Wrist Arthritis
Recognising the Symptoms and Signs
Ali Phillips | Hand & Wrist Specialist
Struggling with a painful, stiff wrist?
I'm Ali Phillips. Dealing with wrist pain can significantly impact your life, making everyday tasks difficult. My goal is to provide clear, supportive information to help you understand your condition and explore the best treatment options for you.
Book a ConsultationWhat is Wrist Arthritis?
In simple terms, arthritis in the wrist means the smooth, slippery cartilage that cushions the bones has worn away. This causes the bones to rub against each other, leading to pain, stiffness, and swelling. It's often a "wear-and-tear" condition (osteoarthritis) that develops over time.
Sometimes, it follows a predictable pattern after an old injury to a wrist bone (like the scaphoid) or a ligament. We call these specific types SLAC (Scapholunate Advanced Collapse) or SNAC (Scaphoid Non-union Advanced Collapse) wrist.
Where is Your Pain Coming From?
The wrist is complex. Where you feel the pain can give us important clues. See which of these descriptions best matches your symptoms to learn more.
Pain on the Thumb Side (STT Arthritis)
This often relates to arthritis at the base of the thumb and index finger. The pain is especially noticeable when you move your wrist from side-to-side, like when waving.
Learn about STT ArthritisPain in the Middle/Top (Midcarpal Arthritis)
A dull ache or clicking sensation felt directly on top of the wrist can be a sign of Midcarpal Arthritis, affecting the joint between the two rows of small wrist bones.
Learn about Midcarpal ArthritisPain on the Little Finger Side (DRUJ Arthritis)
Pain on this side, especially with twisting motions like opening a jar or turning a key, can be related to arthritis of the distal radioulnar joint (DRUJ).
Learn about DRUJ ArthritisGeneral Wrist Pain (Radiocarpal Arthritis)
If your pain is more general across the main wrist joint and is worst when putting weight on your hand (like pushing up from a chair), it may be Radiocarpal Arthritis.
Learn about Radiocarpal ArthritisHow can I help you get better?
There is a lot we can do. We'll create a treatment plan together, always starting with the simplest options.
Activity Modification We'll find ways to perform tasks differently to reduce strain on your wrist, sometimes using helpful assistive devices.
Splinting Wearing a supportive splint can help stabilise the wrist joint, reduce pain during activities, and provide rest.
Hand Therapy A therapist can teach you gentle exercises to improve flexibility and strength, helping to support the joint.
Steroid Injections For persistent pain, an injection of corticosteroid directly into the joint can reduce inflammation and provide temporary relief.
Surgery is considered when other treatments have failed and your quality of life is significantly impacted. The goal is to reduce pain while preserving as much movement and function as possible. The choice of procedure depends entirely on your specific pattern of arthritis.
What it is: A motion-preserving procedure where I remove the first row of arthritic wrist bones (scaphoid, lunate, and triquetrum), allowing the wrist to form a new joint.
Benefits
- Significant pain reduction
- Improves and preserves wrist range of motion
Risks
- Some symptoms may remain (about 1 in 5 people are not happy long-term)
- The procedure may fail and need revising to a fusion (about 1 in 4 cases, especially in younger patients)
- Infection (less than 1 in 100 cases)
What it is: Often used for SLAC/SNAC wrist, this procedure involves removing the damaged scaphoid bone and fusing four of the central wrist bones into a single, solid block. This stops painful movement in the arthritic area.
Benefits
- Reduces wrist pain significantly
- Provides a stable wrist while preserving about half of the normal movement
Risks
- Bones may not fuse together properly (non-union), which can require further surgery (about 1 in 4 cases)
- Painful rubbing from the metal plate or bones (about 1 in 4 cases)
- Need for a second surgery to address issues (about 1 in 7 cases)
What it is: For severe, widespread arthritis, this procedure fuses all the wrist bones together with a plate and screws, creating one solid bone and eliminating all wrist movement.
Benefits
- Eliminates wrist pain reliably
- Creates a very strong and stable wrist for heavy use
Risks
- Complete loss of wrist bending motion
- Bones may not fuse properly (non-union), especially in smokers
- The implant (plate and screws) can sometimes cause irritation
What it is: For arthritis in the specific STT joint (at the base of the thumb), this procedure replaces the joint with a modern implant made of a durable material called pyrocarbon.
Benefits
- Excellent pain relief
- Preserves natural wrist movement, minimising stiffness
- Reliable and proven technology
Risks
- Implant issues, such as shifting out of position (less than 1 in 10 cases)
- Infection (less than 1 in 50 cases)
- Continued pain or stiffness
Understanding Consent for Surgery
If we decide surgery is the right path, it is imperative that you understand the process, the risks, and your rights. This is a partnership, and your informed consent is the most important part.
You have every right to choose not to have surgery, even after we have discussed it. We can always explore other treatment options, or decide on no treatment at this time. The decision is yours.
It is critical to appreciate that all surgery has risks. The decision to proceed is a fine balance between the potential benefits and these risks.
The only person who can judge that balance is you. My role is to give you the clearest possible information so you can make the choice that is right for you.
