Diagnosis

The diagnosis of wrist arthrosis is primarily made with a conventional x-ray in two planes. Here, especially a narrowing of the joint space and subchondral sclerosis are visible. The formation of cystic destruction can also be detected in the X-ray image. In case of acute, activated arthrosis, the wrist also shows clinical abnormalities:

Overheating,
Diffuse soft tissue swelling,
Redness and
Corresponding pain when moving or at rest.
The mobility of the wrist is also reduced in some cases.

Therapy

The therapy of wrist arthrosis should initially be conservative. Surgery is considered the last resort. The following therapy options are available:

The therapy of wrist arthrosis should initially be conventional.
Such therapy includes physiotherapy with cold applications, physiotherapy or stimulation current. To avoid further overloading of the joint, a supporting and movement-limiting cuff (orthosis) can be fitted. This also alleviates pain by supporting the wrist.
If these measures are not sufficient, long-acting pain-relieving or anti-inflammatory drugs can be injected directly into the joint space.
These can both relieve the pain in the joint and inhibit the inflammatory process, thereby slowing down the progress of the disease.
In acute pain conditions, orally and thus systemically effective pain medication can also be taken to make the acute pain more bearable. However, these should only be taken regularly and permanently after consultation with a doctor.
If these measures are not yet sufficient, the nerve itself can be anaesthetized, which makes pain transmission impossible.
If the pain is permanently too strong, a pain catheter can be placed in the immediate vicinity of the supplying nerve for a certain period of time (10 to 14 days). This is advanced to the affected area via a small catheter so that no incision is necessary.
A small dose of local anesthetic can be injected continuously through this catheter. Since the nerves supplying the vessels are also anaesthetised, the blood flow in the affected area is significantly increased. This counteracts especially the pain caused by inflammation.
If, however, conservative therapy measures do not provide satisfactory relief, wrist arthrosis can be treated surgically.
There are various options. On the one hand, the cartilaginous intervertebral disc between ulna and radius can be corrected during arthroscopy to allow the joint surfaces to glide smoothly again.
In addition, muscle tissue can be transplanted into the joint and thus replace the joint cartilage.
If these options are not available, the wrist can be completely replaced by an artificial joint. The interruption of the nerves that supply the wrist sensitively and with pain fibers (denervation) was increasingly abandoned.
The reason for this is the now very successful stiffening (arthrodesis) of the wrist. In this procedure, the joint is completely removed and the bone ends are firmly screwed together. Although the wrist loses its mobility as a result, the hand can be used much better again afterwards due to the subsequent freedom from pain.

Surgical treatment of wrist arthrosis always has the goal of relieving the patient’s symptoms and, in particular, maintaining the mobility of the affected joints.

Surgery for wrist osteoarthritis is usually always considered as a last resort. It is particularly indicated when the disease has progressed to the point where it restricts everyday life and especially movement. In addition, there is unbearable pain in the wrist, which can also be relieved by surgery.

There are various procedures that can be considered: In general, surgery on the wrist should be carefully considered. In addition, the choice of procedure depends on the age of the patient and the severity of the disease.

In the context of denervation (disturbance of nerve conduction), the pain transmission can be interrupted, thus reducing the pain caused by the arthrosis.
This measure is already an enormous relief for many patients.
Another possibility is partial stiffening (partial arthrodesis) of a section of the wrist if the arthrosis does not yet affect all the bones of the wrist. A residual mobility remains, which allows the hand to continue to perform everyday activities. Complete stiffening (arthrodesis) of the wrist is also possible.
The fingers remain mobile. Nevertheless, this procedure should be considered last, as the operation is no longer reversible.
If the wrist is severely damaged by osteoarthritis, implantation of a prosthesis is very useful. Despite the implant, the hand can develop its full strength and can be loaded accordingly.
After a short period of getting used to the hand, its mobility is also largely retained and subsequently offers patients a significant improvement and even freedom from symptoms.

Osteoarthritis is a progressive disease, which is particularly associated with a progredient (progressive) deterioration of the affected joints. It is therefore all the more important that the joints are moved regularly to prevent the progression of the movement restriction. This often presents a particular challenge for patients, as the disease can also be painful and progress in phases.

If operations have already been performed and joints have been replaced by prostheses, such as on the wrist, it is all the more important to keep the remaining joints and fingers active with exercises. A small rubber ball or a so-called water lily can be helpful for such exercises. The fingers are passed through holes and the patient repeatedly closes the fist against a low resistance.This keeps the fingers very flexible and trains the muscles.

Small rubber balls have the same effect. A tennis ball can also be used for daily exercises. For example, it can be covered with both hands with the fingertips.

Now the hand is moved in the wrist and the fingers, just like when screwing a can on and off. This exercise is also particularly suitable for training the wrist. Another exercise for the hand is to circle two smaller balls around each other in one hand.

It promotes the mobility of the fingers and strengthens the muscles of the entire hand. Regular exercises with several repetitions can slow down the arthrosis and avoid more severe wear and tear of the joint surfaces. In the early stages of osteoarthritis, but also as movement is progressively restricted by the disease, conservative measures such as kinesiotape can often relieve the pain and support the muscles.

This relieves the joints. As a result, the pain is relieved and the wear and tear on the joint surfaces is also reduced. The application of the tape strips can first be done by a trained doctor or a physiotherapist.

Once you have learned the technique, you can also tape your wrist yourself. It is important that the tape fits correctly and that there is sufficient traction so that they can produce their effects. The tapes are often applied lengthwise on the back of the hand and on the inside above the wrist up to about the middle of the forearm.

Then a circular strip is applied around the wrist. Different techniques can be used for the application. Which one is the most suitable and possibly also the most tolerable for the patient can be worked out and applied in consultation with the doctor or physiotherapist.