10 Osteoarthritis of the Wrist and Hand

Brittany Homcha and Kenneth F. Taylor

Abstract

Osteoarthritis of the wrist and hand involves progressive destruction of articular cartilage and associated subchondral bony changes including sclerosis, cystic degeneration, and osteophyte formation. Inflammation is not a significant aspect of this process. Onset is often insidious in nature and thought to be age and wear related. Initial treatment modalities include patient education, joint preservation, splint wear, and other physical modalities including therapy, corticosteroid injection, and nonsteroidal anti-inflammatory medications. Surgical options include osteotomy, soft tissue interposition, joint arthrodesis, and arthroplasty.

Osteoarthritis – hand – wrist – joint – arthrodesis – arthroplasty

10 Osteoarthritis of the Wrist and Hand

I. Distal Interphalangeal Joint

A. Background

Highest prevalence of osteoarthritis (OA) in the hand; ¹ commonly accompanied by Heberden’s nodes and mucus cysts (► Fig. 10.1 and ► Fig. 10.2).

**Fig. 10.1** Posteroanterior (PA) radiograph demonstrating distal interphalangeal joint osteoarthritis.

**Fig. 10.2** Lateral radiograph demonstrating distal interphalangeal joint osteoarthritis.

B. Surgical Treatment

Mucous cyst excision: Osteophytes must be excised or mucus cysts will recur.
Arthrodesis: Biomechanical studies demonstrate comparative performance between K-wire fixation (parallel or crossed) and compression screw fixation. ²
- Union rates for headless compression screw approaches 94% (► Fig. 10.3 and ► Fig. 10.4). ³

**Fig. 10.3** Posteroanterior (PA) radiograph of distal interphalangeal joint arthrodesis with headless compression screw.

**Fig. 10.4** Lateral radiograph of distal interphalangeal joint arthrodesis with headless compression screw.

II. Proximal Interphalangeal Joint

A. Background

More common in women; favors dominant hand; accompanied by Bouchard’s nodes.

B. Appearance

May be erosive or nonerosive with abrupt symptom onset of pain, erythema, and loss of joint function along with instability more common with the former; indolent onset more frequently encountered with nonerosive.

C. Radiographs

Central joint degeneration and edge proliferation suggestive of erosive arthritis (► Fig. 10.5 and ► Fig. 10.6).

**Fig. 10.5** Posteroanterior (PA) radiograph demonstrating proximal interphalangeal joint osteoarthritis.

**Fig. 10.6** Lateral radiograph demonstrating proximal interphalangeal joint osteoarthritis.

D. Conservative Treatment

Patient education, anti-inflammatory medications, injection.

E. Surgical Treatment

Arthrodesis: Degree of flexion increases from radial to ulnar (40-55 degrees).
Arthroplasty: Multiple material options exist for arthroplasty including silicone, pyrocarbon, and metal-polyethylene.

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