The anatomy of the wrist and hand joint is extremely complex, probably the most complex of all the joints in the body. These joints and bones let us use our hands in many ways. The wrist must be extremely mobile to give our hands a full range of motion. At the same time, the wrist must provide the strength for heavy gripping. The metacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to the phalanges, which are the bones in the fingers and thumb.
The main reason that the wrist and hand are so complicated is because every small bone forms a joint with the bone next to it.
Ligaments connect all the small wrist, hand and finger bones to each other. Ligaments also connect the bones of the wrist with the radius and ulna (arm bones).
Articular cartilage is the smooth, rubbery material that covers the bone surfaces in most joints. It protects the bone ends from friction when they rub together as the joint moves. Articular cartilage also acts sort of like a shock absorber. Damage to the articular cartilage leads to osteoarthritis.
Pain is the main symptom of osteoarthritis of any joint. At first, the pain comes only with activity. Most of the time the pain lessens while doing the activity, but after stopping the activity the pain and stiffness increase. As the condition worsens, you may feel pain even when resting. The pain may interfere with sleep. The joints may be swollen and may fill with fluid and feel tight, especially after use. When all the articular cartilage is worn off the joint surface, you may notice a squeaking sound when you move your wrist and hand. Surgeons call this creaking crepitus. Osteoarthritis eventually affects the wrist, hands or fingers' movement resulting in stiffness.
In almost all cases, surgeons try nonsurgical treatment first. Surgery is usually not considered until it has become impossible to control your symptoms. The goal of nonsurgical treatment is to help you manage your pain and use your wrist and hand without causing more harm.
Your surgeon may recommend non-steroidal anti-inflammatory drugs (NSAIDs), such as Aspirin and Ibuprofen, to help control swelling and pain. Other treatments, such as heat, may also be used to control your pain.
Physiotherapy has a critical role in the treatment plan for osteoarthritis.
A steroid injection of cortisone (a powerful anti-inflammatory medication) into the joint can give temporary relief. It can very effectively relieve pain and swelling. Its effects are temporary, usually lasting several weeks to months.
If the pain becomes unmanageable, you may need to consider surgery. There is no single surgery for arthritis of the wrist, hand or fingers. Which one is right for you depends on your underlying problem, how much of the joint is involved, and how you need to use your wrist, hand or fingers.
If you have advanced osteoarthritis that affects most of the wrist, your surgeon will probably suggest a wrist fusion or an artificial wrist joint. If you have advanced osteoarthritis that affects your hands, fingers and thumbs your surgeon may consider fusions, bone excision surgery or joint replacements.