All surgeries carry some general risks, which are important to be aware of. These include infection, swelling, stiffness, scar pain, and the potential for nerve irritation causing numbness. The specific risks for each type of wrist surgery are detailed in the section above, but these general possibilities apply to any procedure.
Frequently Asked Questions
Unfortunately, the "wear-and-tear" of osteoarthritis is permanent. However, early and effective treatment is key to managing the symptoms, slowing the progression, and keeping your wrist functional for as long as possible.
While both can cause wrist discomfort, they are very different. Arthritis involves damage to the joints themselves, causing an ache, stiffness, and pain with movement. Carpal tunnel syndrome is pressure on a nerve, which typically causes symptoms of tingling, numbness, and pins-and-needles in the fingers.
Surgery is considered only when non-surgical treatments like splinting, therapy, and injections have failed to relieve your symptoms, and the arthritis is significantly interfering with your hand function or causing severe pain.
Not necessarily. It depends entirely on the type of surgery. A full wrist fusion does eliminate wrist motion to provide maximum pain relief. However, motion-preserving options like a proximal row carpectomy (PRC) or a limited fusion are designed to relieve pain while keeping a functional range of movement.
These are acronyms for specific patterns of arthritis that often develop after an old injury. SLAC (Scapholunate Advanced Collapse) usually follows a ligament tear, while SNAC (Scaphoid Non-union Advanced Collapse) follows a scaphoid bone fracture that didn't heal. Both lead to predictable wear and tear in the wrist.
This depends on the sport and the type of surgery. After a full fusion, activities requiring wrist flexibility (like tennis or yoga) would be difficult, but strength-based activities might be easier. After a motion-preserving surgery, many people can return to a wide range of activities once they have fully recovered.
Recovery time varies significantly. Fusion procedures require a longer period of immobilisation (often in a cast for several weeks or months) to allow the bones to heal. Motion-preserving surgeries may have a slightly quicker initial recovery. Full return to all activities can take several months and requires commitment to hand therapy.
This is where only the specific, damaged bones in the wrist are fused together, leaving the healthy joints free to move. This is an excellent option for relieving pain in a targeted area while preserving as much natural wrist motion as possible.
Yes, hand therapy is essential after most types of wrist surgery. A specialist therapist will guide you through exercises to regain strength, manage swelling, and maximise your mobility and overall function.
While you can't always prevent it, especially if it's related to an old injury, you can reduce your risk. This includes seeking proper treatment for wrist injuries when they happen, using good ergonomics to avoid repetitive strain, and maintaining a healthy lifestyle.
Test Your Knowledge!
Midcarpal Osteoarthritis FAQs
Midcarpal Osteoarthritis is a form of arthritis. It affects the middle joint in your wrist and the degeneration of the cartilage in this joint will lead to pain, stiffness and reduced mobility. The good news is that there’s plenty I can do for you!
The primary cause of Midcarpal Osteoarthritis is the wear and tear of the cartilage that occurs over time. It is typically due to aging. It can also result from injury or repeated stress on the wrist, which accelerates cartilage breakdown, causing pain and loss of function.
Individuals over the age of 50 are more likely to develop this condition. It can occur in younger people who have experienced significant wrist injuries. People who engage in repetitive wrist motions such as athletes or manual laborers, are also at increased risk.
Symptoms you may be experiencing include pain and swelling in the wrist, especially during or after movement, decreased range of motion and a feeling of grinding or catching within the joint. Stiffness in the morning or after periods of inactivity is also common while very occasionally patients can become symptomatic straight after an injury. With this type of injury, it is not the injury itself that causes the exacerbation but for some reason the body “kicks off” a cycle of unremitting pain which is very difficult to treat!
I will get to the diagnosis typically using examination, during which I will assess pain points and range of motion, then arrange some imaging tests, such as X-rays and MRI scans. I often use these to confirm the diagnosis and assess the extent of joint damage and hence options moving forwards.
While there is no cure for osteoarthritis, I can help you manage your symptoms with different treatments while I focus on minimising pain, maintaining hand function and slowing progression of the condition.
We always start with non-surgical options like pain management with medications, wrist splints or braces to support the joint and physical therapy to improve mobility. In more severe cases, I can use cortisone (steroid) injections and surgical interventions such as joint fusion or replacement might be considered as a last resort. There is always something I can do for you so don’t fret!
I always encourage patients to modify activities to reduce stress on the wrist, use assistive devices to grip or hold items and engaging in regular gentle exercise to keep the joint moving and these can help manage symptoms. Occupational therapy may also provide strategies to protect the joint during daily tasks but remember that arthritis likes to be moved but NOT loaded. That means keep it moving but don’t stress it!
Yes, by all means do some gentle exercises as they can be beneficial. This is because they help maintain joint function and reduce stiffness. It’s important to consult with a physiotherapist to get a personalised exercise plan that won’t exacerbate the condition because arthritis like to be moved and not loaded so if you do too much it will make it worse!
The progression of Midcarpal Osteoarthritis varies between individuals but with appropriate management, most people can control pain and maintain a good quality of life. I can help you monitor it and adjustments in treatment can help manage the condition effectively over time.
