Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. It may result from a un-united or mal-united fracture of the scaphoid or distal radius; disruption of the wrist ligaments; avascular necrosis of the carpus; or a developmental abnormality. Whatever the cause, subsequent abnormal joint loading produces a spectrum of symptoms, from mild swelling to considerable pain and limitations of motion as the involved joints degenerate. A meticulous clinical and radiographic evaluation is required so that the pain-generating articulation can be identified and eliminated.
Frequently, patients with wrist osteoarthritis can be helped by nonsurgical means. The use of splint or cast immobilization, nonsteroidal anti-inflammatory medications, and selective intra-articular injections of
corticosteroids may provide patients with improved function and decreased pain.
In many patients with more advanced disease, however, the pain relief granted by nonsurgical methods is limited.
The goal of performing surgery for such a patient is to eliminate the pain associated with the arthritic joint while trying to preserve as much motion as possible in the adjacent joints by maintaining congruity between the undamaged articular surfaces of the wrist. In the most severe cases of arthritis, which involve the entire carpus and distal radius, a total wrist arthrodesis has traditionally been required.