Treatment For Osteoarthritis In The Wrist

Your Wrist Is Much More Complex Than You Might Think...

The Short Answer

Once diagnosed with wrist osteoarthritis, you will need to create a plan focused on finding the best combination treatment for osteoarthritis in the wrist.

This will involve painkilling treatments, therapies to increase your wrist’s mobility and strength training to halt the progress of your osteoarthritis.

In this article, we review all your potential options for wrist osteoarthritis…

Finding The Right Solution For You

The wrist is a complicated joint to treat, partly due to the complex structure of joints and their biomechanics (Kijima et al, The Journal of Hand Surgery). 

On the face of it, advanced wrist osteoarthritis is likely to leave you largely unable to use you hand or your fingers normally.

And although it isn’t weight bearing, it is a complex ‘joint’ actually comprising a number of small joints that are all highly susceptible to osteoarthritis.

It is also used a lot in activities that we carry out, even though we hardly notice it – but you soon do if you develop osteoarthritis in your wrist.

Whether it be lifting heavy loads, playing sports, cooking dinner or just texting friends on your phone… You may not realise it, but you are using your wrist.

When considering treatment for osteoarthritis in the wrist, self-management is normally enough, because your wrists are not weight bearing and so the progress of osteoarthritis is typically slower.

Unfortunately, the flipside is that when the progress is slow, sufferers of wrist pain often don’t see it as potential arthritis – or if they do, they put it aside as ‘just one of those things’. The earlier you get it diagnosed, the greater the chance of successfully halting its progression and managing the symptoms.

So catching the development of osteoarthritis early is key, but once you’ve done that – what next?

Well, the next step is to put together a treatment plan that involves a variety of treatments, as discussed below, and see which work and which don’t.

Not everything will work for everyone, but to achieve the best treatment for osteoarthritis in the wrist, you need to put together a range of successful options.

The good news is that we now understand much more about how osteoarthritis is caused and therefore how best to treat it. As summed up (in technical terms) by Akhondi et al in ‘StatPearls’ –https://www.ncbi.nlm.nih.gov/books/NBK531497/

“Osteoarthritis, a disease previously thought to be due to wear and tear, has more complex pathogenesis. Some of the factors involved are biomechanical factors, proteases like several matrices metalloproteinases (MMPs), cysteine proteinases, serine proteinases, and proinflammatory cytokines.”

This much wider understanding is important because, in years gone by, osteoarthritis was considered to be purely about wear and tear and so treatment focused mainly on painkillers for relief.

Now we know it is the entire joint matrix, with all the supporting muscles, tendons and ligaments.

This offers more treatment options and the chance that, while osteoarthritis can never be cured, it’s progress can be halted to a large extent.

Between all the potential treatments selected, you need to achieve the three key goals with osteoarthritis – relieve the pain, improve the mobility and increase the strength of the joint.

If you achieve all three of these goals, then not only will you slow the development of your osteoarthritis (sadly there is no cure), but also regain as much or your normal life as possible.

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Potential Treatments – Medications

Over-The Counter Medications…

  1. Acetaminophen/ Paracetamol (depending on where you are based, they are the same drug). This is normally an easy rescue medication for an extra dose of pain relief. They are very safe, but unlikely to be effective with more advanced osteoarthritis pain.
  2. NSAIDs. Some ‘non steroidal anti-inflammatory drugs’ are available over the counter. These include Ibuprofen and Naproxen and offer a higher level of pain relief, albeit with some risks. NSAIDs work by reducing inflammation in the effected joint and therefore reducing the pain overall.
  3. Capasaicin Cream. This is another option for a more localised approach. Capsaicin cream can be rubbed in to your wrist directly to apply a direct dose of pain relief. Other pain relieving creams are available.

