Osteoarthritis do Punho Folheto

O que você está sentindo

Provavelmente, você sente uma dor profunda e latejante no punho. Isso é frequentemente causado por artrite por desgaste, na qual a cartilagem de amortecimento entre seus ossos se degradou. A dor geralmente fica no centro do punho ou no lado do polegar. Ela tende a piorar quando você usa a mão para tarefas diárias.

Movimentos simples podem se tornar difíceis. Você pode ter dificuldade em segurar objetos firmemente ou girar uma maçaneta. Alcançar as costas para fechar um sutiã pode parecer rígido e doloroso. Enfiar uma camisa pode exigir que você mova o braço inteiro em vez de apenas o punho. Levantar itens leves, como uma chaleira ou uma sacola de compras, pode causar desconforto agudo.

A dor frequentemente piora após a atividade. Você pode notar que ela lateja mais à noite após um longo dia usando as mãos. Algumas pessoas descobrem que descansar o punho sobre um travesseiro ajuda a aliviar a dor. No entanto, a rigidez também é uma parte importante da experiência. Seu punho pode parecer particularmente tenso e difícil de mover quando você acorda pela manhã. Essa rigidez matinal geralmente diminui um pouco à medida que você se mexe, mas pode retornar se você descansar por muito tempo.

Dormir pode ser desafiador devido a essa dor. Muitos pacientes descobrem que não conseguem deitar de lado sem exercer pressão sobre o punho afetado. Você pode se revirar, tentando encontrar uma posição que não agrave a articulação. Essa falta de sono reparador pode deixá-lo cansado e frustrado durante o dia.

É comum sentir uma sensação de atrito ou ouvir um estalo ao mover o punho. Isso ocorre quando o osso esfrega no osso onde a cartilagem protetora desapareceu. Embora isso possa ser alarmante, é um sinal típico de artrite avançada. Compreender esses sintomas nos ajuda a planejar seu cuidado. Queremos garantir que você se sinta ouvido e apoiado enquanto discutimos o melhor caminho a seguir para sua situação específica.

O que está realmente acontecendo

O seu pulso é composto por oito ossos pequenos, dispostos de forma bem ajustada. Na osteoartrite, a cartilagem lisa que reveste esses ossos se desgasta. Pense na cartilagem como um amortecedor ou uma junta. Sem ela, os ossos roçam uns contra os outros. Isso causa dor, rigidez e inchaço.

A artrite por desgaste geralmente começa em locais específicos. Pode começar onde o antebraço encontra o pulso, ou entre os próprios ossos pequenos do carpo. À medida que a superfície articular se degrada, o pulso perde seu deslizamento natural. Você pode sentir uma sensação de atrito ou travamento ao movê-lo. Tarefas simples, como girar uma maçaneta, tornam-se difíceis.

Seu cirurgião explica que esse dano altera a forma como seu pulso se move. Por exemplo, uma técnica chamada artrodese dos quatro ossos desloca a posição de certos ossos. Esse deslocamento pode aumentar o estresse sobre as articulações restantes. Com o tempo, esse estresse adicional pode levar a um desgaste adicional nessas áreas.

Sabemos que nenhuma cirurgia pode restaurar seu pulso ao seu estado original e perfeito. Cada opção envolve compromissos. Os procedimentos de fusão limitam o movimento para reduzir a dor. A substituição articular visa manter o movimento, mas carrega riscos mais elevados. Seu cirurgião discutirá qual caminho se adequa às suas necessidades diárias e nível de atividade.

O objetivo é interromper a dor e proporcionar um pulso estável. Você pode perder parte da amplitude de movimento, mas ganha confiabilidade. Muitos pacientes consideram que o compromisso vale a pena para o alívio da dor. Nosso foco é ajudá-lo a retornar à sua vida diária com menos desconforto.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, aborda este problema na nossa clínica focando nas suas necessidades específicas. Os pacientes chegam à nossa clínica por referência do médico de família ou fisioterapeuta. Uma avaliação clínica (histórico, exame físico e imagens quando necessário) estabelece o diagnóstico. Para problemas degenerativos ou de longa duração, geralmente tentamos tratamento não cirúrgico — modificação da atividade, fisioterapia ou terapia manual, uso de órteses e injeções — e consideramos a cirurgia quando isso não proporcionou melhora suficiente. Para problemas estruturais ou agudos, a cirurgia pode ser recomendada imediatamente, sem uma tentativa prévia de tratamento não cirúrgico.

