Wrist osteoarthritis
Degenerative cartilage wear affecting the wrist joints, most often secondary to previous injury (scaphoid non-union, scapholunate ligament injury) rather than primary osteoarthritis. Causes pain, stiffness and reduced grip strength.
📊 Primary wrist osteoarthritis is much less common than at other joints. Most symptomatic wrist arthritis is post-traumatic, particularly following untreated scaphoid fractures or scapholunate ligament injuries (SLAC and SNAC wrist patterns).
What is wrist osteoarthritis?
The wrist is made up of eight small bones (the carpus) that connect the end of the radius to the bases of the fingers. Cartilage covers the surfaces where these bones meet each other and the radius. In wrist osteoarthritis the cartilage thins and wears, and the joints stiffen and become painful. Unlike the hip or knee, true primary wrist arthritis is uncommon, most cases follow a previous injury, particularly a scaphoid fracture that did not heal, or a torn ligament between the scaphoid and lunate bones.
The pattern of wear is predictable. After a scapholunate ligament injury, wear progresses in a sequence known as SLAC (scapholunate advanced collapse). After a scaphoid non-union, the pattern is called SNAC (scaphoid non-union advanced collapse). Both progress through recognisable stages and guide treatment decisions. Other causes include rheumatoid arthritis, kienbock disease (lunate avascular necrosis), and previous distal radius fractures.
Treatment depends on which part of the wrist is affected and how active the patient is. Importantly, certain key joints (the radiolunate joint) tend to be spared until very late, which makes many "partial" surgical options possible, including fusion of just part of the wrist (limited intercarpal fusion) or removal of the diseased proximal carpal row.
Common causes
- Old scaphoid fracture that failed to heal (SNAC wrist)
- Old scapholunate ligament injury (SLAC wrist)
- Previous distal radius fracture extending into the joint
- Rheumatoid arthritis and other inflammatory arthritides
- Kienbock disease (lunate avascular necrosis)
- Primary osteoarthritis (uncommon at the wrist)
Who is at risk? Previous wrist injury is by far the most important risk factor, particularly unrecognised scaphoid fractures and scapholunate ligament injuries in young adults. Inflammatory arthritis and heavy manual occupations also increase risk.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Aching pain in the wrist with use, often poorly localised
- Stiffness, particularly in the morning
- Reduced grip strength and difficulty with twisting tasks
- Swelling around the wrist
- A grinding or crepitus on movement
- Reduced wrist extension is usually the first movement to be lost
When to seek help: See your GP or hand specialist if wrist pain is persistent, if grip is becoming weak, or if you have a known old wrist injury that is now becoming symptomatic. Early diagnosis is important as targeted "salvage" operations can preserve some movement and prevent further wear.
How is it diagnosed?
Your hand surgeon will take a detailed history and examine the hand and wrist. The following investigations may be arranged to confirm the diagnosis:
- Clinical examination, tenderness, grind, range of movement, grip strength
- Plain X-rays, standard views plus stress views to look for ligament injury
- MRI or CT, assesses cartilage and bone in detail
- Arthroscopy, sometimes used to grade cartilage wear directly
- Assessment for inflammatory arthritis if multiple joints affected
Identifying the pattern of wear (SLAC, SNAC, pan-carpal, radiolunate sparing) is critical because it determines which surgical options are available. A specialist hand surgeon should review imaging before any operative decision is made.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Splinting and activity modification
A wrist splint worn during aggravating activities offloads the joint and reduces pain. Adaptive grips, lever-style tools, and avoidance of heavy gripping all help. Pain-management input is often valuable.
Corticosteroid injection
An ultrasound-guided injection into the affected part of the wrist provides several months of pain relief in many patients and can be repeated. Particularly useful for radiocarpal or midcarpal arthritis.
Partial wrist fusion or proximal row carpectomy
If the radiolunate joint is preserved, options include a four-corner fusion (with scaphoid excision), capitolunate fusion, or proximal row carpectomy, all of which keep some wrist movement at the cost of grip strength. The choice depends on the pattern of disease.
Total wrist fusion or replacement
For pan-carpal disease, total wrist fusion gives reliable, durable pain relief at the cost of all wrist movement, rotation is preserved. Total wrist replacement preserves movement but is less durable, and reserved for older, low-demand patients.
Recovery
Recovery after wrist surgery is prolonged. Partial fusions and proximal row carpectomy preserve about 60% of normal wrist movement and around 80% of grip strength. Total fusion eliminates wrist movement but most patients adapt remarkably well, and forearm rotation is preserved.
- Splint and injection trial: several months
- After partial fusion, cast: 6 weeks
- Hand therapy and strengthening: 3-6 months
- Full recovery: 6-12 months
What results can I expect?
Outcomes depend on the pattern of disease and the procedure chosen. Pain relief is reliable across all options. Patients who choose joint-preserving surgery accept some risk of progression of wear; patients who choose fusion accept loss of movement in exchange for durability.
Hand therapy guide
Phased exercise programme, key precautions, and what to expect from rehabilitation for this condition.
How is it diagnosed?
- ✓Clinical examination, tenderness, grind, range of movement, grip strength
- ✓Plain X-rays, standard views plus stress views to look for ligament injury
- ✓MRI or CT, assesses cartilage and bone in detail
- ✓Arthroscopy, sometimes used to grade cartilage wear directly
- ✓Assessment for inflammatory arthritis if multiple joints affected
Recovery milestones
- •Splint and injection trial: several months
- •After partial fusion, cast: 6 weeks
- •Hand therapy and strengthening: 3-6 months
- •Full recovery: 6-12 months