Wrist Joint Arthritis

What is Wrist Joint Arthritis?

Arthritis is an inflammation of the joint. Inflammation of the wrist joint is known as Wrist joint Arthritis. Joint arthritis involves inflammation of the end bones, joint cartilages and synovial membrane.

Wrist Joint Arthritis

What Is A Wrist Joint?

Wrist joint is a link between carpal bones, radius and ulna. Smooth and spongy cartilages cover end of bones of the joint. A thin membrane called synovium covers and encloses joint. Synovial membrane produces lubricant or slippery fluid, which is collected within joint cavity covered by synovium. The fluid helps to create a smooth joint movement.

What Makes Joint Stable?

Joint is stable because of strong ligaments that hold the bones together. Ligaments are tough fibrous tissue, which is anchored to proximal and distal bone. Muscles and tendons also support joint to maintain joint stability.

Describe The Types Of Wrist Joint Arthritis?

Types of Wrist Joint Arthritis Are As Follows-

What is Osteoarthritis of Wrist Joint?

Osteoarthritis of the wrist joint is an inflammatory disease that involves inflammation of wrist joint cartilage. Inflammation wears down the cartilages of the joint and eventually bone lies on bone. Prolonged inflammation also damages soft tissues like tendon, ligaments and synovium within the joint.

What is Rheumatoid Wrist Joint Arthritis?

Rheumatoid arthritis is an autoimmune inflammatory joint disease. Rheumatoid arthritis specifically affects synovium. Synovium surrounds joint by enclosing cartilages, ligaments and bone. Synovial membrane also supplies nourishment to surrounding soft tissue by infiltration of its blood vessels. Inflamed synovial membrane secretes excessive fluid resulting in joint swelling and effusion. In severe cases joint is dislocated.

What is Septic Wrist Joint Arthritis?

Septic arthritis is infected wrist joint with abscess filled within the joint. Germs transmitted through blood infect wrist joint and surrounding soft tissue causing cellulitis. Septic arthritis is also caused by local spread of germs from cellulitis or penetrating wound.

What is Psoriatic Wrist Joint Arthritis?

Psoriatic Wrist Joint Arthritis is seen in patients suffering with skin lesion of psoriasis. Patient has skin rashes and multiple joint pains. Joint pain is secondary to inflammatory joint disease. Inflammation of the cartilages, tendon, ligament and synovium causes severe pain in wrist joint.

What is Wrist Joint Gout?

Gout is very rare in wrist joint and is seen mostly in big toe. Gout is a sudden severe attack of joint pain, associated with redness and tender joint. Gout is caused by increased uric acid in blood resulting in joint inflammation caused by uric acid deposit over synovium, tendon and ligaments.

What is Wrist Joint Pseudogout?

Pseudogout is often seen in knee joint. Pseudogout is very rare in wrist joint. Calcium pyrophosphate deposits in the joint causes Pseudogout. The crystals of calcium pyrophosphate are deposited over tendon, ligaments and synovial membrane. Calcium deposits are also observed over cartilages.

Describe The Symptoms Of Wrist Joint Arthritis?

Common symptoms observed in wrist joint arthritis are as follows-

  • Chronic Pain
  • Muscle Spasm
  • Tingling
  • Numbness
  • Morning Stiffness

Wrist Joint Arthritis

What Is Chronic Wrist Joint Pain Caused By Wrist Joint Arthritis?

Wrist Pain lasting more than 3 to 6 months is considered as chronic wrist joint pain. Joint pain is also known as Arthralgia. Pain is localized over wrist joint and surrounding tissue. Pain is of lesser intensity at rest and severe with wrist joint movements.

What Are The Different Causes And Characteristics Of Wrist Joint Pain?

Characteristics and Causes of Chronic Wrist Joint Pain Are As Follows-

Pain at Rest-

  • Mild- Osteoarthritis and Rheumatoid Arthritis.
  • Moderate- Psoriatic Arthritis and Pseudo Gout.
  • Severe – Gout, Pseudogout and Psoriatic Arthritis.

Pain with Activities-

  • Mild- Rheumatoid Arthritis.
  • Moderate- Osteoarthritis, Rheumatoid Arthritis and Psoriatic Arthritis.
  • Severe – Gout, Pseudogout and Psoriatic Arthritis.

Cyclic Pain-

  • Pain is on and often severe and mild in following wrist joint arthritic diseases.
  • Gout, Pseudogout and Psoriatic Arthritis.

Why Are Symptoms Of Occasional Tingling And Numbness Associated With Wrist Joint Arthritis?

Symptoms of tingling and numbness suggest either nerve is irritated or pinched. Radius, ulnar and median nerve passes along the wrist joint. Deformity, inflammation and swelling of the wrist joint caused by rheumatoid arthritis, osteoarthritis or septic arthritis results in pinched or irritation of the nerve.

