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Education · wrist

Wrist Osteoarthritis Info In-depth Evidence

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

What you're feeling

You may notice a deep ache in your wrist that lingers after you have used your hand. This pain often feels worse when you try to lift heavy objects or push against resistance. Simple tasks like opening a jar, turning a key, or lifting a kettle can become difficult and painful. You might find that gripping things tightly causes sharp discomfort or weakness in your hand.

The stiffness in your wrist is likely most noticeable when you first wake up in the morning. It can take some time for the joint to loosen up as you start your day. You may also feel pain at night, which can disturb your sleep if you roll onto that arm. The discomfort tends to flare up after periods of activity, such as typing, gardening, or doing household chores. Resting your hand usually helps to ease the ache, but the stiffness often returns with movement.

As the wear-and-tear arthritis progresses, you might notice a grinding sensation or sound when you move your wrist. This is caused by the bones rubbing together where the protective cartilage has worn away. Your wrist may also feel less stable, making it harder to perform precise movements. You might avoid using your hand for certain tasks to prevent pain, which can lead to weakness in your fingers and forearm over time.

If you have rheumatoid arthritis, the pain and swelling may be more severe, especially if the joint is unstable or damaged. In these cases, the discomfort can be constant and interfere with daily life more significantly. You may also experience reduced range of motion, making it hard to bend or straighten your wrist fully. This limitation can affect how you hold objects or support your body weight when standing up from a chair.

It is important to understand that these symptoms vary from person to person. Some people find that over-the-counter pain relief helps manage the discomfort, while others may need more targeted treatment. Your surgeon will assess the severity of your symptoms and the condition of your joint to recommend the best course of action. Whether you are considering wrist fusion or joint replacement, understanding your current symptoms helps in planning your care.

What's actually happening

Your wrist is a complex cluster of small bones that slide against each other to give you movement. In osteoarthritis, the smooth cartilage lining these bones wears away. Think of this cartilage as the shock absorber in your car. When it thins out, the bones rub directly against one another. This friction causes pain and stiffness, making everyday tasks like turning a doorknob or lifting a cup difficult.

As the wear-and-tear progresses, the joint structure changes. The bones may shift slightly out of their normal alignment. This alters how force travels through your wrist. You might feel a grinding sensation or notice swelling. These changes are your body’s response to the instability and increased pressure on the joint surfaces.

Your surgeon explains that this process is often gradual. Over time, the joint becomes less flexible and more painful. In some cases, the damage is severe enough that the joint becomes unstable. This is why you might experience weakness or a feeling of the wrist giving way. The goal of treatment is to address this mechanical breakdown.

We discuss two main paths forward. One option is to fuse the bones together. This removes the painful moving parts by creating a single, solid bone. It stops the pain but limits motion. The other option is joint replacement. This keeps some movement but carries different risks. The choice depends on your specific joint damage and daily needs.

No treatment can fully restore the wrist to its original, perfect state. However, we can significantly reduce pain and improve function. Understanding what is happening inside your wrist helps you make an informed decision. It allows us to tailor a plan that fits your lifestyle and expectations.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. We begin by helping you manage pain and keep your wrist moving. Simple changes to your daily activities can reduce strain on the joint. Physiotherapy or hand therapy aims to strengthen the muscles around your wrist and improve flexibility. We usually recommend giving this approach a fair try for several weeks to see if it provides enough relief.

If gentle movement and rest are not enough, we look at medical management. This may include pain relief medication or anti-inflammatories to calm the swelling and discomfort in your joint. We can also offer injections into the wrist. Cortisone injections reduce inflammation and can provide pain relief for a period of time, though the effect is temporary. Other options like hyaluronic acid or platelet-rich plasma (PRP) injections may be discussed to help lubricate the joint or support healing, depending on what is right for you.

We consider surgery when non-operative care has not given you enough improvement. Surgical options such as fusion or joint replacement are selected based on the specific joint involved, your personal demands, and the risk of complications. There is no single preferred option for everyone, so we discuss the best path for your unique situation. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment (history, examination, and imaging where needed) establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, physiotherapy or hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement.

What to expect

Your wrist will likely settle into a stable, pain-free state, though it will not move as it did before. Total wrist fusion is the most common approach for severe wear-and-tear arthritis. It reliably reduces pain and restores grip strength. You can expect good functional outcomes, particularly if your arthritis is at an advanced stage. While you will regain the ability to use your hand for daily tasks, no procedure can restore entirely full wrist function. You will notice a reduction in disability, but some stiffness will remain.

If you have had a joint replacement that fails, conversion to fusion is a safe and effective option. This salvage technique reliably improves wrist function compared to living with a failed implant. Similarly, if fusion is considered in the future, conversion back to a modern joint replacement is feasible. This can yield significant pain relief and stable implants. The decision between these paths depends on your activity levels and your willingness to accept different risks. Fusion offers predictable stability, while replacement aims for more motion but carries higher complication rates.