Prescribed Drugs…

In more advanced cases of wrist osteoarthritis, your family doctor may need to look at different options. These include –

  1. Even stronger NSAIDs known as Cox2 inhibitors. Some of these were withdrawn from the market, but celebrex still exists in most countries.
  2. Opioids. Well known for providing powerful pain relief for patients just waking up from serious surgery or for end-of life patients, these are increasingly being prescribed for conditions such as chronic pain and fully developed arthritis (the dangers remain though)

2. Lifestyle Changes

  • Try An Anti-Inflammatory Diet
  • Lose Weight
  • Exercise Regularly

Try An Anti-Inflammatory Diet.

Knowing (as we do now), that osteoarthritis is not just about wear and tear, but also about the supporting joint structures, then anything you can do to remove inflammation is a good thing.

The effectiveness of NSAIDs rely on reducing inflammation, but there is considerable evidence that an anti-inflammatory diet can have a similar effect.

Even if you adopted 50% of an anti-inflammatory diet, then it is likely to some potential impact on your pain levels, by reducing the inflammation.

Lose Weight.

This may seem strange advice, but it’s not about reducing the load on your joints (as it might be for your knee), but rather that overweight people have a proven tendency to promote inflammation.

By losing weight you can actually reduce you’re the level of inflammation in all your joints, including your wrist, which can help treat the pain.

Exercise.

There aren’t any specific exercises for wrist osteoarthritis, but it is vital that you keep moving your wrist as much as possible.

It may hurt, but simply putting your wrist in a splint forever will only further weaken the surrounding joint matrix and lead to even more developed osteoarthritis.

3. Self-Administered Treatments

Hot And Cold Therapy…

Cold therapy for your wrist is particularly good at reducing the inflammation that will be causing much of your pain. In this context it can provide great pain relief.

Most athlete will then also follow this up with a hot wrap to soothe sore muscles around your joint and promote healing in your supporting tendons/ ligaments.

Self-Hypnosis…

The brain is an exceptionally powerful tool when controlling pain. Without your brain , you wouldn’t feel pain in the 1st place, as it is your brain that transmits signals from injured areas and turns these into the pain you feel.

Knowing this, it is perhaps no surprise that the power of hypnosis can be turned to your advantage with the right direction.

Instead of tricking people into thinking they are naked on stage, self hypnosis could convince your brain into reducing the levels of pain you feel.

The evidence is strong and compelling – providing you go into it with an open mind.

Aromatherapy…

Aromatherapy is another strong pain relieving treatment, with evidence around it’s use for osteoarthritis that often gets over-looked because people consider to be left-field.

The reality is the use of essential oils (aromatherapy) was the 1st medicine before we had todays’ drugs and many of the tablets that we rely on actually contain extracts of the same plants.

Furthermore, many of the oils with painkilling or anti inflammatory properties (such as lavender oil) also come in topical creams that can be applied locally to your wrist.

The side effect profile is virtually nil, proving you follow guidance and they can be taken to fit your lifestyle, giving aromatherapy a lot of advantages.

Cognitive Behavioural Therapy…

It the context of wrist arthritis, this will involve looking at activities that arthritis has perhaps now stopped you from doing and working out a plan to start them again.

This involves taking the bigger problem and breaking it down in to a series of smaller ‘tasks’ that are achievable.

The theory is that by doing this you not only give yourself a chance to achieve something that, as one big challenge seemed impossible – but you also greatly improve your focus and acceptance of working through your condition.

When it comes to your wrist, this could be any challenge from learning to play snooker again to managing to paint a picture again.

Acupuncture…

By piercing certain nerves/ ligaments in the wrist, acupuncturists claim to be able to restart the healing process or block off pain messages to the brain.

Fish Oil…

Fish oil has been proven to have many benefits for the human body. One of these is it’s ability to lubricate your joints.

Extra lubrication will help prevent the painful rubbing of bone on bone caused by osteoarthritis and reduce the inflammation that also causes additional pain.

Supportive Aids…

Wrist supports can provide vital added strength – providing they actually do offer support and transfer the load and mobility flex away from your wrist to your forearm or hand.

Other supporting aids such as special cutlery for arthritis sufferers will help you flex your wrist less and special jar openers/ cupboard openers will make daily tasks that bit easier too.

