05 Jul Treatment Options for Wrist Arthritis with Dr. Todd Wurth

_{Originally published in the Williamson Source} –

Wrist arthritis is incredibly common, with one in seven Americans suffering from the ailment. But the good news is there are many effective, non-invasive or minimally-invasive treatment options available.

Todd Wurth, M.D. is an upper extremity specialist with Bone and Joint Institute of Tennessee treating nerve-related disorders, fractures, and arthritis in the shoulder, elbow, wrist, and hand. He shares valuable insights into what wrist arthritis is and how to treat it.

Types of Wrist Arthritis

Like any joint, there are three types of wrist arthritis:

1. Osteoarthritis: Wear and tear arthritis, which develops with time and age.

2. Inflammatory arthritis: A condition where the body’s immune system will attack joints. Those conditions can include rheumatoid arthritis and lupus.

3. Post-traumatic arthritis: Occurs after a fracture or serious ligament injury in the wrist that results in instability and arthritis. This is the most common type of wrist arthritis that Bone and Joint Institute treats.

When to See a Doctor for Wrist Arthritis

When the condition starts to negatively impact your life, such as affecting your ability to do things you want or need to do, that’s when you should consider seeing an expert.

Here’s a look at the treatment options for wrist arthritis:

Intermittent Wrist Splinting

This treatment option is non-invasive and good for patients who have mild discomfort or swelling. Arthritis is a condition where you may have good weeks and bad weeks. Some weeks you might have times when you have no problems at all and feel no need to wear the splints. Then you have weeks where you have pain with weather changes or overuse and choose to wear the splints to get back on track. This puts the patient in charge of their needs based on their comfort levels.

Anti-Inflammatory Medication 

Oral medications available to help include Advil and Aleve, but there are also topical medications that work well because the wrist joint is not considered a deep joint. Topical medication is especially good for those who struggle with oral anti-inflammatory drugs, such as individuals on blood thinners or patients with an ulcer or other stomach conditions.

Cortisone Injections

Another initial treatment option before surgery is a cortisone injection in the wrist. Cortisone is a potent anti-inflammatory. Your medical provider will inject a small but concentrated dose that goes directly to the site of the arthritis. 

It does not cure the problem, but it can provide significant relief of symptoms. The length of the relief an injection provides will vary based on the arthritis and the patient. The more severe the arthritis, the less relief time you may get with cortisone injections.

Dr. Wurth generally recommends getting one injection in any joint in the body no more than every six months. If you do them too close together, such as every two months, it isn’t good for the soft tissue and in some instances can speed up the arthritic process. However, utilizing cortisone injections with six months between treatments will not create any adverse reactions or conditions.

Wrist Denervation

If a patient’s condition reaches a point where all of the previous options are not helping and they can’t do what they want or need to do in a day, that’s when providers might start discussing surgical options. Surgery for wrist arthritis can vary depending on the location in the wrist where the arthritis is located.

The most minimally-invasive procedure is wrist denervation. The wrist has two nerves that supply it with pain pathways. These nerves do not serve crucial muscle functions to the body like those in the arm and forearm, which means they can be dissected and removed to prevent signals of pain delivered from joints around your hand and wrist. This procedure is for people who have mild to moderate arthritis in their wrists, but patients with more severe pain might not get the most relief from this method.

To find out whether an individual will benefit from wrist denervation, Dr. Wurth has patients visit his clinic in Franklin and does a nerve block with a long-acting local anesthetic. The nerve block lasts 12 hours near those two nerves in the wrist that would be impacted by the wrist denervation. Once the nerve block is in place, he advises patients to go out and do what they love and try to use their wrists – play golf, work in the yard, or do something that will aggravate the wrist while monitoring how it feels over the next 12-24 hours. If they have a positive response to this, then the wrist denervation may work well for them. 

While wrist denervation often offers mild relief of symptoms, it is not permanent relief and does not stop the arthritic process, which can get worse with time. The procedure, however, has historically offered many patients years of relief.

Wrist Arthroscopy

Patients that are not candidates for wrist denervation can be evaluated for wrist arthroscopy. During this process, the surgeon scopes the wrist and removes damaged tissue or foreign objects from the joint. This is a more common option for patients with inflammatory-related arthritis.

Proximal Row Carpectomy

For advanced arthritis, Dr. Wurth looks at procedures where he removes a couple of carpal bones in the arthritic portion of the wrist. While removing bones from the wrist sounds unnerving, a patient’s wrist has many carpal bones that will adjust naturally to the surgically-altered wrist to accommodate the change with rehabilitation. 

Limited Wrist Fusions

Limited wrist fusion involves taking out one bone that is arthritic and then fusing other bones together. The procedure still allows patients to flex and extend their wrists while offering good pain relief. 

Total Wrist Fusion

Total wrist fusion is reserved for more extensive arthritic conditions or arthritis associated with instability.  The procedure does not allow patients to flex or extend their wrist but still allows them to rotate their forearm/wrist.  For patients presenting with a wrist fusion as an option for relief, Dr. Wurth instructs patients to wear a wrist splint full-time to get a feel for what their mobility will be like after the wrist fusion.

Wrist Replacements

Wrist replacements are reserved for special conditions. Generally, they serve as an option for patients with lower mobility demands and are largely not suitable for patients that need their wrists for higher-demand activities such as lifting heavier objects. This procedure is usually best for patients with immune-related arthritis and multiple-joint arthritis.

Preventing Wrist Arthritis

If you’ve fallen and have significant swelling around the wrist and pain that has lasted more than two weeks, it’s worth getting an X-ray. Dr. Wurth sees many patients who come in and have experienced a fall. In the aftermath, they visited an urgent care facility or the ER and the X-ray showed everything was normal. Dr. Wurth recommends patients spend two weeks in a wrist splint and repeat the x-ray in two weeks if pain and swelling persist.

Dr. Wurth also warns that wrist fractures can be sneaky because they might not show up on X-ray initially, and then when you repeat the x-ray later on they suddenly become evident. 

Lots of patients visit Bone and Joint in their 30s and 40s with arthritis in their wrist and when the medical professional does the x-ray, they see a fracture that never healed. These patients can often share an instance from decades ago where they fell and suffered a wrist injury, yet the x-ray didn’t show anything. 

From a prevention standpoint, it’s always best to pay close attention to wrist injuries and listen to your body. Ongoing pain is often trying to tell you something.

Wrist Pain Treatment at Bone and Joint Institute

Patients experiencing wrist pain should visit the hand and wrist specialists at Bone and Joint Institute. Learn what’s causing your pain and evaluate the best treatment options based on your needs. To schedule an appointment today, click on the blue button at the top of the page, click here, or call the clinic at (615) 791-2630.

Todd Wurth, M.D. is a board-certified orthopaedic surgeon specializing in treatment of the shoulder, elbow, hand and wrist. Dr. Wurth has a particular expertise in shoulder arthroplasty, including Exactech CT guided navigation, rotator cuff repair, carpal tunnel release and A1 pulley release. He has been recognized by the Nashville Business Journal multiple times as one of “Nashville’s Best Hand Surgeons” and commonly treats conditions like trigger finger, shoulder, hand and wrist arthritis, rotator cuff tears, fractures and carpal tunnel.