Wrist Arthritis (Including SLAC, SNAC, and DRUJ Arthritis)

What it is

Wrist arthritis is loss of the smooth cartilage between the wrist bones. It can involve the joint between the forearm and the wrist bones (radiocarpal), the joints between the two rows of small wrist bones (midcarpal), or the joint between the radius and ulna (DRUJ), which causes pain when turning the palm up or down.

What causes it

• Wear and tear: degenerative arthritis, often without a clear reason
• Inflammatory arthritis: such as rheumatoid arthritis, usually managed with a rheumatologist
• Previous injury: fractures into the joint, such as distal radius and scaphoid fractures, and ligament tears such as the SL ligament and TFCC

SLAC wrist (scapholunate advanced collapse) and SNAC wrist (scaphoid nonunion advanced collapse) are predictable patterns of arthritis that follow an untreated SL ligament tear or a scaphoid fracture that did not heal.

Symptoms

Pain, swelling, and stiffness that may come and go when mild and become constant when severe.

Diagnosis

An examination and X-rays, which show narrowing between bones and bone spurs. MRI or CT is occasionally used to look at the pattern of arthritis or the ligaments.

Treatment

Without surgery: rest, a splint, over-the-counter medication, avoiding aggravating activities, and steroid injections for temporary relief.

Surgery: smaller procedures include denervation, removing the nerves to the painful joint. It does not cause numbness of the skin and recovery is simple, but it is often not a permanent solution. Larger procedures remove one or more of the small wrist bones or fuse some or all of the wrist bones together. Total wrist replacement is an option for some patients. The right choice depends on your pattern of arthritis, age, and activity level, and is a decision you make together with your surgeon.