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.
10 Osteoarthritis of the Wrist and Hand
I. Distal Interphalangeal Joint
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
II. Proximal Interphalangeal Joint
More common in women; favors dominant hand; accompanied by Bouchard’s nodes.
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.
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.