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Osteoarthritis ng Pulso

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Wrist osteoarthritis — understanding symptoms, non-surgical options, and when wrist replacement might be considered.

Updated Aug 2026
Isang guhit-kamay na ilustrasyon ng isang walang mukhang tao na may matigas at masakit na pulso, na nahihirapan buksan ang takip ng bote.
Osteoarthritis ng pulso, na may pagkawala ng normal na espasyo ng kasu-kasuan. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Maaaring mararamdaman mo ang malalim at masakit na pananakit sa iyong pulso. Karaniwang dulot ito ng arthritis na sanhi ng pagkasira o paggamat ng cartilage na nagsisilbing cushion sa pagitan ng iyong mga buto. Karaniwang nasa gitna ng pulso o sa gilid ng hinlalaki ang sakit. Madalas itong lumala kapag gumagamit ng iyong kamay para sa mga pang-araw-araw na gawain.

Ang mga simpleng galaw ay maaaring maging mahirap. Maaaring mahirapan kang hawakan nang mahigpit ang mga bagay o ikutin ang hawakan ng pinto. Ang pag-abot sa likod upang isara ang bra ay maaaring maging matigas at masakit. Ang pagtupi ng damit ay maaaring nangangailangan ng paggalaw ng buong braso mo imbes na ang pulso lamang. Ang pag-angat ng kahit magagaan na mga bagay, tulad ng kettle o bag ng mga bilihin, ay maaaring magdulot ng matulis na panghihina.

Madalas na lumalala ang sakit pagkatapos ng aktibidad. Maaaring mapansin mo na mas malakas ang pulso sa gabi pagkatapos ng mahabang araw ng paggamit ng iyong mga kamay. May mga taong nakakakita na nakakatulong ang pagpahinga ng kanilang pulso sa isang unan upang bawasan ang pananakit. Gayunpaman, ang katigasan ay isa ring pangunahing bahagi ng karanasan. Maaaring maging partikular na matigas at mahirap galawin ang iyong pulso kapag gising ka pa lang sa umaga. Karaniwang bahagyang nagluluwag ang katigasan sa umaga habang gumagalaw ka, ngunit maaari itong bumalik kung magpapahinga ka nang masyado.

Mahirap ang pagtulog dahil sa sakit na ito. Maraming pasyente ang nakakakita na hindi nila makahiga sa kanilang gilid nang walang paglalagay ng presyon sa apektadong pulso. Maaaring ikulog at ikulog ang kama, sinusubukan mong hanapin ang posisyon na hindi nagpapalala sa kasukasuan. Ang kakulangan sa payapang tulog ay maaaring mag-iiwan sa iyo ng pagkapagod at pagkabigo sa araw.

Karaniwan ang pakiramdam ng pagkagiling o pagdinig ng tunog ng pag-click kapag gumagalaw ang iyong pulso. Ito ang buto na kumikiskis sa buto kung saan nawala ang protektibong cartilage. Bagama't maaaring nakakatakot ito, ito ay isang karaniwang senyales ng advanced na arthritis. Ang pag-unawa sa mga sintomas na ito ay nakakatulong sa amin na magplano ng iyong pag-aalaga. Gusto naming matiyak na naririnig at sinusuportahan ka habang pinag-uusapan natin ang pinakamainam na landas para sa iyong partikular na sitwasyon.

Ano ang nangyayari talaga

Ang iyong pulso ay binubuo ng walong maliit na buto na magkasamang nakapaloob. Sa osteoarthritis, ang makinis na cartilage na nakabalot sa mga butong ito ay unti-unting nawawala. Isipin ang cartilage bilang shock absorber o gasket. Kung wala ito, ang mga buto ay magkaka-igihan. Ito ang nagdudulot ng sakit, stiffness, at pamamaga.