Você pode começar alterando a forma como utiliza a mão. Recomendamos evitar o levantamento de pesos pesados ou o aperto repetitivo que cause dor. Um fisioterapeuta pode ensinar exercícios para manter o pulso móvel e fortalecer os músculos ao redor. As órteses podem apoiar a articulação durante as tarefas diárias. Geralmente, recomendamos dar algumas semanas para que essa abordagem surta efeito. Se a dor persistir, podemos sugerir medicação. Analgésicos ou anti-inflamatórios disponíveis sem receita podem ajudar a controlar o desconforto. Em alguns casos, oferecemos injeções na articulação. As injeções de cortisona reduzem o inchaço e a dor por um período limitado. As injeções de ácido hialurônico ou PRP visam amortecer a articulação, embora os efeitos variem. Esses tratamentos não revertem a artrite, mas podem melhorar o seu conforto e função.

A cirurgia é considerada quando o tratamento conservador não proporcionou melhora suficiente. O objetivo é aliviar a dor e restaurar a estabilidade. As opções incluem a fusão, que une os ossos para impedir o movimento doloroso, ou a substituição, que troca as superfícies danificadas por artificiais. Selecionamos a melhor opção com base na articulação específica envolvida, nas suas demandas e no risco de complicações. Não há uma única opção preferida para a osteoartrite do punho na maioria dos cenários. Discutimos essas escolhas com você para alcançar uma decisão compartilhada.

O que esperar

O seu pulso provavelmente ficará rígido e doloroso durante semanas ou meses após o tratamento. O alívio da dor é o objetivo mais comum, e a maioria das pessoas nota uma melhora significativa dos seus sintomas com os cuidados adequados. Sem tratamento, a artrose por desgaste geralmente persiste ou piora lentamente ao longo do tempo. Os seus sintomas podem aparecer e desaparecer, mas os danos articulares subjacentes tendem a progredir.

Se optar pela fusão do pulso, pode esperar um alívio da dor confiável. Este procedimento é a opção de salvamento mais comum para artrose grave. Estabiliza a articulação e reduz a incapacidade. No entanto, limita o movimento do seu pulso em todas as direções. Não recuperará totalmente a função completa do pulso. A sua força de preensão geralmente melhora, mas o seu alcance de movimento será reduzido.

Se optar pela substituição articular, o objetivo é obter maior mobilidade. Esta opção apresenta um risco maior de complicações do que a fusão. Pode enfrentar problemas como afrouxamento ou a necessidade de cirurgia adicional. Se a substituição falhar, a conversão para fusão é um plano de segurança seguro e eficaz. Esta cirurgia de salvamento melhora a função de forma confiável e proporciona um alívio significativo da dor. Por outro lado, se a fusão falhar, a conversão para uma substituição moderna também é viável.

A recuperação envolve um período de atividade limitada. Começar a realizar movimentos suaves precocemente ajuda a recuperar a função motora mais rapidamente. Terá menos visitas de terapia se iniciar este processo cedo. A maioria das pessoas retorna às tarefas diárias com dor reduzida, mas algumas limitações permanecem. Cerca de 20% dos pacientes permanecem insatisfeitos com o resultado, enquanto 86% retornam às atividades completas. O seu cirurgião ajudará a ponderar o compromisso entre mobilidade e estabilidade. A decisão depende do seu nível de atividade e da disposição para aceitar os riscos potenciais de revisão.

