Arthrosis of the wrist joint: symptoms and treatment

The wrist joint is one of the complex joints and has more than two articular surfaces. It differs from most other joints, because it involves 5 bones (and not 2-3, as, for example, in the knee or interphalangeal joints). In addition, the wrist joint has two axes of rotation rather than one. This allows you to move the brush in all directions and even rotate it in a circle.

Such a complex mechanism ideally adapts human hands to work and life associated with many small manipulations. Therefore, failure of this joint often leads to disability and loss of ability to work. What are the symptoms and treatment of arthrosis of the wrist joint?

Specifics of the degenerative process in the wrist joint

The fragile wrist joint is located between the hand and forearm and, due to its location, is susceptible to injury (for example, from a fall). In everyday life, it experiences less functional load than, say, the knee joint, but its joint capsule is thinner. Therefore, the joint is vulnerable to even minor damage.

Cases of arthrosis of the wrist joint due to natural abrasion of cartilage are extremely rare. Therefore, in the absence of injuries or work stress, the likelihood of contracting it is low.

Types of radial fractures

The most common situation is a fracture of the beam in a typical location. This is a violation of the integrity of the distal part involved in the formation of the wrist joint. The radius is not strong, and the weakest point is the styloid process.

Rice. 2 a, b. X-rays show different types of fractures of the styloid process and the distal radius.

When struck or dropped from a height, the radius bone is damaged in the middle section or near the elbow.

If the integrity of the skin is not broken, then the fracture of the ray is called closed; with an open injury, a wound is formed. This type of injury can damage muscles, blood vessels and nerves, and increases the risk of infection.

Based on the degree of integrity violation, a radius fracture, a fracture, and a crack are distinguished. In case of a fracture, the area of damage affects no more than 50% of the diameter of the beam, in case of a crack - more than half, in case of fractures there is a complete violation of the integrity of the beam. Fractures and cracks occur in children.

In children, there is a special type of injury - subperiosteal, or green branch type. The inner part of the bone is damaged, but the periosteum remains intact.

Displaced ray fracture

There are injuries with displacement of bone fragments and without displacement. An injury with displacement of fragments to the palmar side is called a Smith fracture, and to the back - a Colles fracture. If there is displacement, reposition and stabilization of the bone fragments is necessary; if this procedure is performed incorrectly, the function of the hand will not be restored.

Fig.3 a. Schematic representation of the Colles and Smith fracture; b. X-rays show a fracture of the diaphysis of the radius and ulna in c/3 with displacement.

Fracture of the ulna and radius

More often there is a violation of the integrity of both bones of the forearm in the diaphyseal part; this occurs with a strong blow. A fall can cause damage to the proximal portion of both bones. Such injuries are unstable, often accompanied by the presence of multiple fragments and a violation of their position. The victim experiences severe pain and deformity of the limb is noted.

Causes of arthrosis of the wrist

Arthrosis of the wrist joint can be either a primary (idiopathic) or a secondary disease. In the first case, we have a healthy joint that changes due to adverse external influences - injury or occupational stress. In the second, there is an underlying disease (gout, diabetes, rheumatoid arthritis and others), which leads to degenerative changes in the cartilage.

Among the factors that influence the development of arthrosis of the wrist joint, it is worth mentioning:

excessive load and injuries - sports, household, professional (for example, when working with a vibrating tool);
hypothermia;
advanced inflammatory pathologies in the joint or periarticular tissues;
endocrine and metabolic disorders and autoimmune diseases;
past infections (reactive arthritis, tuberculosis, osteomyelitis and others);
female;
heredity (affects collagen synthesis, cartilage density, anatomical structural features).

Trauma is the most common cause of the disease. In this case, symptoms of cartilage destruction may not appear immediately, but after several years.

Osteoarthritis of the wrist often begins due to arthritis of the wrist joint and proceeds in parallel with it. Age factors have little effect on the development of wrist arthrosis. Although menopausal hormonal changes in women can affect the strength of cartilage tissue.

Most often, osteoarthritis of the wrist joint is observed in builders, craftsmen working in factories and in the finishing of premises, office employees, as well as professional athletes (especially in the presence of dislocations and subluxations, fractures, ruptures and sprains of ligaments or muscles).

