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Wrist Arthritis Workup

  • Author: Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
Updated: Nov 25, 2015

Approach Considerations

Plain radiography is central to the workup of wrist arthritis. Bone scanning may show hot spots, but findings are not specific and do not provide additional information. Arthroscopy can be diagnostically useful, and are occasionally used as therapeutic procedures. Arthrography is not useful in common practice, but can be combined with arthroscopy to enhance information.

Computed tomography (CT) scanning may be useful to delineate the problem in individual bones and their articulations; however, it is not routinely used for primary osteoarthritis (OA) or rheumatoid arthritis (RA).[6] Magnetic resonance imaging (MRI) is especially useful to assess instability caused by ligamentous tears but not for established OA of the wrist.[7, 8]


Plain Radiography

Radiographic findings in wrist posteroanterior and lateral views reveal degenerative changes.[9, 10, 11] See images below.

Osteoarthritis of the wrist. Osteoarthritis of the wrist.
Osteoarthritis of the wrist, lateral view. Osteoarthritis of the wrist, lateral view.

The important areas to focus on are the radioscaphoid joint, the radiolunate joint, around the capitate, and the scaphotrapeziotrapezoid joint. However, all the joints should be individually evaluated for evidence of OA.

In general, surgical procedures are based on assessments of the radioscaphoid joint, radiolunate joint, and head of the capitate, which forms the main articulation of the midcarpal joint. The exact surgical option of choice is directly related to which joints are preserved and which joints are destroyed.


MRI scans

MRI scans have been shown to be useful in rheumatoid arthritis, especially in early stages to predict radiographic progression. In 2013, Baker et al showed that high baseline score and poor improvement over the first 24 weeks in synovitis and in bone edema were independent predictors of radiographic progression at 1 year.[12] An increase in bone erosion of greater than 0.5 at weeks 12 and 24 also predicted progression. In addition, radiographic and MRI progression at 1 year were associated with poor 12-week improvement in bone edema. As these early changes in MRI scans predicted the future progression, this investigation is valuable in shorter-duration studies to determine the efficacy of rheumatoid arthritis therapies in preventing structural damage.

Contributor Information and Disclosures

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth) Consultant Spinal Surgeon, Department of Trauma and Orthopaedics, Sunderland Royal Hospital, UK

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth) is a member of the following medical societies: British Orthopaedic Association, AOSpine

Disclosure: Nothing to disclose.


Lester Sher, MB, BCh, FRCS Honorary Clinical Lecturer, Department of Orthopedics, Wansbeck Hospital, UK

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic Association

Disclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

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Severe wrist arthritis.
The clinical presentation of wrist arthritis can be severe deformity, especially in patients with rheumatoid arthritis.
Rheumatoid arthritis of the wrist.
Osteoarthritis of the wrist.
Osteoarthritis of the wrist, lateral view.
Range of motion may be normal in hyperelastic individuals despite underlying wrist arthritis.
Range of motion may be normal in hyperelastic individuals despite underlying wrist arthritis.
Synovitis of the wrist with extensor tenosynovitis.
Universal incision of the wrist.
Extensor retinaculum of the wrist.
Exposure of the distal end of the ulna for a Darrach procedure.
After resection of the distal ulna.
Radiolunate fusion with staples.
Follow-up of radiolunate fusion (limited arthrodesis) shows good dorsiflexion and palmar flexion.
Intramedullary pin fixation for wrist arthrodesis.
Total wrist fusion using an AO (Arbeitsgemeinschaft für Osteosynthesefragen, or Association for the Study of Osteosynthesis) plate in osteoarthritis of the wrist.
Total wrist fusion using an AO (Arbeitsgemeinschaft für Osteosynthesefragen, or Association for the Study of Osteosynthesis) plate in a person with rheumatoid arthritis of the wrist.
Wrist arthroplasty in rheumatoid arthritis of the wrist.
Distal radioulnar joint fusion with distal ulnar resection (Sauve-Kapandji procedure).
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