Quando procurar ajuda

Consulte o seu médico de família se tiver dor no pulso persistente que não melhora com o repouso. Solicite uma avaliação especializada se notar fraqueza, instabilidade ou uma sensação de bloqueio ou cedência. Estes sintomas podem interferir no seu sono ou no trabalho. Procure ajuda em caso de qualquer piora súbita da sua condição. O seu cirurgião irá avaliar se tem artrose por desgaste. Irá discutir se a fusão do pulso ou a substituição da articulação é a opção adequada para si. Esteja ciente de que ambas as opções comportam riscos. A fusão do pulso oferece um alívio da dor fiável, mas limita o movimento. A substituição da articulação preserva a mobilidade, mas tem taxas mais elevadas de complicações. O seu cirurgião irá orientá-lo através destas escolhas com base nas suas necessidades específicas.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Osteoarthritis of the hand and wrist requires an individualized approach to treatment strategies based on site-specific diagnoses and varying disease manifestations [1].
While functional improvement was observed for arthroplasty patients, robust long-term follow-up data on wrist arthroplasty are not yet available [3].
Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery in patients with rheumatoid arthritis [9].
While outcomes are generally favorable for therapeutic surgeries like arthrodesis and arthroplasty, further study is required to determine the best indications for ulnar head arthroplasty [36].
Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications [19].
Minimal arthroplasty may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery [26].
The technique of closing wedge radial osteotomy could prove a reliable first line treatment for patients with debilitating wrist osteoarthritis confined to scaphoid/scapholunate articulation with radius as it preserves the ligamentous insertions and the bone stock [4].
Distal scaphoid excision should be preferred to improve functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates in radioscapholunate fusion for radiocarpal osteoarthritis [17].
The authors prefer proximal row carpectomy for SLAC wrists with preserved capitate head cartilage due to socio-economic benefits, lower complication rates, and procedural ease [46].
Wrist denervation was a viable salvage option for patients with symptomatic SLAC wrist osteoarthritis to preserve motion, decrease pain, and increase function with a low absolute failure rate at mid- to long-term follow-up [12].
Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term [5].

Anatomy & Pathophysiology

Type I and III wrists in early rheumatoid arthritis exhibit radiographic progression and ultimately undergo deformation [8].
Combining traditional qualitative evaluation and quantitative measurements may improve the classification of wrist osteoarthritis [11].
The Watson and Ballet classification of scapholunate advanced collapse (SLAC) wrist osteoarthritis is widely accepted, simple, and a well-recognized guide to treatment despite significant limitations [20].
Radiographic classification of SLAC wrist has moderate reliability and reproducibility [27].
Classification of scaphoid nonunion advanced collapse (SNAC) wrist has limited reliability [27].
Staging systems for SNAC wrist lack agreement [28].
SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability [34].
In the early stages of hand osteoarthritis, there is a functional deficit associated with reduced muscle activity of the wrist muscles during manual activities [40].

Classification

Advanced osteoarthritis of the midcarpal joint without radiocarpal involvement may be more common than previously thought [7].
Isolated osteoarthritis of the scaphotrapeziotrapezoidal joint is the most prevalent pattern of wrist osteoarthritis [7].
Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification for SNAC wrist [30].
The Simmen classification of wrist destruction in rheumatoid arthritis is useful in early disease in about 50% of cases [44].
The Simmen classification provides reasonably reliable identification of wrists at significant risk of becoming severely unstable, though the false-negative rate is substantial [44].

Clinical Presentation

Hand manifestations of osteoarthritis can be debilitating, with initial treatment being medical and many patients doing well with splinting and hand therapy [2].
Subtle differences in history, examination, laboratory values, and imaging, rather than one pathognomonic finding, can improve the diagnostic acumen and expedite appropriate treatment options for monoarticular arthritis of the hand and wrist [6].
The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints is affected by the presence of osteoarthritis of the adjacent joint [16].
Patients with wrist arthritis who undergo surgery face higher risks of carpal tunnel syndrome (CTS) and subsequent carpal tunnel release (CTR) than those managed conservatively [13].

Investigations

Initial treatment for hand manifestations of osteoarthritis is medical, with many patients doing well with splinting and hand therapy [2].
Subtle differences in history, examination, laboratory values, and imaging can improve diagnostic acumen and expedite appropriate treatment options for monoarticular arthritis of the hand and wrist [6].
Type I and III wrists had radiographic progression and ultimately underwent deformation [8].
The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints was affected by the presence of osteoarthritis of the adjacent joint [16].
Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification for SNAC wrist arthritis [30].
With CT as the reference method, MRI showed moderate sensitivity and good specificity and accuracy for detection of erosions in rheumatoid arthritis and healthy wrist bones [49].
Radiography showed very low sensitivity for detection of bone erosions in rheumatoid arthritis and healthy wrist bones [49].
Subjective radiographic grading of the radioscaphoid joint was unable to detect mild arthritis but was able to distinguish between mild and moderate/severe arthritis [50].
Bone density was greater at the capitolunate joint, the radial styloid, and the radiolunate joint in SNAC wrists compared to controls [52].
Computed tomography is more sensitive than conventional radiography for detecting bone erosions in rheumatoid arthritis [53].