Without treatment, pain and stiffness often persist or worsen as the joint surface deteriorates. Managing the condition well typically involves accepting limited motion in exchange for comfort. You may require therapy to regain functional range of motion in your forearm and wrist. Starting this early helps you recover function sooner with fewer visits. Some patients experience radiographic changes over time, but clinical results often remain good. You should anticipate a gradual improvement in your ability to perform daily activities. The goal is a stable wrist that supports your hand function, rather than a fully mobile joint. Your surgeon will guide you toward the approach that best balances pain relief with your specific functional needs.

When to see someone

Ask for a specialist review if you have persistent wrist pain that does not improve with rest. Seek help if you notice weakness, instability, or a locking sensation. Symptoms that interfere with sleep or work also warrant assessment. Sudden worsening of pain is another clear sign to act. Your surgeon will evaluate these issues to determine the best path forward. This may involve discussing options like wrist fusion or joint replacement. These procedures aim to relieve pain and restore function. Early consultation helps manage symptoms effectively and prevents further joint damage.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Wrist osteoarthritis is worth the extra reading because it contains one of the clearest examples in hand surgery of a sensible-sounding idea that made outcomes worse — and because the choice between fusing and replacing the joint is closer than it is usually presented.

Cutting more nerves makes the result worse, not better

Wrist denervation treats pain without altering the joint. The nerve branches carrying pain sensation from the wrist capsule are divided, leaving the joint mechanically unchanged. It preserves movement and does not preclude anything later, which makes it an attractive option.

The commonest version divides the posterior interosseous nerve alone. Since the anterior interosseous nerve also supplies the capsule, dividing both should logically give more complete relief.

It does not. Across 325 patients, anterior plus posterior interosseous neurectomy does not offer greater advantages compared with isolated posterior neurectomy — and, more strikingly, the combined procedure seems to be associated with a paradoxical increase in the failure rate [1].

An intervention that does more and achieves less is worth pausing on. Whatever the mechanism, the finding is a caution against reasoning from anatomy to outcome, which is exactly the kind of reasoning that makes the combined operation sound better.

The broader evidence for denervation itself is encouraging but soft: a trend towards positive outcomes for pain relief, return to work and satisfaction, with heterogeneity across the literature and a call for standardised outcome reporting [2].

Fusion and replacement are closer than they sound

For advanced arthritis, the two definitive options are presented as opposites: fuse the wrist and lose all movement, or replace it and keep some. The evidence puts them nearer together than that framing suggests.

Across 961 patients, both wrist arthrodesis and wrist arthroplasty were effective at alleviating pain and improving grip strength, with comparable complication rates of 17% and 19% — functional improvement was observed after arthroplasty, but robust long-term follow-up data for replacement were lacking [3]. A network meta-analysis of 359 patients found replacement significantly improved DASH, pain and PRWE scores against pre-operative values in both inflammatory and non-inflammatory arthritis [4].

So both work, and both carry roughly a one-in-five complication rate. The real difference lies in what each leaves you with and how it fails. A fusion is durable and predictable, and its failure mode is nonunion — a defined problem with a defined solution. A replacement preserves motion, and its failure mode is loosening over years, in a joint at the end of a long lever with limited bone stock for revision.

The long-term data gap is the honest limitation, and it is the reason age and demand weigh so heavily: a wrist replacement needs to outlive the person's need for it.

Union rates after fusion are reliable

Where fusion is chosen, the technical variations do not appear to matter much. Across 3,517 patients, there was no difference in union or complication prevalence between total wrist arthrodesis techniques, or between different treatments of the carpometacarpal joint — though the authors note the included studies were of low quality with high heterogeneity, limiting confidence [5].

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

References for the advanced reading
  1. Fidanza A, Necozione S, Garagnani L. Does anterior plus posterior interosseus neurectomy lead to better outcomes than isolated posterior interosseus neurectomy? A systematic review and meta-analysis. EFORT Open Rev. 2023;8(3):110-6.
  2. Chin KWTK, Engelsman AF, van Gulik TM, Strackee SD. Selective denervation of the wrist for chronic pain: a systematic literature review. J Hand Surg Eur Vol. 2019;45(3):265-72.
  3. Zhu XM, Perera E, Gohal C, Dennis B, Khan M, Alolabi B. A systematic review of outcomes of wrist arthrodesis and wrist arthroplasty in patients with wrist arthritis. J Hand Surg Eur Vol. 2020;46(3):297-303.
  4. Chong HH, Zabaglo M, Asif A, Boksh K, Kulkarni K. A systematic review and network meta-analysis of outcomes after total wrist arthroplasty. J Hand Surg Eur Vol. 2023;49(1):17-24.
  5. Owen DH, Booth JW, Agius PA, Perriman DM, Smith PN, Roberts CJ. Union and complication rates after total wrist arthrodesis: a systematic review and meta-analysis. J Hand Surg Am. 2025;50(4):508.e1-508.e12.
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

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