What Is Morning Wrist Joint Stiffness?

Morning stiffness of the wrist is observed in patients suffering with osteoarthritis. Patients often have difficulty moving wrist in the morning because of increased pain or stiffness. Symptoms are observed in patients suffering with osteoarthritis.

Describe The Signs Of Wrist Joint Arthritis?

  • Swelling and Joint Deformity
  • Muscle Weakness
  • Joint Stiffness
  • Painful Joint Movement

What Is Wrist Joint Deformity?

Deformity of the Wrist joint is observed in almost all types of wrist joint arthritis.

Causes Of Deformity Of The Wrist Is As Follows-


  • Hypertrophy of the bones.
  • Osteophytes of the bones of the wrist joint.

Rheumatoid Arthritis

  • Hypertrophy Of Synovial Membrane.
  • Hypertrophy of Tendon.
  • Increased Secretions Of Synovial Fluid In The Joint.

Psoriatic Arthritis

  • Hypertrophy and thickening of synovial membrane.
  • Hypertrophy of tendon.
  • Osteophytes.


  • Hypertrophy and thickening of synovial membrane.
  • Inflammatory hypertrophy of tendon.
  • Secretion of synovial fluid in the joint.


  • Hypertrophy and thickening of synovial membrane.
  • Inflammatory hypertrophy of tendon.
  • Secretion of synovial fluid in the joint.

What Are the Causes of Wrist Joint Weakness Seen Wrist Joint Arthritis?

Causes of Wrist Joint Weakness Are As Follows

  • Hand or forearm muscle atrophy or wastage as a result of minimum use of the muscles because of pain.
  • Patient is often reluctant to move the joint. Long term passive joint immobility results in stiffness of the joint ligament and tendons.
  • In rare cases, muscle weakness is secondary to motor nerve injury or irritation of the nerve lying along the wrist joint resulting in muscle paralysis.

Why is Wrist Joint Movement Painful in Wrist Joint Arthritis?

Wrist joint movement is often painful in wrist joint arthritis. Severe wrist joint pain is because of inflammation of tendon, ligament and synovial membrane.

How Is Wrist Joint Arthritis Diagnosed?

Wrist Joint Arthritis Is Diagnosed By Following Test-

  • Radiological studies- like X-ray, CAT Scan and MRI.
  • Ultrasound Studies.
  • Blood Examinations.
  • Arthrocentesis.

Describe The Radiological Studies Performed To Diagnose Wrist Joint Arthritis?

X-Ray of Wrist Joint Helps Identify the Following Findings:-

  • Irregular broken cartilage linings of radius and ulna bone.
  • Wrist joint space is narrowed.
  • Bone spurs around edges of the joint are observed.

MRI Of The Wrist Joint Helps Identify The Following Findings:-

  • Joint cartilages are uneven as seen in osteoarthritis and psoriatic arthritis.
  • Joint space is narrowed, mostly observed in osteoarthritis and psoriatic arthritis.
  • Excess joint synovial fluid is seen in patients suffering with Rheumatoid arthritis.
  • Bone spurs around edges of the joint are observed in Osteoarthritis.
  • Synovial membrane thickening is the diagnostic findings of Rheumatoid arthritis and Psoriatic arthritis.
  • Abscess in joint as fluid collection is seen in Septic Wrist Joint Arthritis.
  • Localized radio-opaque thickening known as tophi are observed on MRI in patients suffering with rare wrist joint gout.
  • Wrist joint calcification of the synovium, ligaments and joint capsule are observed in Pseudogout of wrist joint.

Describe The Blood Examinations Performed To Diagnose Wrist Joint Arthritis?

Blood Examination

  • ESR- Erythrocyte Sedimentation Rate (ESR) is increased in Rheumatoid Arthritis and Septic Arthritis.
  • White Blood Cell Count (WBC) - WBC is increased in Septic Wrist Joint Arthritis.
  • Rheumatoid Factors (RF) - Rheumatoid factor is positive in Rheumatic arthritis.
  • Citrulline Modified Proteins (Anti-CCP) - Specific antibodies produced in Rheumatoid Arthritis.
  • ANA Blood Test- ANA is a non-specific antibody test, which is often positive as in all autoimmune disease such as Rheumatoid Arthritis and Psoriatic Arthritis.
  • HLA-B27 Genetic Marker- Test is positive in inflammatory joint diseases like Psoriatic Wrist Joint Disease, Ankylosing Spondylitis and Reiter's Syndrome.
  • Antineutrophil Cytoplasmic Antibodies (ANCA) - ANCA is an abnormal anti-body seen in Wegener's granuloma resulting in wrist joint arthritis.
  • Serum Cytokines- Cytokins and related protein factors are elevated in early stages of Rheumatoid Arthritis.

What is Arthrocentesis?