Treatment

Non-Operative Management

Neuromuscular exercise therapy and range-of-motion training show no clinically meaningful differences in the treatment of wrist osteoarthritis at 6 and 12 months [39].

Surgical Management: General Principles

Surgical intervention markedly improves hand and wrist function for many rheumatoid patients [29].
Preservation of movement is beneficial to function, and a preferable compromise may be selective excision and partial fusion of the wrist using knowledge of the aetiology and pattern of degenerative change [25].
Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given proper patient selection and indications [19].

Surgical Management: Arthrodesis and Fusion

Patients tolerate the restrictions caused by a stiff wrist provided it is painless [21].
Four-corner fusion and scaphoid excision using headless compression screws for SLAC and SNAC wrist deformities result in most patients being pleased postoperatively, with improvement in wrist pain being the most common finding [10].
Radioscapholunate fusion for radiocarpal osteoarthritis benefits from distal scaphoid excision to improve functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates [17].
Closing wedge radial osteotomy is a reliable first-line treatment for patients with debilitating wrist osteoarthritis confined to the scaphoid/scapholunate articulation with the radius, as it preserves ligamentous insertions and bone stock [4].

Surgical Management: Arthroplasty

Newer fourth-generation wrist implants appear to be performing better than earlier designs [18].
Minimal wrist arthroplasty may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery [26].

Surgical Management: Salvage and Other Procedures

Wrist denervation is a viable salvage option for patients with symptomatic SLAC wrist osteoarthritis to preserve motion, decrease pain, and increase function with a low absolute failure rate at mid- to long-term follow-up [12].
Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication [51].

Complications

Robust long-term follow-up data on wrist arthroplasty are not yet available [3].
Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery [9].
Most patients were pleased postoperatively following four-corner fusion and scaphoid excision, with improvement in wrist pain being the most common finding [10].
There is an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain following partial wrist denervation [14].
Functional results of four-corner fusion for SLAC and SNAC wrist were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [15].
Elbow, wrist, and hand surgery provided long-lasting benefits in rheumatoid arthritis patients [23].
The overall survival probability of partial wrist denervation in painful wrist osteoarthritis is above 50% at 5 years [24].
Delayed-onset ulnar neuropathy at the wrist can occur 12 to 30 years after conservatively treated distal radius fractures with malunion and distal radioulnar joint (DRUJ) arthritis [31].

Recovery

Partial wrist denervation in inflammatory arthritis carries an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain [14].
Functional results of 4-corner fusion for SLAC and SNAC wrist are good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [15].
Elbow, wrist, and hand surgery provided long-lasting benefits in rheumatoid arthritis patients according to patient-reported outcome assessments [23].
Partial wrist denervation in painful wrist osteoarthritis has an overall survival probability above 50% at 5 years [24].
Delayed-onset ulnar neuropathy at the wrist can occur 12 to 30 years after conservatively treated distal radius fractures with malunion and distal radioulnar joint arthritis [31].

