Abstract
Arthritis of the wrist is a common complaint that can cause significant pain and suffering. The wrist joint is susceptible to the development of arthritis from various conditions that have in common the ability to damage joint cartilage. Patients with arthritis of the wrist present with pain, swelling, and decreasing function of the wrist. Decreased grip strength is also a common finding. Osteoarthritis is the most common form of arthritis that results in wrist joint pain. However, rheumatoid arthritis, posttraumatic arthritis, and psoriatic arthritis are also common causes of arthritic wrist pain. These types of arthritis can result in significant alteration in the biomechanics of the wrist because they affect not only the joint but also the tendons and other connective tissues that make up the functional unit.
Most patients presenting with wrist pain secondary to osteoarthritis or posttraumatic arthritis complain of pain that is localized around the wrist and hand. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination. If the pain and dysfunction are secondary to rheumatoid arthritis, the metacarpophalangeal joints are often involved, with characteristic deformity.
Keywords
osteoarthritis, rheumatoid arthritis, gout, intra-articular injection wrist, ultrasound guided injection, diagnostic ultrasonography, wrist pain, septic arthritis, psoriatric arthritis
ICD-10 CODE M19.90
Keywords
osteoarthritis, rheumatoid arthritis, gout, intra-articular injection wrist, ultrasound guided injection, diagnostic ultrasonography, wrist pain, septic arthritis, psoriatric arthritis
ICD-10 CODE M19.90
The Clinical Syndrome
Arthritis of the wrist is a common complaint that can cause significant pain and suffering. The wrist joint is susceptible to the development of arthritis from various conditions that have in common the ability to damage joint cartilage. Patients with arthritis of the wrist present with pain, swelling, and decreasing function of the wrist. Decreased grip strength is also a common finding. Osteoarthritis is the most common form of arthritis that results in wrist joint pain. However, rheumatoid arthritis, posttraumatic arthritis, and psoriatic arthritis are also common causes of arthritic wrist pain. These types of arthritis can result in significant alteration in the biomechanics of the wrist because they affect not only the joint but also the tendons and other connective tissues that make up the functional unit.
Signs and Symptoms
Most patients presenting with wrist pain secondary to osteoarthritis or posttraumatic arthritis complain of pain that is localized around the wrist and hand. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination. If the pain and dysfunction are secondary to rheumatoid arthritis, the metacarpophalangeal joints are often involved, with characteristic deformity.
In addition to pain, patients suffering from arthritis of the wrist joint often experience a gradual reduction in functional ability because of decreasing wrist range of motion that makes simple everyday tasks such as using a computer keyboard, holding a coffee cup, turning a doorknob, or unscrewing a bottle cap quite difficult ( Fig. 49.1 ). With continued disuse, muscle wasting may occur, and adhesive capsulitis with subsequent ankylosis may develop.
Testing
Plain radiographs are indicated in all patients who present with wrist pain ( Fig. 49.2 ). Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing. Magnetic resonance and/or ultrasound imaging of the wrist is indicated if joint instability is thought to be present, as well as to further characterize the causes of pain and functional disability ( Figs. 49.3 and 49.4 ). If infection is suspected, Gram stain and culture of the synovial fluid should be performed on an emergency basis, and treatment with appropriate antibiotics should be started.