Arthrocentesis is an invasive procedure performed to aspirate wrist joint fluid. The wrist joint fluid is then sent to lab for study or analysis.

How Is Lab Analysis or Results of Arthrocentesis Interpreted To Diagnose Wrist Joint Arthritis?

Results of Arthrocentesis are interpreted as follows-

  • Presence of Uric Acid in Wrist Joint Fluid- Gout.
  • Presence of Calcium Pyrophosphate in Wrist Joint Fluid- Pseudogout.
  • Presence of Bacterial Cells, Red Blood Cells and Pus Cells in Wrist Joint Abscess- Septic Arthritis.

What Are The Treatment Choices For Wrist Joint Arthritis?

Treatment Choices Are As Follows-

  • Conservative Treatment
  • Medications
  • Physical Therapy
  • Interventional Pain Therapy
  • Surgery

What is Conservative Treatment of Wrist Joint Arthritis?

  • Conservative treatment is a noninvasive external therapy.
  • Conservative treatment does not include medication taken in the form of tablets or injections.
  • Conservative treatment does not include surgery.
  • Conservative treatment does not include any type of injection treatment.
  • Physical therapy is often considered as conservative treatment even though physical therapy is classified as a separate choice of treatment.

What Does Conservative Treatments Of Wrist Joint Arthritis Involve?

Conservative Treatments for Wrist Joint Arthritis Are As Follows-

  • Rest
  • Exercise, Swimming, and Yoga Therapy.
  • Heat or Cold Therapy
  • Weight Loss
  • Alternative Therapy

Which Medications Are Prescribed For Chronic Pain Caused By Wrist Joint Arthritis?

Chronic pain caused by wrist joint arthritis is treated with following medications-

NSAIDs- Indications for Non-Steroidal Anti-inflammatory Medications are as follows-

  • Acute and Chronic Pain
  • Joint Inflammation

Opioids- Indications for opioids are as follows-

  • Inadequate Pain Relief With NSAIDs or
  • Severe Side Effects Observed With NSAIDs.

Antidepressant Analgesics- Antidepressants like Cymbalta or Elavil Are Prescribed for Following Reasons-

  • Inadequate Pain Relief with NSAIDs.
  • Neuropathic Pain.
  • Pain Not Responding To Opioids.

Antiepileptic Analgesics-

  • Inadequate Pain Relief with NSAIDs.
  • Neuropathic Pain.
  • Pain Not Responding To Opioids.

How Is Inflammation Of Wrist Joint Arthritis Treated?

Inflammation of the Wrist Joint Arthritis Is Treated With Following Medications-

  • NSAIDs- Anti-inflammatory medications e.g. Ibuprofen, Naproxen, Daypro or Celebrex.
  • Corticosteroids- Corticosteroids are prescribed as follows-
    1. Tablets- Prednisone, dexamethasone.
    2. Injections- Intramuscular or Intravenous: Prednisone or dexamethasone.
    3. Intra-articular- Depomedrol or Kenalog.
  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs) - DMARD prevents permanent damage of the synovial membrane of the joint and ligaments. Following medications are often used as DMARDs.
    1. Methotrexate (Trexall)
    2. Leflunomide (Arava)
    3. Hydroxychloroquine (Plaquenil)
    4. Sulfasalazine (Azulfidine)
  • Immunosuppressant- Rheumatoid disease is associated with exaggerated immune activities. Following medications are used to suppress hyperactivities of immune system-
    1. Azathioprine (Imuran, Azasan).
    2. Cyclosporine (Neoral, Sandimmune, Gengraf).
  • TNF-Alpha Inhibitors- Rheumatoid arthritis causes increased secretion of Tumor Necrosis Factor-Alpha (TNF-alpha). TNF-alpha triggers inflammation. Following medications are used to inhibit secretions of TNF- alpha factors.
    1. Etanercept (Enbrel)
    2. Infliximab (Remicade)
    3. Adalimumab (Humira)
    4. Golimumab (Simponi)
    5. Certolizumab (Cimzia)

Which Opioids Are Prescribed For Wrist Joint Pain?

Opioids prescribed for pain are divided in two groups-

  • Short Acting Opioids
  • Long Acting Opioids

When Are Short Acting Opioids Prescribed?

  • Prescribed for acute pain lasting less than 3 months.
  • Prescribed for breakthrough pain.

Which Are The Most Common Short Acting Opioids Used To Treat Wrist Joint Pain?

Most common short acting opioids prescribed are as follows-

  • Hydrocodone- Vicodin, Lortab and Norco.
  • Oxycodone- Oxy IR and Percocete.
  • Morphine- MS IR.

When Are Long Acting Opioids Prescribed?

  • Prescribed for chronic pain lasting more than 3 to 6 months.
  • Prescribed for chronic severe pain not responding to NSAIDs and short acting opioids.

List The Most Common Long Acting Opioids Used To Treat Wrist Joint Pain?