Key Evidence

[L5] Osteoarthritis of the hand and wrist requires an individualized approach to treatment strategies based on site-specific diagnoses and varying disease manifestations. [1] (10.1016/j.jht.2022.01.001)
[L5] The hand manifestations of osteoarthritis can be debilitating, with initial treatment being medical and many patients doing well with splinting and hand therapy. [2] (10.1016/j.hcl.2010.09.003)
[L2] While functional improvement was observed for arthroplasty patients, robust long-term follow-up data on wrist arthroplasty are not yet available. [3] (10.1177/1753193420953683)
[L4] The technique could prove a reliable first line treatment for patients with debilitating wrist osteoarthritis confined to scaphoid/scapholunate articulation with radius as it preserves the ligamentous insertions and the bone stock. [4] (10.1016/j.jisako.2025.100448)
[L3] Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term. [5] (10.1186/s13018-021-02856-x)
[L5] Subtle differences in history, examination, laboratory values, and imaging, rather than one pathognomonic finding, can improve the diagnostic acumen and expedite appropriate treatment options for monoarticular arthritis of the hand and wrist. [6] (10.1016/j.jhsa.2012.04.010)
[L4] Advanced osteoarthritis of the midcarpal joint without radiocarpal involvement may be more common than previously thought, with isolated osteoarthritis of the scaphotrapeziotrapezoidal joint being the most prevalent pattern. [7] (10.1177/17531934241275450)
[L2] Type I and III wrists had radiographic progression and ultimately underwent deformation. [8] (10.1016/j.jhsa.2009.01.016)
[L4] Total wrist arthroplasty using the semiconstrained arthroplasty system achieves favorable clinical outcomes with no serious complications requiring revision for 10 years after surgery. [9] (10.1016/j.jhsa.2024.03.002)
[L4] Most patients were pleased postoperatively, with improvement in wrist pain being the most common finding. [10] (10.1097/bth.0b013e3181f60fec)
[L4] Combining traditional qualitative evaluation and quantitative measurements may improve the classification of wrist osteoarthritis. [11] (10.1177/1753193416669261)
[L4] This method of wrist denervation was a viable salvage option for patients with symptomatic SLAC wrist osteoarthritis to preserve motion, decrease pain, and increase function with a low absolute failure rate at mid- to long-term follow-up. [12] (10.1016/j.jhsa.2021.02.023)
[L2] Patients with wrist arthritis who undergo surgery face higher risks of CTS and subsequent CTR than those managed conservatively. [13] (10.1016/j.jhsa.2026.01.013)
[L4] Our findings suggest an approximate 10% risk of secondary wrist arthrodesis in patients with persistent or progressive ulnar wrist pain. [14] (10.1007/s10067-019-04645-8)
[L4] Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. [15] (10.1177/1558944716681949)
[L4] The occurrence of osteoarthritis of the scaphotrapeziotrapezoid and distal radioulnar joints was affected by the presence of osteoarthritis of the adjacent joint. [16] (10.1016/j.jhsa.2023.05.009)
[L4] Distal scaphoid excision should be preferred to improve functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates. [17] (10.1055/s-0039-1688939)
[L1] The newer fourth-generation wrist implants appear to be performing better than earlier designs. [18] (10.1055/s-0038-1646956)
[L3] Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications. [19] (10.1016/j.jhsa.2013.02.013)
[L5] Despite its significant limitations, the Watson and Ballet classification of SLAC wrist osteoarthritis is widely accepted, simple, and a well-recognized guide to treatment. [20] (10.1097/corr.0000000000000451)
[L4] Patients tolerate the restrictions caused by a stiff wrist provided it is painless. [21] (10.1054/jhsb.2002.0806)
[L4] Our original patient-reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long-lasting benefits in RA patients. [23] (10.1111/1756-185x.13340)
[L3] The study found an overall survival probability above 50% at 5 years after partial wrist denervation in painful wrist OA. [24] (10.1177/17531934261425490)
[L5] Preservation of movement is beneficial to function, and a preferable compromise may be selective excision and partial fusion of the wrist using knowledge of the aetiology and pattern of degenerative change. [25] (10.1302/0301-620x.97b10.35717)
[L4] Minimal arthroplasty as described may provide a temporary solution for active patients with symptomatic early wrist arthritis who are not candidates for salvage wrist surgery. [26] (10.1055/s-0033-1338255)
[L4] Radiographic classification of SLAC wrist has moderate reliability and reproducibility, whereas classification of SNAC wrist has limited reliability. [27] (10.1177/1753193413484629)
[Paper] Staging systems for SNAC wrist lack agreement. [28] (10.1007/s12593-012-0062-2)
[L5] Surgical intervention markedly improves hand and wrist function for many rheumatoid patients. [29] (10.5435/jaaos-d-20-00102)
[L4] Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification. [30] (10.1177/1558944720937359)
[L4] Delayed-onset ulnar neuropathy at the wrist can occur 12 to 30 years after conservatively treated distal radius fractures with malunion and DRUJ arthritis. [31] (10.1016/j.jhsa.2009.11.005)
[L4] SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability. [34] (10.1186/s12891-025-08652-6)
[L5] While outcomes are generally favorable for therapeutic surgeries like arthrodesis and arthroplasty, further study is required to determine the best indications for ulnar head arthroplasty. [36] (10.1016/j.jht.2013.12.002)
[L1] We found no clinically meaningful differences between the neuromuscular exercise therapy program and range-of-motion training in the treatment of wrist osteoarthritis at 6 and 12 months. [39] (10.1186/s12891-025-09463-5)
[L3] In the early stages of HOA, there is a functional deficit associated with a reduced muscle activity of the wrist muscles during manual activities. [40] (10.1016/j.jht.2019.12.010)
[L3] The Simmen classification of wrist destruction in rheumatoid arthritis is useful in early disease in about 50% of cases and provides reasonably reliable identification of wrists at significant risk of becoming severely unstable, though the false-negative rate is substantial. [44] (10.1054/jhsb.1999.0196)
[L3] The authors prefer proximal row carpectomy for SLAC wrists with preserved capitate head cartilage due to socio-economic benefits, lower complication rates, and procedural ease. [46] (10.1177/1753193408087116)
[L4] With CT as the reference method, MRI showed moderate sensitivity and good specificity and accuracy for detection of erosions in rheumatoid arthritis and healthy wrist bones, while radiography showed very low sensitivity. [49] (10.1186/ar2378)
[L3] Subjective radiographic grading of the radioscaphoid joint was unable to detect mild arthritis but was able to distinguish between mild and moderate/severe arthritis. [50] (10.1007/s11552-013-9522-9)
[L4] Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication. [51] (10.1016/j.jhsa.2014.04.022)
[L3] Bone density was greater at the capitolunate joint, the radial styloid, and the radiolunate joint in SNAC wrists compared to controls. [52] (10.2106/jbjs.22.01350)
[L3] Computed tomography is more sensitive than conventional radiography for detecting bone erosions in rheumatoid arthritis. [53] (10.1186/1471-2474-14-265)

