Pathophysiology

Generally seen in those aged over 65 years. Can be brought on from previous surgery, previous trauma (e.g. fracture), inflammatory condition (e.g. rheumatoid arthritis) or overuse injuries.

There is often a poor link between changes visible on an x-ray and symptoms of osteoarthritis; minimal changes can be associated with a lot of pain, or modest structural changes to joints can occur with minimal accompanying symptoms.

Osteoarthritis is a condition that results from a loss of cartilage with subsequent remodelling of adjacent bone and subsequent inflammation. It is some of these changes in the joint structure that can then be seen on x-ray. It is a dynamic process that involves all joint tissues: the bones, cartilage, joint capsule, lubricating fluid and surrounding muscles.

Sometimes the altered joint structure compensates for the changes and does not cause pain. It’s when the natural repair process cannot compensate enough that the joint starts to become painful.

Symptoms

• Stiffness on wrist movements and restriction in range of movement
• Pain at end of range movements
• Grinding, grating or clicking noises from the wrist
• May have generalised swelling, pain and weakness

Management

• Activity modification
• Ice or heat
• Pain relief
• Physiotherapy to include range of movement exercises and a graded strengthening programme
• Splinting can help reduce repetitive strain on the wrist
• Orthopaedic options in severe cases may include joint fusion

Investigations

X-ray can assess the level of osteoarthritis although generally will not change the management