The wrist is the most complex joint in the body, containing 8 small bones that sit between the two forearm bones and the thumb and finger bones. Arthritis, or wearing out of the joint surfaces, can occur in any of these joints and often in more than one joint at once. Despite this complexity there are some patterns of wear that we see frequently. Some of these patterns are known to be associated with earlier injuries to the wrist. For instance a fracture (break) of the scaphoid bone in the wrist is known to result in wrist arthritis if it is not treated promptly and so fails to heal up well. Similarly a significant injury to the very small ligament between the scaphoid bone and the lunate bone (the scapholunate ligament) can result in these two bones not moving normally together and the wrist wearing out prematurely over time.
A scaphoid fracture and a scapholunate ligament injury both commonly occur after a fall onto the hand. Persisting pain in the wrist after such a fall should be investigated thoroughly to exclude these injuries and try and prevent arthritis from occurring.
Once arthritis has set in and the smooth lining of the joints has started to wear away patient often suffer with stiffness (loss of flexibility and movement) in the wrist. This can be accompanied by swelling and a variable amount of pain.
Arthritis can often be seen on a simple xray. Sometimes scaphoid fractures and scapholunate injuries can also be confirmed with simple xrays but more frequently complex tests such as MRI scans, sometimes with dye injected into the joint (an arthrogram), are also needed. Ultimately the best information regarding the internal state of the wrist joint can be gained by an arthroscopy. This entails an operation to look inside the joint with a very small camera. During this operation both the surfaces of the wrist bones and the ligaments that connect them together can be inspected.
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Scaphoid fractures can often just be treated in a plaster cast but special care needs to be taken to be 100% sure that any break has fully healed up. Xrays may not give enough information to do this and a CT scan may also be necessary to examine the scaphoid in detail and confirm healing. Some patterns of scaphoid injury are much less likely to heal well than others. Your surgeon may recommend that these patterns are treated with a screw placed down the centre of this bone, across the fracture site, early on to increase the chances of the bone healing. If the scaphoid is starting to heal but is in a poor position, or if the diagnosis is made very late after the injury. bigger operations might be necessary. These can involve opening up the bone, putting in a piece of bone from elsewhere in the body (a bone graft) and then holding the scaphoid and graft with a screw.
A complete scapholunate injury, confirmed by arthroscopy, can be treated within 6 weeks of a fresh injury by repairing the ligament directly. If the injury is more than 6 weeks old it is unlikely that the ligament will heal with a simple repair and a ligament reconstruction might be recommended. Various techniques are available for this, your surgeon will discuss this in more detail with you.
A wrist that is already arthritic should be treated on the basis of how intrusive the symptoms are for you. In many cases the symptoms can be controlled with activity modification, painkillers, removable splints to support the wrist and perhaps steroid injections to reduce the local irritation in the joints. If this does not work surgery might be considered. The two main options involve removing the arthritis parts and either fusing the remaining bones together or replacing the joint surfaces with an artificial joint. Your surgeon will discuss your particular situation with you.
Rehabilitation after some sorts of wrist surgery can be quite rapid – for instance most people will be back to using the hand reasonably normally two weeks after a wrist arthroscopy.
Some of the larger operations can take many months to recover from and require significant input from the hand therapy team to optimise your function.
Your surgeon will discuss your particular requirements with you.