Types and Treatment of Wrist Arthritis

Wrist arthritis typically refers to osteoarthritis (OA) of the wrist. OA is the most common form of arthritis caused by the aging-related wear and tear of joints. Over time, this can lead to joint stiffness and pain as cartilage is progressively lost and bones of the wrist start to remodel abnormally.

Wrist arthritis is diagnosed with a physical exam and imaging studies. Treatment of OA may involve exercise, oral pain relievers, cold/heat application, cortisone shots, and, in severe cases, surgery.

This article describes the causes and symptoms of wrist arthritis, including what it feels like and how to tell it apart from other causes, like rheumatoid arthritis (RA). It also explains how OA of the wrist is commonly diagnosed and treated.

What Does Wrist Arthritis Feel Like?

Wrist osteoarthritis is a chronic (persistent) condition that typically gets worse over time. Even so, the severity of symptoms can vary from one person to the next, with some people able to manage reasonably and others experiencing extreme disability.

Symptoms of wrist OA may include:

• Wrist pain and stiffness that tend to be worse in the morning and ease as the day goes on
• Joint swelling
• Loss of range of motion, particularly when flexing the wrist
• Clicking sounds with movement
• Joint weakness and instability
• Difficulty gripping objects

Changes in the joint coupled with low-level inflammation can irritate nerves servicing the wrist joint. This can contribute to carpal tunnel syndrome, a condition that causes tingling, numbness, and pain in the wrist and hand.

What Causes Wrist Arthritis?

Osteoarthritis of the wrist is a progressive disorder associated with aging. Over time, the cartilage that cushions joint bones gradually wears away, exposing the underlying bone. As the bones rub against each other and start to degrade, the body will initiate the normal process of remodeling to repair the injury.

Over time, however, the remodeling process can become haphazard, causing joints to become misshapen and tiny bone spurs (osteophytes) to develop. This further exacerbates joint pain and stiffness.

While older age is a major contributor to OA—which is why OA is commonly referred to "wear-and-tear arthritis"—there are other contributing factors, including:

• Prior wrist injuries: Post-traumatic arthritis is a type of osteoarthritis that is caused by an injury like a bone fracture or dislocation.
• Overuse injuries: Also known as repetitive stress injuries, these typically involve occupations that require repeated wrist movements, such as plumbing, baking, or professional tennis.

How Wrist Arthritis Is Diagnosed

The diagnosis of wrist arthritis starts with a review of your medical history and a physical exam. During the physical exam, your healthcare provider will examine your wrist for pain, swelling, and the loss of the expected range of motion. This may involve gently twisting and flexing of the wrist. 

The next step is medical imaging. In most cases, a plain-film X-ray will do, but people with severe symptoms may benefit from a computed tomography (CT) scan which generates more detailed images by combining multiple X-ray images.

Blood tests are usually unnecessary unless some other cause, like RA, is suspected. This may be the case if you don't fit the "profile" for OA (such as being a younger age) or have symptoms consistent with RA (such as bilateral joint involvement and symptoms that come and go).

In such cases, certain blood tests can help establish if RA is the cause. including:

• C-reactive protein (CRP), which detects generalized inflammation (generally higher with RA)
• Erythrocyte sedimentation rate (ESR), which also detects generalized inflammation
  
• Anti-cyclic citrullinated peptide antibodies, which are elevated with autoimmune disease
• Rheumatoid factor (RF), which is also elevated with autoimmune diseases

How Wrist Arthritis Is Treated

Some treatment options can easily be done at home and may have a big impact on your pain. That said, at-home treatments are done in conjunction with medical treatments.

Home Remedies and Lifestyle

These options work best when you are committed to following them day in and day out:

• Lifestyle modifications: Many people with symptoms of wrist arthritis find relief simply by modifying their activities. Avoiding certain movements or tasks, such as lifting and carrying heavy loads, may provide relief from the symptoms of your wrist arthritis.
• Wrist splint: Support braces can help some people who have wrist arthritis. These braces act as a gentle support to wrist movements. They will not prevent severe injuries but may help you perform simple activities.
• Occupational therapy: Occupational therapy, under the guidance of a professional, can help you adapt your movements to avoid exacerbating your condition and prevent injuries.
• Cold/heat applications: Ice application is generally beneficial for acute pain and swelling. Heat applications can help improve joint function and ease stiffness prior to activity.

Medications

Medication is often needed to tame inflammation and provide added pain relief:

• Anti-inflammatory medications: Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for pain caused by problems such as wrist arthritis.
• Cortisone injections: Cortisone is a powerful medication that treats inflammation. You can discuss the potential benefits of a cortisone injection for your wrist arthritis with your healthcare provider.

Surgery

Surgery is not often needed in the treatment of wrist arthritis, but it can be an option when symptoms are severe and other treatments have not provided relief.

Surgical procedures for wrist arthritis include:

• Wrist fusion: A wrist fusion is a procedure that eliminates all movement at the wrist joint by securing the bones of the forearm to the bones in the wrist and hand. A fusion might provide relief of wrist arthritis pain, but the loss of motion can prevent some normal activities.
• Proximal row carpectomy: A proximal row carpectomy is a procedure in which three of the small bones of the wrist joint are removed. When the arthritic bone is removed, pain is diminished. Because there is no fusion, the wrist motion is preserved. Proximal row carpectomy is only an option for some types of wrist arthritis.
• Wrist replacement: A wrist replacement surgery is the removal of the damaged bone, followed by replacement with a metal and plastic implant. It's not a common procedure and the results are not as predictable as some other surgical procedures (such as knee replacements and hip replacements).

Summary

Osteoarthritis is the most common cause of wrist arthritis, caused by aging-related deterioration of the wrist joint. Symptoms include joint stiffness and pain, loss of range of motion, and joint deformity. Treatments include oral pain medications, wrist splints, cortisone shots, and surgery.

Rheumatoid arthritis is a less common cause of wrist arthritis, but one that is no less impactful. This autoimmune disease shares many symptoms of OA but affects both wrists and manifests with symptoms that come and go.

Other causes of wrist arthritis include gout, psoriatic arthritis, juvenile idiopathic arthritis, fibromyalgia, and lupus.