4. Physiotherapy

Physiotherapy for wrist osteoarthrititis will work on maintaining the maximum level of mobility available in your wrist – while building up strength in your supporting muscles to make your wrist stronger.

There are a range of different exercises that your physiotherapist can help you with to develop further strength in your wrist. Exercise and particularly strengthening exercises are one of the best ways to slow down the development of your osteoarthritis.

5. Injections

Steroid Injections

Cortisone injections can be guided in to your wrist and will offer pain relief with a high degree of success, that may last for up to a couple of months.

6. Wrist Surgery

Wrist surgery is normally a final resort for the more advanced cases of wrist osteoarthritis. In many cases, your surgeon may book you in for a ‘wrist arthroscopy’ first.

This is an investigative procedure that involves your surgeon inserting a camera into your wrist under anesthetic. This will give them a much clearer idea of any damage to the surrounding ‘matrix’ of your joint including the ligaments and tendons.

From there your hand surgeon will have 3 basic options available –

  • Wrist Fusion
  • Wrist Replacement
  • Carpectomy

Wrist Fusion

Wrist Fusion works really well for advanced cases of osteoarthritis.

There are two basic options – ‘limited fusion’ and ‘total fusion’.

Limited fusion is ideal when the affected area in your wrist is relatively small. Surgeons can join together just a few bones of your wrist, supporting the damaged bones but still providing some limited mobility.

Total fusion, as the name suggests, fuses the entire wrist by inserting a plate across your wrist and literally screwing your wrist bones to it. The mobility of your wrist will be completely lost – but if you suffer with severe osteoarthritis, then it will provide pain relief as well as a strong (albeit fixed) joint.

Wrist Replacement

Wrist replacements are similar in some ways to hip or knee replacements, even if they are conducted less frequently. The advantage over wrist fusion is that you still have a working joint, albeit an artificial joint.

The disadvantage is that the replacements will wear out over time, making them not an ideal option for younger or active people. You will also have the challenge of finding a surgeon, since not all hand surgeons are happy to perform replacement surgery.

Carpectomy

A carpectomy involves the removal of small bones. The benefit is it can remove one or two troublesome bones, without damaging the mobility of the wrist too much.

A ‘proximal row carpectomy removes 3 small wrist bones. This can be a much better option for anyone that might not be the best natural candidate for wrist fusion, perhaps because they smoke or live a generally unhealthy life – either of which will increase either chances of complications causing the fusion to fail.

The Final Word –

Hopefully, the information above has given you a really good start to forming a treatment plan.

Unfortunately, there is no actual data comparing the effectiveness of surgery with that of non-surgical treatments (Dean et al, F1000 Research), but surgery is only used as a last resort because it is likely to considerably reduce the flexibility in your wrist.

As a result, the first line of treatments almost always involves painkillers and a range of self-administered treatments. Increasingly, painkillers are also being phased out, due to concerns over the damage caused by long-term use.

Don’t be afraid to try a treatment for a month or more and then move on if it doesn’t work for you.

Even if it does, it is still worth trying other options too – the best treatment for your wrist osteoarthritis will consist of a range of treatments in combination.

But give each one a period of a month or so before changing anything – enough that you can make a fair assessment of how effective it’s been for you.

Pain is very much a subjective response – what works for one person, will not necessarily work for someone else, which is why trialing several treatments is key.

Apply this principle and you should find the best treatment for the osteoarthritis in your wrist.

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References Used –

1. Yasumu Kijima, MD and Steven F. Viegas, MD, PhD. (Oct 2009). Wrist Anatomy and Biomechanics. The Journal of Hand Surgery
2. Hossein Akhondi; Sreelakshmi Panginikkod. (July 2020). Wrist Arthritis. StatPearls.
3. Benjamin Dean, Shwan Henari, Neal Thurley, Chris Little, Ian McNab, Nicholas Riley. (Dec 2018). Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis. F1000 Research.

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