At-risk groups

In principle, each of us may need treatment for the wrist joint, which will restore the hands to their former mobility, the ability to lift your own child, pet a dog, or easily perform professional duties. But for some people, the risk of becoming semi-disabled (and sometimes completely) for a long time is much higher. These include:

those who are engaged in heavy physical labor , where the load falls mainly on the hands. For example, rowers, loaders, lumberjacks;
office workers - from secretaries to programmers. Here the risks even increase, since many of these employees work in non-design conditions. For example, the ratio of the height of the table and the chair is not observed, and excess pressure is constantly placed on the wrists;
athletes whose hands are actively and constantly working - badminton players, tennis players, boxers (the latter are at greatest risk in terms of injuries and bruises of the wrist joint);
people whose profession requires constant use of fine motor skills . These include seamstresses and lacemakers; signers of dishes, eggs, cups; musicians, especially those who play stringed instruments and those who work with the piano.

Treatment of the wrist joint may also be required for ordinary people - those who cannot imagine life without playing online games. Spending a lot of time at the computer, such people have to make a huge number of monotonous movements with the hand, which seriously overload the radial joint. At a certain stage, this approach to one’s own hands turns into acute illnesses that turn into chronic forms.

Signs of arthrosis of the wrist joint

In the early stages, arthrosis rarely makes itself felt. Key signs of arthrosis of the wrist joint are observed already in osteoarthritis - when the destructive process proceeds to the heads of the bones. The disease begins with discomfort in the wrist area, a feeling of tightness, and mild pain. The sensations are somewhat reminiscent of sore throat.

It is characteristic that signs of arthrosis of the wrist joint are observed only in this joint, while other rheumatic diseases seem to “move” from one joint to another, affecting several at the same time.

If the following symptoms appear, you should contact a rheumatologist as soon as possible:

pain in the joint, especially after physical activity on the wrist, stress, dehydration;
difficulty in movement, which increases as the disease progresses (a feeling as if something is preventing you from moving your arm freely);
encircling swelling of the wrists, swelling of the hand (optional, but a characteristic symptom);
a rough crunch in the joint (instead of the normal light click, a dull sound appears, which is accompanied by tension).

The pain intensifies when carrying heavy objects, even holding them suspended for a short time, trying to lean on the palm, or stretching the hand. It is typical that it is felt in extreme positions for the joint (bending the hand) or during specific movements. If after an injury, inflammatory symptoms in the joint are observed for more than 2-3 weeks, this may also be a symptom of the onset of the disease.

At first, stiffness in movements may go away after warm baths and warm-up. Over time, mobility decreases by 30-50%. When cartilage wears away and exposes the surface of the subchondral bones, osteophytes appear. They significantly impede movement in the wrist - especially when trying to rotate the hand. Small fragments of osteophytes sometimes cause acute pain and severe inflammation in patients.

The presence of osteophytes can usually only be determined using an x-ray. But the patient can recognize it by the following manifestations:

limited range of motion in the joint;
frequent uncontrollable spasms, especially when moving the hand;
On palpation, hard subcutaneous lumps are revealed.

Pain due to osteoarthritis of the wrist should be distinguished from arthritic pain. With arthritis, pain intensifies at rest, closer to night, in the morning. With osteoarthritis, on the contrary, in the daytime - during everyday activity.

Deformation of the wrist joint during the disease is usually absent, as is severe swelling. The characteristic “thinning” of the limb due to muscle atrophy is also characteristic of wrist arthritis rather than arthrosis.

Symptoms of the disease

What is the characteristic of styloiditis of the wrist joint?

aching pain in the wrist area, which can extend to the elbow or hand;
increased discomfort in the joint when moving the thumb or hand, at night or when weather conditions change;
if the cause was injury, pain is felt even if you just touch your hand;
the appearance of all signs of inflammation - redness, swelling, increased temperature;
the joint crunches when moving;
the tendon tightens and becomes hard;
decreased sensitivity, including pain;
problems with fine motor skills and finger movements, difficulty grasping and holding objects;
fingers become numb, tingling or burning may be felt;
muscle tone and strength deteriorate.

Degrees and stages of arthrosis of the wrist joint

The progression of carpal arthrosis is slow - before treating wrist arthrosis, the patient may not be aware of the disease for ten years. During the course of the disease, the cartilage becomes soft, its regeneration process is disrupted, and the synovial fluid loses its viscosity and is produced in ever smaller quantities. Depending on the severity of the lesions, the following stages of the disease are distinguished.

Arthrosis of the wrist joint 1st degree

The destructive process begins with mild pain in the wrist, which periodically bothers the patient - mainly after heavy exertion. They are not so intense that patients attach importance to them. The sensations with arthrosis of the wrist joint of the 1st degree resemble aching pain - like “the weather”. There is slight swelling and other symptoms of deterioration of tissue trophism, and occasionally a soft crunching sound is heard.

