Management Options for Arthritis of the Hand and Wrist

Arthritis is a common condition that affects millions of people worldwide 1. It is characterized by pain, stiffness, and swelling in the joints. Arthritis can affect any joint in the body, but it is particularly common in the hands and wrists. Hand and wrist arthritis can make it difficult to perform everyday tasks, such as writing, opening jars, and buttoning clothes.

Anatomy of the Wrist and Arthritis

The wrist is one of the most complex joints in the body. It is made up of eight small bones called carpals, which connect the bones of the forearm (radius and ulna) to the bones of the hand (metacarpals) 1. Arthritis in the wrist may occur in different places where these bones connect:

  1. Distal radioulnar joint arthritis: This is arthritis at the base of your wrist, where your two forearm bones, your radius and your ulna, meet. This joint allows you to turn your palm up.
  2. Midcarpal joint arthritis: This is arthritis between the eight small carpal bones. These bones move together with your finger bones when they move.
  3. Radiocarpal joint arthritis: This is arthritis at the point where your two forearm bones and your carpal bones meet. This joint allows you to rotate your wrist and flex and extend your hand.

Types of Arthritis

There are a number of different types of arthritis that can affect the hand and wrist. The most common types are osteoarthritis, rheumatoid arthritis, and psoriatic arthritis 2.

  1. Osteoarthritis is a degenerative joint disease that occurs when the cartilage that cushions the bones in a joint breaks down. It can develop due to normal wear and tear in the wrist, particularly in older people and those who have a family history of arthritis 2. Osteoarthritis in the wrist can also develop from Kienböck's disease.
  2. Kienböck's disease occurs when the blood supply to one of the small bones in the wrist (the lunate) is disrupted, causing the bone to die and collapse. Over time, this can lead to osteoarthritis in the wrist 2.
  3. Rheumatoid arthritis is an autoimmune disease that causes the body's immune system to attack the lining of the joints. It often starts in smaller joints, such as those found in the hand and wrist 2. Rheumatoid arthritis can cause tendon rupture, leading to deformity and loss of function in the hand 2. Early surgical intervention may be more likely to be successful in treating rheumatoid arthritis of the hand and wrist 3.
  4. Psoriatic arthritis is a form of arthritis that affects people with psoriasis, a skin condition.

The symptoms of hand and wrist arthritis can vary depending on the type of arthritis and the severity of the condition. Common symptoms include:

  1. Pain
  2. Stiffness
  3. Swelling
  4. Warmth
  5. Redness
  6. Decreased range of motion
  7. Weakness
  8. Clicking or crackling sounds when the joint moves
  9. Carpal tunnel syndrome (numbness or tingling in the wrist) 1

There is no cure for arthritis 2, but there are a number of treatments that can help manage the symptoms and improve quality of life. Treatment options include conservative measures, such as splinting, occupational therapy, and injections, as well as surgical procedures, such as joint fusion, joint replacement, and tendon transfer.

Conservative Treatment Options

Conservative treatment options are often the first line of treatment for hand and wrist arthritis. These treatments can help to relieve pain, reduce inflammation, and improve joint function. Conservative treatment options include:

Activity Modification

One of the first steps in managing hand and wrist arthritis is to limit activities that worsen your pain 2. This may involve avoiding repetitive motions or heavy lifting.

Splinting

Splints are devices that are worn to support and protect the joints. Splints can be helpful for people with hand and wrist arthritis by:

  1. Resting the joint
  2. Providing support
  3. Reducing pain
  4. Improving joint alignment
  5. Lessening strain on the joint 5

There are two main types of splints: resting splints and working splints 6. Resting splints are worn at night or during rest periods to help reduce inflammation and pain 6. Working splints are worn during activities to support the joints and reduce pain 6.

Occupational Therapy

Occupational therapy can help people with hand and wrist arthritis to learn new ways to do everyday tasks that may be difficult because of their arthritis. Occupational therapists can also teach people how to protect their joints from further damage.

Occupational therapy can help with hand and wrist arthritis by:

  1. Providing advice on using your joints without straining them
  2. Providing splints to support your joints while working or resting
  3. Helping with choosing tools and equipment to help with your activities, including assistive devices 7
  4. Teaching techniques to help with planning your activities, pacing yourself, and relaxation
  5. Providing exercises to improve hand and wrist strength and mobility
  6. Providing advice on driving, mobility problems, and/or home adaptations if needed
  7. Providing support to help with work activities
  8. Providing fatigue management advice 7

Pain Medications

Pain medications can be used to relieve the pain and inflammation associated with hand and wrist arthritis.

