal arthritis that may progress to midcarpal arthritis. Patients may present with a history of an old injury and complain of wrist pain, stiffness, and weakness. Diagnosis is often made with radiographs that will show a scaphoid nonunion and show the progression of the collapse. Treatment of this condition begins conservatively with bracing and cortisone injections, but definitive treatment requires surgery.

SLAC

Scaphoid lunate advanced collapse usually occurs as result of a chronic scapholunate ligament injury. This 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 complain 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 deformity.

Four Corner Fusion

A four corner fusion is one technique in which midcarpal arthritis can be addressed surgically. This procedure involves removing the scaphoid bone and fusing together four of the remaining carpal bones. This is usually reserved for patients with a well preserved radiolunate joint and isolated midcarpal arthritis. The capitate, lunate, hamate, and triquetrum are fused together with screws or large metal staples. This eliminated motion between these bones, but preserves some motion at the wrist. These bones over time will fuse together into one bone with no joint space. The goal of this surgery is to eliminate pain caused by midcarpal arthritis and allow the patient to return to having a functional pain free hand and wrist.

Proximal Row Carpectomy

A proximal row carpectomy involves removing the scaphoid, lunate, and triquetrum bones. This may be used in patients with Kienbock’s disease (avascular necrosis of the lunate), scaphoid nonuion, SLAC or SNAC wrist. It is usually not a good option for patients with advanced arthritic changes. The goal of the surgery is to remove the bones causing pain while allowing the patient to retain some motion. The recovery time is generally quicker following this procedure because you do not need to wait for any bones to fuse before returning to activities.

Total or Partial Wrist Fusion

A partial wrist fusion involves fusing the radiocarpal joints that have been most affected by arthritis while a total wrist fusion involves fusing the whole radiocarpal joint. This may be done with screws, plates, or staples. The patient will be sacrificing wrist motion for pain relief. Recovery will involve immobilization for about 6 weeks while the fusion heals.