At this stage, the symptoms and treatment of wrist arthrosis are tolerated quite easily.

Arthrosis of the wrist joint 2nd degree

At this stage, the cartilage is almost completely destroyed on the supporting surfaces. The first bone growths appear, clearly visible on x-rays, and a clear narrowing of the joint space. Sometimes osteophytes can be felt independently. The pain becomes noticeable, almost daily. When moving, the patient hears a distinct crunching sound. Your hands get tired faster than before. Full recovery from grade 2 arthrosis of the wrist joint is no longer possible, but treatment greatly improves the patient’s quality of life and maintains mobility in the joint.

Arthrosis of the wrist joint grade 3

Stiffness in the wrist imposes significant restrictions on patients in daily life. Ultimately, ankylosis develops - complete immobility of the joint, in fact its fusion, since the edges of the osteophytes close. Pain with advanced osteoarthritis of the wrist joint bothers the patient even at rest, after rest. The curve of your arm may look unnatural. At the third stage, only surgical treatment is possible. It is not possible to completely restore mobility even after surgery.

Please note: the less developed the muscles around the affected joint, the faster the disease progresses. A healthy muscular system maintains the natural position of the joint, provides it with nutrition, and protects it from damage.

In a hopeless situation

In case of purulent inflammation of the wrist joint, drainage is placed, and in most cases this is enough for recovery. However, in some cases this technique does not produce results. And under other circumstances, with different diagnoses, conservative treatment may be ineffective. If remission is incomplete, and relapses are too frequent, if joint degradation progresses, surgical intervention is required. During the operation, the sheaths of the inflamed tendons are excised; in the case of hygroma, the capsule of the neoplasm is excised or it is burned out with a laser. Treatment is carried out under local anesthesia. After the operation, a tight bandage is required, and in some cases, immobilization of the hand. Sutures are removed between the fifth and seventh day after the intervention. Typically, the postoperative period requires injection of antibiotics.

For the final rehabilitation of the wrist joint, physiotherapeutic procedures will be required: mud applications, paraffin therapy, electrophoresis, ozokerite and laser exposure. Exercises will be prescribed aimed at restoring full mobility of the hand and developing the joint itself. Limiting the load on the affected arm can last for quite a long time.

Take care of your hands, and you will never need treatment for your wrist joint. But if you already feel discomfort from your hands, please go for an examination so as not to lose the ability to self-care and not be left without work.

Diagnosis of arthrosis of the wrist joint

Symptoms of osteoarthritis of the wrist are similar to other rheumatic diseases. Therefore, to make an accurate diagnosis, the doctor requires the following studies:

oral questioning of the patient, palpation and examination of the affected joint at the initial appointment;
x-ray (2 or 3 projections);
general blood test and, if necessary, urine;
biochemical blood test according to indications;
rheumatic factor analysis;
Ultrasound, computed tomography or magnetic resonance imaging as indicated;
Occasionally, a puncture may be necessary to assess synovial fluid.

Modern approach to treatment

Whatever the treatment, it is very important to eliminate the provoking factors at the start - joint overload, repeated microtraumas and injuries. For this purpose, it is recommended to use special fixing bandages or orthopedic wristbands during physical work, and, if necessary, to temporarily abandon potentially dangerous professional activities.

Arthrosis of the hands develops in those who perform monotonous movements

Treatment of osteoarthritis of the wrist joint

The treatment strategy is selected by the doctor individually for each case, taking into account the causes of the disease, its stage, the general health of the patient, and other things.

The standard approach to the treatment of arthrosis of the wrist joint stage 1-2 includes:

pharmacotherapy;
physiotherapy;
therapeutic exercises;
a healthy diet and daily routine;
compliance with the orthopedic regimen.

At stage 3, the decision to operate is usually made.

Treatment of arthrosis of the wrist joint occurs in stages. At the first stage, the acute symptoms of the disease - pain and inflammation - are “extinguished”. The second requires complex treatment. And the third involves rehabilitation of the patient to consolidate the effect after the main course.

Due to the difficulties in daily activities caused by joint dysfunction, physical discomfort is accompanied by psychological discomfort. It can be one of the factors in the development of depression, so patients are recommended to visit a psychologist and rehabilitation specialist.

Please note that osteoarthritis of the wrist joint is a chronic disease that requires lifelong adherence to the doctor’s recommendations.

