When a handshake hurts

Arthritis of the wrist can cause you to lose your grip in more ways than one. If wrist-protecting tactics and medication don’t bring relief, surgery may be the answer.

Until your wrists start to hurt or stiffen, you may not realize how much you depend on them—to hold a fork, turn a doorknob, type an e-mail, and much more. Arthritis of the wrist can make these movements difficult—or, in severe cases, nearly impossible.

How trouble begins

Like the knees and hips, the wrist is a synovial joint, in which the ends of bones, cushioned by slippery cartilage tissue, move easily against one another. The wrist, however, is a more complicated joint. It consists of a row of 4 small bones called carpals, which join with the 2 long bones of the forearm (the radius and ulna) to form the wrist joint.

The bones of the wrist are held together by a capsule of fibrous material that attaches to bone on either side of the joint. The capsule is lined with thin tissue—the synovial membrane—which releases fluid to lubricate the joint. Other tissues—ligaments, muscles, and tendons—help stabilize the wrist and allow it to move.

Arthritis throws a wrench into this complex apparatus, causing pain, restricting movement, and weakening the supportive structures. In osteoarthritis, the cartilage that protects the ends of bones gradually wears down, leaving bone to grind painfully against bone. Rheumatoid arthritis causes the synovial membrane to become inflamed, leading to damaged bone, cartilage, and other structures. Eventually the bones of the joint may become poorly aligned, resulting in deformity and loss of wrist function.

Early in the course of arthritis, wrist pain may occur from time to time, provoked by activity and relieved by rest. As the disease worsens, the pain becomes more constant, sometimes changing from a dull ache to a sharp, radiating pain. The joint gets harder to move. Hand and finger strength may decline, making it difficult to pinch or grip. In some cases, joint swelling presses against nerves that travel through the wrist, causing nerve damage. (One such case is the familiar carpal tunnel syndrome.)

Medical guidance

To make a diagnosis, your doctor will ask about symptoms and examine your wrist. X-rays will be taken. If rheumatoid arthritis is suspected, laboratory blood tests may be ordered.

Mild to moderate pain and joint swelling can often be relieved with conservative measures. Your doctor may ask you to modify activities that stress your wrist and to follow a prescribed exercise program. You may need to immobilize the joint in a splint for a short period of time and to take anti-inflammatory medications such as aspirin or ibuprofen. Periodic injections of a corticosteroid may also be needed to relieve symptoms.

If these measures don’t provide adequate relief or if wrist movement is significantly impaired, you may want to consider surgery.

Surgical options

Many considerations—the type of arthritis you have, how much damage it has done, how much wrist movement you need on the job and elsewhere—should be factored into your decision on whether to have surgery. A surgeon can discuss your surgical options, the possible complications, and the outcomes you can expect. You’ll have to decide, too, whether you can comply with the post-operative program of splinting, physical therapy, and possible restrictions on activities.

The following surgical procedures may be considered.

Excision. Arthritis may enlarge the knob-like bone that juts out from the wrist where the forearm meets the side of the hand where your pinky finger is. Pain and tendon damage develop. In excision surgery, the bony prominence is smoothed and then covered with soft tissue.

Joint fusion. In this procedure, known as arthrodesis, bones of the joint are fused to stabilize the wrist. The result is less pain—but also less wrist motion.

Joint replacement. In this surgery, also called arthroplasty, the damaged bone ends are removed and replaced by an implant. This relieves pain and preserves some joint function. An implant is more appropriate for people who don’t put great physical demands on their hands. Wrist implants have improved significantly in recent years; with careful use, an implant can be expected to last 10 to 15 years.

From Arthritis Self-Management and American Family Physician