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Updated: May 20 2021

Wrist Arthritis

Images arthritis.jpg arthritis.jpg arthritis.jpg head replacement.jpg
  • Summary
    • Various forms of wrist arthritis based on location
      • SLAC wrist (scapholunate advanced collapse)
        • most common
      • STT arthrosis
        • second most common
      • SNAC (scaphoid nonunion advanced collapse)
      • DRUJ arthrosis
      • Pisotriquetrial arthrosis
  • Etiology
    • Mechanism
      • degenerative
        • primary OA
      • posttraumatic
        • leads to SLAC/SNAC/DRUJ
      • inflammatory
        • Rheumatoid arthritis
      • congenital
        • may be secondary to Madelung's deformity
      • idiopathic
        • may secondary to Kienbock's or Preiser's disease
    • Pathoanatomy
      • SLAC
        • Injury to SL ligament --> palmar rotary subluxation of scaphoid --> incongruency of joint surfaces --> arthrosis of radiocarpal joint --> arthrosis of capitolunate joint
        • radiolunate typically spared
      • SNAC
        • proximal portion of scaphoid remains attached to lunate while distal scaphoid flexes
        • leads to early arthritis between radial styloid and distal scaphoid
        • like SLAC, radiolunate typically spared
      • Rheumatoid arthritis
        • wrist becomes supinated, palmarly dislocated, radially deviated, and ulnarly translocated
        • early disruption of DRUJ leads to dorsal subluxation of ulna (Caput-ulna)
  • Anatomy
    • Wrist ligaments and biomechanics
  • Imaging
    • Radiographs
      • obtain standard hand series with additional views to visualize specific joints
      • pisotriquetral joint (pisotriquetral arthrosis) obtain lateral in 30 degrees of supination
  • Treatment
    • Nonoperative
      • NSAIDs, bracing, intra-articular steroid injections
        • indications
          • first line of treatment for mild to moderate symptoms
    • Operative
      • aimed at addressing diseased area
        • SLAC
        • SNAC
        • Pisotriquetrial arthritis
          • excision of pisiform in refractory cases
        • DRUJ abutment syndrome & arthrosis
          • distal ulna resection (Darrach procedure)
          • Sauv√©-Kapandji procedure
          • partial ulna resection and interposition
          • ulnar head replacement
            • can be used as primary procedure, or as salvage for failed Darrach
            • early results are promising, long-term results pending
        • Rheumatoid arthritis
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