Pharmacotherapy

In the treatment of arthrosis of the wrist joint, the following pharmacological groups are used:

non-hormonal anti-inflammatory drugs (NSAIDs, NSAIDs) - courses up to 21 days;
glucocorticosteroids;
chondroprotectors;
vasodilators;
muscle relaxants;
vitamin and mineral complexes;
if the disease is infectious - antibiotics

They are used in the form of tablets and capsules, ointments, gels, compresses and intra-articular injections.

Self-medication of wrist arthrosis can lead to worsening of the condition and problems with the gastrointestinal tract. Before using all drugs (except ointments and gels for topical use), you must consult a doctor.

Tablets for osteoarthritis of the wrist joint

To relieve inflammation, pain and heat in case of arthrosis of the wrists, the following tableted NSAIDs are recommended: diclofenac, celecoxib, ibuprofen, piroxicam, ketoprofen, indomethacin, meloxicam, nimesulide, butadione and others.

To prevent further cartilage degeneration, the doctor may prescribe chondroprotectors: artracam, teraflex, structum and others.

During the rehabilitation period, drugs are used to improve tissue trophism (pentoxifylline, trental) and muscle relaxation (mydocalm, tizalud).

If pain cannot be eliminated with tablets, injections are added to the prescription: methylprednisolone, diprospan, hydrocortisone.

Ointments for osteoarthritis of the wrist

Non-steroidal ointments and creams for external use are widely used as aids in the treatment of osteoarthritis of the wrist joint. For example, fastum gel, dollit, voltaren, diclak gel, ketoprofen. Chondroprotectors are also produced in these dosage forms - artracam, structum, rumalon.

Surgical treatment of arthrosis of the wrist joint

Surgical treatment of arthrosis of the wrist is indicated for stage 3 of the disease and in cases where other methods are ineffective.

Preference is given to plasma lifting and endoprosthetics of synovial fluid - minimally invasive manipulations. They involve the injection of the patient's blood plasma or hypoallergenic polymers that act as a lubricant directly into the joint capsule. This helps relieve pain and inflammation and prevent erosion for up to 24 months.

If this approach does not work, it is possible to implant a pyrocarbon prosthesis that simulates cartilage. It is not attached to the proximal bones, and therefore does not become loose and can be used even with severe damage to the articular surfaces.

If it is not possible to preserve or replace the joint, doctors resort to the last resort of orthopedic surgery - partial arthrodesis with the implantation of a titanium plate. During this operation, the destroyed joint is completely immobilized. So at least the patient will not be bothered by constant pain and inflammation.

Physiotherapy for osteoarthritis of the wrist

To relieve pain, improve microcirculation and mobility with wrist arthrosis, the following techniques are used:

manual therapy;
medicinal, incl. acupressure;
post-isometric relaxation;
hirudotherapy;
infrared laser therapy;
magnetic therapy;
cryotherapy;
electrophoresis;
ultrasound therapy;
electromyostimulation;
paraffin therapy;
balneotherapy (therapeutic mud);
other.

Physiotherapeutic treatment of arthrosis of the wrist joint is carried out in courses.

Therapeutic exercises (physical therapy) for osteoarthritis of the wrist

Therapeutic exercise for osteoarthritis of the wrist is designed to consolidate the results of therapy, prevent further erosion and help the patient lead a full life.

The volume and types of exercises are determined by the exercise therapy instructor on an individual basis. Exercises (for example, pinch-spread of the indicated fingers, rotation of the forearm while fixing the wrist with the healthy hand) are performed 2-3 times a day as a warm-up and do not require special equipment. Exercises with a ball are advisable.

Nutrition for osteoarthritis of the wrist

Maintaining a healthy diet while treating wrist osteoarthritis is easy. It is necessary to exclude salty foods from the diet, which lead to dehydration, and also include in the diet dishes rich in vitamin A (antioxidant, chondrocyte growth), C (cell protection, collagen synthesis), E (protects cartilage from free radicals and aging), B5 and B6 (regeneration, relieve inflammation), copper (improves cellular “respiration” of cartilage), selenium (for the production of synovial enzymes), as well as collagen, chondroitin and glucosamine (building material for cartilage tissue). To do this, eat fish, meat and bone broths, jellied meat, fruit jellies, animal cartilage, wheat germ and other healthy foods.

Recovery

Recovery is aimed at returning motor activity and joint functions. Rehabilitation mainly consists of performing gymnastics, therapeutic exercises, and also establishing a balanced nutrition system. Wearing fixing bandages and bandages to speed up the restoration of cartilage tissue also gives good results.

To prevent deforming osteoarthritis and other similar diseases - maintain normal body weight, avoid heavy loads, and be attentive to changes in health.