References

[1] Surgical management of osteoarthritis of the hand and wrist. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2022.01.001

[2] Current Concepts in the Surgical Management of Rheumatoid and Osteoarthritic Hands and Wrists. Hand Clinics. 2011. DOI: 10.1016/j.hcl.2010.09.003

[3] A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with rheumatoid arthritis. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420953683

[4] Case Series: Closing Wedge Radial Osteotomy for Scaphoid Nonunion and Scaphoid Nonunion Advanced Collapse (SNAC) Wrists. Journal of ISAKOS. 2025. DOI: 10.1016/j.jisako.2025.100448

[5] Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02856-x

[6] Diagnostic Considerations for Monoarticular Arthritis of the Hand and Wrist. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.04.010

[7] Patterns of osteoarthritis of the wrist: a single-centre observational cohort study. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241275450

[8] Prediction of Wrist Prognosis in Patients With Early Rheumatoid Arthritis According to Radiographic Classification. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.01.016

[9] Clinical Outcomes of Total Wrist Arthroplasty in Patients With Rheumatoid Arthritis: Minimum 10-Year Follow-Up Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.03.002

[10] Four-Corner Fusion and Scaphoid Excision Using Headless Compression Screws for SLAC and SNAC Wrist Deformities. Techniques in Hand & Upper Extremity Surgery. 2011. DOI: 10.1097/bth.0b013e3181f60fec

[11] Comparing radial styloid size between osteoarthritic and healthy wrists: a pathoanatomical three-dimensional study. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416669261

[12] Midterm Patient-Reported Outcomes in Wrist Denervation for Post-Traumatic Arthritis. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.02.023

[13] Surgical Management of Wrist Arthritis Is Linked to Increased Carpal Tunnel Syndrome/Carpal Tunnel Release Risk: Rethinking Preoperative Evaluation. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.013

[14] Patient satisfaction and outcomes of partial wrist denervation in inflammatory arthritis. Clinical Rheumatology. 2019. DOI: 10.1007/s10067-019-04645-8

[15] Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist. HAND. 2016. DOI: 10.1177/1558944716681949

[16] Prevalence and Associated Factors for Primary Osteoarthritis of the Scaphotrapeziotrapezoid, Radiocarpal, and Distal Radioulnar Joints in the Japanese General Elderly Population. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.05.009

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[18] Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis. Journal of Wrist Surgery. 2018. DOI: 10.1055/s-0038-1646956

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