  1. Over-the-counter pain relievers , such as ibuprofen and naproxen, can be helpful for mild to moderate pain 8.
  2. Topical pain relievers , such as creams and gels, can also be helpful 9.
  3. For more severe pain, your doctor may prescribe stronger pain medications, such as opioids 8.
  4. Other medications that may be used to treat hand and wrist arthritis include corticosteroids (oral or injected) and biologic agents 8.

Hot and Cold Packs

Applying hot and cold packs to the affected joints can help to reduce pain and swelling 1. Cold packs can help to numb the pain and reduce inflammation. Heat packs can help to relax the muscles and increase blood flow to the area.

Contrast Soaks

Contrast soaks involve alternating between soaking the affected hand or wrist in warm and cold water. This can help to reduce swelling and improve circulation 2.

Injections

There are two main types of injections that may be used to treat hand and wrist arthritis: corticosteroid injections and hyaluronic acid injections.

Corticosteroid Injections

Corticosteroid injections are injections of a steroid medication into the joint. Corticosteroids are powerful anti-inflammatory medications that can help to reduce pain and swelling. Corticosteroid injections are often used for people who have not responded to other conservative treatments.

Cortisone shots might be most effective in treating inflammatory arthritis, such as rheumatoid arthritis 10. However, there is a risk of a "flare" after a cortisone shot, where the pain may get worse for 1 to 2 days before the steroid takes effect 11.

Hyaluronic Acid Injections

Hyaluronic acid is a natural substance that is found in the fluid that lubricates joints. Hyaluronic acid injections can help to replace the lost hyaluronic acid in the joints and reduce pain and stiffness. Hyaluronic acid injections are most commonly used for people with osteoarthritis.

Hyaluronic acid injections, also called viscosupplementation, help replace the lubricant lost to breakdown in osteoarthritis 12. Different brands have different dosing schedules, usually one injection per week for three or five weeks 12.

Platelet-Rich Plasma (PRP) Injections

Platelet-rich plasma (PRP) injections are a newer treatment option for hand and wrist arthritis. PRP is made from your own blood and contains a high concentration of platelets, which are cells that help with healing. PRP injections may help to reduce pain and inflammation and promote healing 1.

Surgical Procedures

Surgical procedures are usually considered for people with hand and wrist arthritis who have not responded to conservative treatments. Surgical procedures can help to relieve pain, improve joint function, and correct deformities. Surgical procedures for hand and wrist arthritis include:

Joint Fusion

Joint fusion is a surgical procedure in which the bones in a joint are fused together. This procedure can eliminate pain, but it also eliminates movement in the joint. Joint fusion is typically used for people with severe arthritis who have a lot of pain and limited range of motion.

During the procedure, the surgeon removes the damaged cartilage and then uses pins, plates, or screws to hold the joint in a permanent position 2. Bone grafts may also be used to help the bones fuse together 13. In some cases, the surgeon can perform a partial fusion, in which just some of the bones are fused together. This addresses the damaged joint surfaces but leaves the healthy joints intact to preserve some wrist motion 2.

Joint Replacement

Joint replacement is a surgical procedure in which the damaged joint is replaced with an artificial joint. This procedure is typically used for people with severe arthritis who want to maintain movement in the joint. Joint replacement can relieve pain and improve joint function, but it is a more invasive procedure than joint fusion.

Patient selection for wrist replacement surgery is very important to ensure a good outcome 14. There is also a possibility of tendon rupture as a complication of joint replacement surgery 15.

Tendon Transfer

Tendon transfer is a surgical procedure in which a tendon is moved from one part of the hand to another. This procedure is typically used for people who have lost function in a tendon due to arthritis or injury. Tendon transfer can help to restore function to the hand. Tendon transfer surgery is often a last resort after other treatments have failed 16.

Tendon transfer involves moving a functioning tendon from its original attachment to a new one to restore the action that has been lost 17. The time from rupture to surgery should be considered when performing a tendon transfer 17. In some cases, tendon grafts can be used as an alternative to tendon transfer 17.

Synovectomy

Synovectomy is a surgical procedure in which the inflamed lining of the joint (synovium) is removed. This procedure is typically used for people with rheumatoid arthritis. Synovectomy can help to reduce pain and swelling. The procedure may be performed by open surgery or arthroscopic surgery 3.

Synovectomy is not a permanent solution for rheumatoid arthritis, as the inflammation can return 18.

Tenosynovectomy

Tenosynovectomy is a surgical procedure in which the inflamed lining of the tendon sheath (tenosynovium) is removed. This procedure is typically used for people with rheumatoid arthritis or other inflammatory conditions that affect the tendons. Tenosynovectomy can help to reduce pain, swelling, and tendon weakness 3.

Risks and Benefits of Treatment Options

Each treatment option for hand and wrist arthritis has its own risks and benefits. It is important to discuss the risks and benefits of each treatment option with your doctor to determine which treatment is right for you.