Most common short acting opioids prescribed are as follows-

  • Oxycodone- Oxy-contin.
  • Morphine- MS Contin.
  • Methadone.

How Is Muscle Pain And Muscle Spasm Associated With Wrist Joint Arthritis Treated?

Muscle spasm and muscle pain is treated with muscle relaxants. Muscle relaxants are often used with NSAIDs and opioids. Following muscle relaxants are often prescribed for muscle pain and spasm-

  • Baclofen
  • Flexeril
  • Skelaxin
  • Robaxin

When Is Physical Therapy (PT) Advised?

Indications for Physical Therapy are as follows-

  • Pain
  • Muscle Spasm
  • Joint Stiffness
  • Joint Instability
  • Abnormal Gait

What Are The Different Physical Therapy (PT) Techniques Used To Improve Wrist Joint Arthritis?

Exercise Therapy

  • Stretching.
  • Weight Exercises.

Manual Therapy

  • Manual Pressure Technique.
  • Manual Passive Joint Motion.
  • Joint and Extremity Vibration Massage Therapy.
  • Use Mechanical Aids To Massage Muscles And Soft Tissue.

Heat Therapy or Thermotherapy

  • Hot Cloth.
  • Hot Water Bag.
  • Heating Pad.
  • Whirlpool Bath.

Cold Therapy

  • Cryo-therapy.
  • Cold Compression Ice Bag.


  • Non-invasive Therapy.
  • Ultrasound Probe Is Gently Swirled Over The Area.
  • Ultrasound Uses High-Frequency Sound Waves To Deliver Heat Deep Into Tissues (e.g. muscles).

Electrical Stimulation

  • Transcutaneous Electrical Nerve Stimulation (TENS).
  • TENS delivers a painless electrical current to nerves in subcutaneous tissue and muscles.
  • The current produces tingling and paresthesia which helps to reduce pain.
  • TENS also produces mild heat, which helps to reduce muscle and joint stiffness.
  • TENS treatment improves wrist joint mobility.

Which Tissue Or Organs Are Targeted During Manual Physical Therapy?

Target Tissues for Manual Physical Therapy Are As Follows-

  • Muscles
  • Tendons
  • Ligaments
  • Skin
  • Joint
  • Connective Tissue
  • Blood Circulation
  • Lymphatic Flow

What Are The Goals Of Physical Therapy (PT)?

Goal of Exercise Therapy Is As Follows-

  • Maintain Muscle Tone.
  • Improve Muscle Power.
  • Improve Joint Mobility.

Goals of Manual Therapy-

  • Improve Blood Circulation Within Muscles.
  • Improve Muscle Stiffness.
  • Improve Pain.
  • Prevent Muscle Atrophy.

Goals of Heat Treatment-

  • Heat Treatment- To reduce joint stiffness and improve joint movement.
  • Reducing Pain
  • Relieving Muscle Spasms
  • Reducing Inflammation
  • Reduce Edema
  • Increase Blood Flow

Goals of Cold Therapy

  • Reduce Joint Or Tendon Swelling.
  • Treatment of Pain.
  • Inflammation after Acute Injury or Surgical Procedures.
  • Decrease Metabolic Rate.

Goals of Ultrasound Treatment

  • Ultrasound Treatment Helps To Reduce Pain And Improve Circulation.
  • Treat Back and Neck Pain.
  • Treats Tendon and Ligament Injury.
  • Muscle Spasms.
  • Joint Problems and Other Spine Related Conditions.

Goals of Electric Stimulation

  • This Treatment Is Non-Invasive With No Known Side Effects.
  • Used To Control Acute Pain And Chronic Pain.
  • Used To Relieve Muscle Spasm.

What Is Interventional Therapy?

Interventional pain therapy involves invasive treatment. Invasive treatments includes following treatment-

  • Cortisone Injection by Inserting Needle in Wrist Joint.
  • Chronic Pain Is Treated With Nerve Block.
  • Chronic Pain Is Treated With Spinal Cord Stimulator And Morphine Pump.

What Are The Choices Of Surgical Treatment For Wrist Joint Arthritis?

  • Synovectomy of Wrist Joint- Synovectomy is removal of synovium of wrist joint. Removal of synovium is indicated when synovitis associated with arthritis is not responding to medications, physical therapy and cortisone injection is treated with surgery.
  • Fusion- Wrist joint fusion surgery is advised for joint deformity and advanced arthritis. Cartilages and synovial membrane of wrist joint is surgically removed. Ends of the bone is shaved so two adjacent bones are fused. Fusion causes loss of joint movement and reduces pain.
  • Wrist Joint Exploration and Arthroplasty- Surgery involves removal of the osteophytes, spurs, loose cartilages and inflame tissue.


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Written, Edited or Reviewed By:


Last Modified On: May 10, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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