Osteoarthritis of the Hand and Wrist

Essentials

• Other causes of joint swelling must be distinguished from osteoarthritis.
• In its management, it is essential to educate the patient about the condition, and for the patient to reduce strain on the affected joints, to exercise independently, possibly to wear supports and to use sufficient analgesic medication.
• If the patient continues to suffer unduly from pain at rest, restricted movement or instability despite appropriate conservative treatment, surgical options should be considered.

Definition and aetiology

• Primary osteoarthritis of the hand occurs most often in certain joints 1.
  • In fingers, primary osteoarthritis occurs most commonly in DIP joints but also in PIP joints.
  • Primary osteoarthritis occurs in the MCP joint of the thumb, but it is rare in MCP joints of other fingers.
  • Primary osteoarthritis of the proximal thumb joint, or CMC I joint, is very common.
• Most cases of osteoarthritis of the wrist occur around the scaphoid bone. This is probably due to the central role of the scaphoid bone in the stability and loading of the wrist.
• In the wrist, osteoarthritis may occur:
  • between carpal bones
  • in the joint between the carpal bones and the radius (radiocarpal joint)
  • in the joint between the carpal bones and the ulna (ulnocarpal joint)
  • in the joint between the radius and the ulna (distal radioulnar joint or DRUJ).
• Factors predisposing to primary osteoarthritis
  • Ageing
  • Female sex
  • Heredity
  • Recurrent, long-term work or movements straining the hands or wrists
  • Hormonal and dietary causes, circulatory failure and recurrent microtrauma have also been discussed as possible aetiological factors.
• Secondary osteoarthritis may develop in any joint after trauma or infection, for example.
• Differential diagnosis
  • Various types of arthritis and connective tissue disorders (such as rheumatoid arthritis, psoriatic arthropathy, SLE, scleroderma, gout)
  • Anomalies (bone anomalies, accessory carpal bones)
  • Avascular necrosis of carpal bones (lunatomalacia, or Kienböck's disease Lunatomalacia (Kienböck's Disease), or Preiser's disease of the scaphoid)

Symptoms and diagnosis

• Signs and symptoms of osteoarthritis
  • At the early stage, pain and swelling
  • As the disease progresses, restricted movement and instability of the joint
  • Fluctuation is characteristic; there may be joint symptoms for a few weeks or months, which may then subside even for a long time.
  • No general symptoms or heat of the joint, such as may occur in rheumatoid arthritis, for example.
• Plain X-ray 2
  • Joint space narrowing
  • Subchondral sclerosis and cystic changes
  • Osteophytes
  • Radiological findings do not always correlate with the symptoms.
• At a later stage, the joint may be deformed due to callus formation (osteophytes). In the fingers, such changes are called Heberden's (distal joints) or Bouchard's (proximal joints) nodes.
• DIP osteoarthritis may be associated with a mucous cyst with passage of synovial fluid into the joint (Image 3).
• As osteoarthritis progresses, the joint may gradually spontaneously become stiffer, which will alleviate the symptoms.

Treatment