Procedure Benefits Risks
Splinting Reduces pain, rests the joint, supports the joint, improves joint alignment, lessens strain on the joint 5 Skin irritation, pressure sores, nerve compression 19
Occupational therapy Improves function, reduces pain, protects joints, helps with choosing assistive devices 7 May not be effective for all people 20
Pain medications Relieves pain 8 Side effects, such as stomach upset, drowsiness, and addiction 21
Corticosteroid injections Reduces pain and inflammation 10 Cartilage damage, joint infection, tendon weakening, pain flare 10
Hyaluronic acid injections Reduces pain and stiffness 12 Pain, swelling, and stiffness at the injection site 12
Joint fusion Eliminates pain, improves stability 22 Loss of mobility, risk of nonunion 22
Joint replacement Relieves pain, restores movement 23 Implant loosening, infection, nerve damage, tendon rupture 23
Tendon transfer Restores function 17 Infection, bleeding, nerve damage 24
Synovectomy Reduces pain and swelling 18 Infection, stiffness 25
Tenosynovectomy Reduces pain, swelling, and tendon weakness 3 Postoperative adhesions 26

Recovery Process

The recovery process for hand and wrist arthritis treatment varies depending on the treatment option. Conservative treatments, such as splinting and occupational therapy, typically have a shorter recovery time than surgical procedures.

  1. Splinting: Recovery time for splinting may take 6+ months 27.
  2. Occupational therapy: Recovery time for occupational therapy may take up to 3 months 28.
  3. Pain medications: Recovery time for pain medications may take 3 to 5 days 29.
  4. Corticosteroid injections: Recovery time for cortisone shots may take 24 hours to a week 30.
  5. Joint fusion: Recovery time for joint fusion may take 3 to 12 months 31.
  6. Joint replacement: Recovery time for joint replacement may take 6 to 12 weeks 32.
  7. Tendon transfer: Recovery time for tendon transfer may take 1 to 2 months 17.
  8. Synovectomy: Recovery time for synovectomy may take 3 to 6 weeks 33.

After surgery, you will need to follow your doctor's instructions carefully to ensure proper healing. You may need to wear a splint or cast for several weeks, and you may need to participate in physical therapy to regain strength and range of motion.

Conclusion

Hand and wrist arthritis can be a painful and debilitating condition. However, there are a number of treatments that can help manage the symptoms and improve quality of life. These treatments range from conservative measures, such as splinting and occupational therapy, to surgical procedures, such as joint fusion and joint replacement. Each treatment option has its own set of benefits and risks. It is important to work with your doctor to develop an individualized treatment plan that is right for you, taking into account your specific needs and circumstances. Medical studies have shown that early intervention and appropriate treatment can significantly improve outcomes for people with hand and wrist arthritis. If you are experiencing symptoms of hand and wrist arthritis, it is important to seek medical attention to discuss your treatment options.

Works cited

1. Arthritis in Wrist: Causes, Types, Prevention & Treatment - Cleveland Clinic, accessed February 17, 2025, https://my.clevelandclinic.org/health/diseases/21595-arthritis-in-wrist

2. Arthritis of the Wrist - OrthoInfo - AAOS, accessed February 17, 2025, https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-of-the-wrist/

3. Hand and Wrist Surgery for Rheumatoid Arthritis (RA) - WebMD, accessed February 17, 2025, https://www.webmd.com/rheumatoid-arthritis/hand-wrist-surgery-rheumatoid-arthritis

4. Wrist Arthritis Treatment - Penn Medicine, accessed February 17, 2025, https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/orthopaedics/hand-and-wrist-pain/arthritis-in-hand-and-wrist-treatment/wrist-arthritis-treatment

5. Daily Living - Splints And Braces - Arthritis Society Canada, accessed February 17, 2025, https://arthritis.ca/support-education/online-learning/daily-living/splints-and-braces

6. Splints | Uses - Versus Arthritis, accessed February 17, 2025, https://versusarthritis.org/about-arthritis/treatments/splints/

7. Occupational Therapy | Benefits for daily life - Versus Arthritis, accessed February 17, 2025, https://versusarthritis.org/about-arthritis/treatments/therapies/occupational-therapy/

8. Arthritis of the Hand: Symptoms, Types & Treatments - Cleveland Clinic, accessed February 17, 2025, https://my.clevelandclinic.org/health/diseases/7082-arthritis-of-the-wrist-and-hand

9. Hand and Wrist Arthritis Medications | Arthritis Foundation, accessed February 17, 2025, https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/hand-and-wrist-arthritis-medications

10. Cortisone shots - Mayo Clinic, accessed February 17, 2025, https://www.mayoclinic.org/tests-procedures/cortisone-shots/about/pac-20384794

