Osteoarthritis of the Wrist
From Plastic Surgery, Mayo Clinic. Received for publication February 22, 2013; accepted August 13, 2013. Copyright © 2014 by the American Society of Plastic Surgeons
Cenk Cayci, M.D. Brian T. Carlsen, M.D.
This article reviews pathogenesis and treatment of wrist osteoar- thritis. Because there is no cure for osteoarthritis, treatment is directed at symptomatic relief. Surgical treatment is reserved for patients who have failed nonoperative modalities. This article reviews the surgical treatment of wrist osteoarthritis with an emphasis on selection of the appropriate procedure. Literature guiding surgical treatment with patient outcomes is reviewed.
Wrist osteoarthritis commonly results from ligamentous injury that leads to a predictable pathway and sequence of degeneration. Successful treatment of the osteoarthritic wrist is possible and largely dependent on the individual patient’s symptoms and impairment balanced against the risks and benefits of any particular treatment. As there is no cure for osteoarthritis, treatment is directed at symptomatic improvement. Therefore, treatment should be stepwise, starting with the least invasive and risky options (e.g., lifestyle modification, rest, and steroid injection). When these treatments fail, more invasive procedures may be indicated, such as proximal row carpectomy and partial or total wrist fusion procedures. The literature is lacking in regard to definitive, level I evidence to guide treatment. Level I comparative studies with long-term follow-up are needed to guide future treatment.