Degenerative Arthritis of the Hand and Wrist

Abstract

Degenerative arthritis (OA) of the hand and wrist is commonly encountered and can involve the interphalangeal, carpometacarpal (CMC), midcarpal, radiocarpal, and distal radioulnar articulations. In all cases of degenerative arthritis, it is key to assess the functional impairment and pain that a patient is experiencing when deciding treatment; one must not succumb to treating a patient based on a radiograph. Both the operative and nonoperative treatment options for these conditions are numerous. Nonoperative modalities include splinting, corticosteroid injections, and non-steroidal anti-inflammatories (NSAIDs). Surgical treatment options for interphalangeal (PIP, DIP) and metacarpophalangeal (MCP) joint OA arthritis include fusion and several athroplasty options. Similarly, there are a multitude of procedures for thumb CMC OA, with trapeziectomy with ligament reconstruction and tendon interposition (LRTI) being the most common. In terms of the radiocarpal joint, the student must be aware of the commonly encountered patterns of degenerative wrist OA, i.e., scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC). Finally, the management of DRUJ OA includes several reconstructive options, which will be reviewed.