11. Cortisone Shot (Steroid Injection) - OrthoInfo - AAOS, accessed February 17, 2025, https://orthoinfo.aaos.org/en/treatment/cortisone-shot-steroid-injection/

12. Joint Injections for Arthritis Pain, accessed February 17, 2025, https://www.arthritis.org/health-wellness/treatment/treatment-plan/disease-management/joint-injections-for-arthritis-pain

13. Hand, Wrist and Elbow Arthritis Surgery | OrthoVirginia, accessed February 17, 2025, https://www.orthovirginia.com/hand-wrist-and-elbow-arthritis-surgery/

14. Wrist Joint Replacement - Shoulder Arthroscopy Folsom CA, accessed February 17, 2025, https://www.folsomortho.com/wrist-joint-replacement-orthopaedic-surgery-ca.html

15. Arthroplasty of the Digits or Wrist, Replacement Surgery - Tampa General Hospital, accessed February 17, 2025, https://www.tgh.org/institutes-and-services/treatments/arthroplasty-of-the-digits-and-wrist

16. Approaches for Hand Arthritis Surgery - The Orthopaedic Hand and ..., accessed February 17, 2025, https://www.orthohandandarm.com/approaches-for-hand-arthritis-surgery/

17. Tendon Transfer Surgery - Massachusetts General Hospital, accessed February 17, 2025, https://www.massgeneral.org/orthopaedics/hand/conditions-and-treatments/tendon-transfer-surgery

18. Arthroscopic synovectomy of the wrist - Archives of Hand and Microsurgery, accessed February 17, 2025, https://www.handmicro.org/journal/view.php?number=2475

19. Private Hand & Wrist Splinting (Custom) - Circle Health Group, accessed February 17, 2025, https://www.circlehealthgroup.co.uk/treatments/hand-and-wrist-splinting

20. Occupational therapy for rheumatoid arthritis - PMC, accessed February 17, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7017227/

21. Medications for Arthritis Pain Relief: Risks and Benefits - WebMD, accessed February 17, 2025, https://www.webmd.com/osteoarthritis/oa-pain-relief-risks-benefits

22. Joint fusion - arthrodesis - Melbourne Hand Surgery, accessed February 17, 2025, https://melbournehandsurgery.com/other/33-hands/other/245-joint-fusion-arthrodesis

23. Joint Replacement Surgery For Hands, Wrists, & Elbows In Dallas, accessed February 17, 2025, https://handandwristinstitute.com/joint-replacement-hands/

24. Tendon Transfer Surgery Overview | Hand & Upper Extremity Center, accessed February 17, 2025, https://www.advancedreconstruction.com/hand-upper-extremity/procedures/tendon-transfer-surgery

25. Synovectomy for Synovitis: Arthroscopic or Open Surgery - HSS, accessed February 17, 2025, https://www.hss.edu/conditions_synovectomy.asp

26. Hand and Wrist Surgery in Rheumatoid Arthritis - Medscape Reference, accessed February 17, 2025, https://emedicine.medscape.com/article/1287449-overview

27. Thumb Arthritis - Hand & Wrist Treatment in Muskegon & Grand Haven, MI | Orthopaedic Associates of Muskegon, accessed February 17, 2025, https://www.oamkg.com/specialties/hand-wrist/thumb-arthritis-wrist.html

28. Physical or Occupational Therapy in Cleveland for Wrist Pain - Osteoarthritis, accessed February 17, 2025, https://www.therapy-specialists.com/Injuries-Conditions/Wrist/Wrist-Issues/Osteoarthritis-of-the-Wrist-Joint/a~380/article.html

29. Pain Medications After Orthopaedic Surgery - OrthoInfo - AAOS, accessed February 17, 2025, https://orthoinfo.aaos.org/en/recovery/managing-pain-with-medications/

30. Do You Need To Rest After A Cortisone Injection? - HSSH, accessed February 17, 2025, https://hssh.health/blog/do-you-need-to-rest-after-a-cortisone-injection/

31. What is a wrist fusion? - OrthoIndy Blog, accessed February 17, 2025, https://blog.orthoindy.com/2020/09/01/what-is-a-wrist-fusion/

32. Hand Arthritis Treatment Seattle | Wrist Arthritis Bellevue, WA - Dr Wayne Weil, accessed February 17, 2025, https://www.seattlehandandelbow.com/arthritis-of-hand-wrist-hand-wrist-surgeon-seattle-bellevue-wa.html

33. Synovectomy, Tendon Sheath, Radical (Tenosynovectomy), Flexor Tendon, Palm and or Finger, each Tendon - St George Surgical Center, accessed February 17, 2025, https://www.stgeorgesurgical.com/procedure/synovectomy-tendon-sheath-radical-tenosynovectomy-flexor-tendon-palm-andor-finger-tendon/