Roughly a quarter of American adults have arthritis, an inflammatory condition that progressively degrades the cartilage that protects your bones from rubbing against each other in your joints. Over time, the bones wear away, causing pain, stiffness, and limited mobility in the joints.

Wrist arthritis is a condition that affects the joints in your wrist, causing pain, stiffness, and swelling. Arthritis can develop in the wrist due to aging, overuse, or injury to the joint. The symptoms of wrist arthritis can make it difficult to perform daily activities such as typing, writing, or gripping objects. Treatment options for wrist arthritis include pain relief medication, physical therapy, and the use of splints or braces. In some cases, surgery may be necessary to relieve pain and restore mobility to the wrist joint.

In some cases, arthritis of the wrist can progress and develop into different conditions, including scaphoid nonunion advanced collapse and scaphoid lunate advanced collapse. Patients with a history of wrist injury may also develop Kienbock’s disease, which can progress into wrist arthritis.

Not all wrist arthritis conditions require surgery, but it’s important to meet with a qualified hand surgeon to talk about your treatment options and help manage symptoms.

Scaphoid Nonunion Advanced Collapse

Progressive wrist arthritis may present with a specific pattern called scaphoid nonunion advanced collapse. This pattern is associated with chronic scaphoid nonunion and is diagnosed when a patient has progressive wrist pain, wrist instability, and imaging indicating scaphoid fracture nonunion along with arthritis in the radioscaphoid joint. A signature feature of scaphoid nonunion advanced collapse is degenerative changes in the radioscaphoid area, followed by pancarpal and midcarpal arthritis. Symptoms include weakness, reduced grip strength, stiffness, loss of wrist mobility, and localized tenderness.

Scaphoid nonunion advanced collapse is classified in three stages, with stage 3 being the most severe. Early on, the condition is usually observed and managed non-operatively with rest, anti-inflammatory medications, steroid injections, and splinting. Based on how severe your wrist osteoarthritis is, your hand surgeon can recommend a variety of surgical treatment options, including:

• Radial Styloidectomy: Resection of a portion of the distal radius (forearm bone), along with reduction and stabilization of the scapholunate.
• Proximal Row Carpectomy: Removal of several small carpal bones to relieve painful impingement and arthritis.
• Partial Wrist Arthrodesis: Removal of the scaphoid bone, and fusion of the lunate, capitate, hamate, and triquetrum bones with a metal plate to provide stability to the wrist.
• Total Wrist Arthrodesis: Fusing the radius (forearm bone) to the metacarpal bone of the middle finger with a metal plate.

Scaphoid Lunate Advanced Collapse

Scaphoid lunate advanced collapse is another pattern associated with wrist degenerative osteoarthritis. Patients with this condition have dissociation between their scaphoid and lunate in the wrist, causing them to have wrist stiffness, progressive hand weakness, localized tenderness, and difficulty bearing weight. Your hand surgeon will perform a physical examination and may order x-rays to confirm the diagnosis and evaluate staging.

In mild cases, the condition can be managed with anti-inflammatory medications, wrist splinting, and corticosteroid injections. Scaphoid lunate advanced collapse is classified in three stages, with stage 3 being the most severe. Based on how severe your wrist osteoarthritis is, your hand surgeon can recommend a variety of surgical treatment options, including:

• Radial Styloidectomy: Resection of a portion of the distal radius (forearm bone).
• Denervation of the Posterior and Anterior Interosseous Nerves: The posterior and anterior interosseous nerves provide sensation. Severing these nerves can provide pain relief without impairing movement.
• Proximal Row Carpectomy: Removal of several small carpal bones to relieve impingement and create a new wrist joint surface.
• Partial Wrist Arthrodesis: Removal of the scaphoid bone, and fusion of the lunate, capitate, hamate, and triquetrum bones with a metal plate to provide stability to the wrist.
• Total Wrist Arthrodesis: Fusing the radius (forearm bone) to the metacarpal bone of the middle finger with a metal plate.

Kienbock’s Disease

Kienbock’s disease occurs when the lunate collapses due to a lack of blood supply, often following injury to the hand and wrist. This leads to progressive wrist pain and abnormal carpal motion in the wrist. Late-stage Kienbock’s disease can cause the wrist to become arthritic. Patients with Kienbock’s disease often have wrist pain during activity, swelling, localized tenderness, reduced range of motion, and loss of grip strength.

Early on, the condition may be managed non-operatively with splinting, rest, and anti-inflammatory medications. If the condition progresses to stage I, II, or III, then your hand surgeon may suggest surgical treatment options.

Medical Review: This procedural information has been medically reviewed by plastic and reconstructive surgeon, Brian A. Cripe, M.D.