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Wrist Arthritis

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Dr Jacqueline Tan

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Wrist arthritis occurs when cartilage in the wrist joint degenerates, leading to inflammation and structural changes in the bones and surrounding tissues.

The wrist comprises the radius and ulna in the forearm, and two rows of small carpal bones, all covered by cartilage. Loss of cartilage between these bones affects the wrist’s complex network of ligaments and joints, causing pain and reduced function during activities like writing, typing, or gripping objects. This progressive condition can significantly impact work, recreational activities, and quality of life.

Symptoms of Wrist Arthritis

The manifestation of wrist arthritis symptoms varies among individuals and often develops gradually over time.

  • Pain During Movement: Discomfort occurs during wrist rotation, flexion, or extension, particularly when gripping or lifting objects.
  • Morning Stiffness: The wrist feels rigid and difficult to move upon waking, typically improving after 30-60 minutes of activity.
  • Reduced Range of Motion: The wrist becomes less flexible, limiting its ability to bend or rotate fully in different directions.
  • Weakness: Hand strength diminishes, affecting the ability to grip objects or perform tasks requiring wrist stability.
  • Swelling: The wrist joint becomes puffy or swollen, particularly after extended periods of use.
  • Grinding Sensations: A feeling of clicking, crackling, or grinding occurs during wrist movement.

Causes and Risk Factors

Several factors contribute to the development and progression of wrist arthritis.

  • Age: The likelihood of developing wrist arthritis increases with age due to natural wear and tear of joint cartilage.
  • Previous Injury: Fractures, ligament tears, or other wrist trauma can lead to post-traumatic arthritis.
  • Repetitive Motion: Occupations or activities requiring repeated wrist movements can accelerate joint wear.
  • Genetics: Family history of arthritis increases the risk of developing the condition.
  • Inflammatory Conditions: Autoimmune diseases like rheumatoid arthritis can trigger joint inflammation.
  • Gender: Women have a higher prevalence of certain types of wrist arthritis, particularly after menopause.

Types of Wrist Arthritis

Different forms of wrist arthritis affect the joint through distinct mechanisms and require specific treatment approaches.

Osteoarthritis

The most common type, characterised by gradual wear and tear of the cartilage between wrist bones. This form typically develops over years and may affect one or multiple joints within the wrist. Those with previous wrist injuries face a higher risk of developing this type.

Rheumatoid Arthritis

An autoimmune condition where the body’s immune system attacks the joint lining. This type typically affects both wrists simultaneously and can lead to severe joint deformity if left untreated. The condition often appears between ages 40-60 and may occur alongside other joint involvement.

Post-traumatic Arthritis

Develops after a wrist injury such as a fracture or ligament tear. This type can appear months or years after the initial trauma and often affects the specific joint that was injured. The severity depends on the extent of the original injury and how it healed.

Psoriatic Arthritis

An inflammatory condition that affects both the skin and joints. It is associated with psoriasis, a chronic skin disease characterized by red, scaly patches. Psoriatic arthritis can involve the wrist, causing pain, swelling, and stiffness. Over time, it may lead to joint damage and deformity if left untreated.

Diagnostic Methods

Physical Examination

The doctor assesses wrist range of motion, strength, and areas of tenderness. They observe swelling, deformity, and compare both wrists to identify differences. This examination helps determine the impact on daily function.

Imaging Studies

X-rays show joint space narrowing, bone spurs, and changes in bone alignment. CT scans provide detailed cross-sectional images of the wrist bones. MRI scans reveal soft tissue damage and early arthritic changes not visible on X-rays.

Blood Tests

Laboratory analysis helps identify specific types of arthritis. Tests measure inflammatory markers and check for antibodies associated with rheumatoid arthritis.

Arthroscopy

A minimally invasive procedure using a small camera to view the joint interior. This method allows direct visualisation of cartilage damage and can guide treatment decisions. It may be used when other diagnostic methods provide unclear results.

Treatment Options

Treatment for wrist arthritis aims to reduce pain, maintain function, and slow disease progression.

Non-Surgical Treatment

Medication

Anti-inflammatory drugs are commonly used to reduce pain and swelling in wrist arthritis. For rheumatoid arthritis, disease-modifying anti-rheumatic drugs (DMARDs) may be prescribed to slow joint damage. Topical treatments, such as creams or gels, can provide targeted, localised pain relief directly to the affected area.

Physical Therapy

Specific exercises help maintain joint mobility and strengthen the muscles around the wrist, while proper hand positioning during activities minimises stress on the joint. Therapy sessions often incorporate heat or cold therapy to manage inflammation and alleviate discomfort. Regular physical therapy can help preserve function and slow the progression of arthritis.

Splinting

Wrist splints are used to reduce stress on the joint during everyday activities. Different types of splints are available for various purposes, such as daytime use, nighttime use, or specific tasks. Custom-fitted splints ensure optimal support and comfort, helping to stabilise the wrist and minimise pain.

Corticosteroid Injections

Injecting anti-inflammatory medication directly into the joint can provide temporary relief from severe pain and inflammation. The effects typically last for several months, but the frequency of injections is limited to avoid potential tissue damage.

Surgical Treatment

Joint Fusion

This procedure permanently joins the affected wrist bones, eliminating painful motion entirely. While it provides pain relief, it does so at the cost of wrist mobility. Patients undergoing this surgery require 8-12 weeks of immobilisation to ensure proper recovery and bone healing.

Proximal Row Carpectomy

This surgical technique involves removing a row of small wrist bones to reduce pain while retaining some wrist motion. It is appropriate for specific types of arthritis and helps preserve partial wrist function. Recovery from this procedure typically takes 6-8 weeks.

Total Wrist Replacement

This procedure replaces the damaged surfaces of the wrist joint with artificial components, allowing for maintained motion while imposing certain activity restrictions. It is best suited for older patients with lower physical demands, providing a balance between pain relief and functional use of the wrist.

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Prevention and Management

Regular wrist exercises are necessary for maintaining flexibility and strength, while staying active supports overall joint health. Using ergonomic tools and maintaining proper posture during activities can significantly reduce stress on the wrist joint. Managing body weight helps prevent excessive load on the joints, further reducing strain. Additionally, modifying activities and incorporating regular breaks during repetitive tasks can help minimise the risk of symptom flares and support long-term joint health.

Frequently Asked Questions

Can arthritis spread to other joints from the wrist?

Rheumatoid arthritis commonly affects multiple joints, while osteoarthritis develops independently in each joint. The type of arthritis determines the pattern of joint involvement.

Can wrist arthritis lead to deformities?

Yes, in severe cases, arthritis, especially rheumatoid arthritis, can result in joint deformities over time. This occurs due to the progressive loss of cartilage, leading to changes in the joint’s structure and alignment.

Can I prevent wrist arthritis if I’ve had a wrist injury?

While it is not always possible to prevent wrist arthritis entirely after an injury, you can reduce the risk of developing post-traumatic arthritis by properly rehabilitating the injury, using ergonomic tools to minimise strain, and avoiding repetitive wrist movements that could aggravate the joint.

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Dr Jacqueline Tan

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

  • Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
  • Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
  • Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
  • Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

Widely Published
In hand surgery

Active In
Academic Teaching

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    Mt Elizabeth Novena Hospital

    38 Irrawaddy Road #07-42
    Singapore 329563

    Weekdays: 8:30am – 5:30pm
    Saturdays: 8:30am – 12:30pm
    Sundays & Public Holidays: Closed

    +65 9230 9554