Ang wear-and-tear arthritis ay madalas na nagsisimula sa mga partikular na lugar. Maaari itong magsimula kung saan ang iyong forearms ay nagtatagpo sa pulso, o sa pagitan ng mga maliit na carpal bones. Habang ang ibabaw ng kasukasuan ay lumalala, nawawala ng natural na galaw ang iyong pulso. Maaaring maranasan mo ang pakiramdam ng pagkagiling o pagkakadikit kapag gumagalaw ka. Ang mga simpleng gawain tulad ng pag-ikot ng doorknob ay nagiging mahirap.

Ipinapaliwanag ng iyong surgeon na ang pinsalang ito ay nagbabago ng paraan ng paggalaw ng iyong pulso. Halimbawa, ang isang teknik na tinatawag na four-corner arthrodesis ay nagbabago ng posisyon ng ilang mga buto. Ang pagbabagong ito ay maaaring magdagdag ng stress sa natitirang mga kasukasuan. Sa paglipas ng panahon, ang dagdag na stress na ito ay maaaring magdulot ng karagdagang pagkasira sa mga lugar na iyon.

Alam namin na walang operasyon ang maaaring ibalik ang iyong pulso sa orihinal, perpektong estado. Ang bawat opsyon ay may mga trade-offs. Ang mga fusion procedures ay limitado ang galaw upang bawasan ang sakit. Ang joint replacement ay layuning panatilihin ang paggalaw ngunit may mas mataas na mga panganib. Ang iyong surgeon ay talakayin kung aling landas ang angkop sa iyong pang-araw-araw na pangangailangan at antas ng aktibidad.

Ang layunin ay pigilan ang sakit at bigyan ka ng matatag na pulso. Maaari kang mawalan ng ilang range of motion, ngunit nakakuha ka ng reliability. Maraming pasyente ang nakikita na ang trade-off ay worth it para sa pagpapagaan ng sakit. Nakatuon kami sa pagtulong sa iyo na bumalik sa iyong pang-araw-araw na buhay na may mas kaunting discomfort.

Ano ang maaari naming gawin dito

Si Dr. Kieran Hirpara, isang surgeon sa itaas na bahagi ng katawan sa Mater Private Hospital Rockhampton, ay tumutugon dito sa aming klinika sa pamamagitan ng pagtuon sa iyong mga partikular na pangangailangan. Dumadating ang mga pasyente sa aming klinika sa pamamagitan ng referral mula sa GP o physiotherapist. Isang pagsusuri sa klinika (kasaysayan, pagsusuri, at pag-imaging kung kinakailangan) ang nagtatatag ng diagnosis. Para sa mga dehenratibo o matagal nang problema, karaniwan naming sinusubukan ang non-operative na paggamot — pagbabago ng aktibidad, physiotherapy o hand therapy, paggamit ng splint, at mga injeksyon — at pinag-aaralan ang operasyon kapag hindi ito nagbigay ng sapat na pagpapabuti. Para sa mga structural o acute na problema, maaaring irekomenda ang operasyon agad, nang walang nakaraang non-operative na pagsubok.

Maaari kang magsimula sa pagbabago ng paraan ng paggamit ng iyong kamay. Inirerekomenda namin na iwasan ang mabigat na pagbuhat o paulit-ulit na pagkapit na nagdudulot ng sakit. Isang physiotherapist ang matututuro sa iyo ng mga ehersisyo upang panatilihin ang mobility ng iyong pulso at palakasin ang mga kasamang kalamnan. Ang mga splint ay maaaring sumuporta sa kasukasuan sa panahon ng mga pang-araw-araw na gawain. Karaniwan naming inirerekomenda na bigyan ang ganitong pamamaraan ng ilang linggo upang magtrabaho. Kung patuloy ang iyong sakit, maaari naming imungkahi ang gamot. Ang mga over-the-counter na pain relievers o anti-inflammatories ay makakatulong sa pamamahala ng hindi komportableng pakiramdam. Sa ilang kaso, nag-aalok kami ng mga injeksyon sa loob ng kasukasuan. Ang mga cortisone injections ay nagbabawas ng pamamaga at sakit para sa isang limitadong panahon. Ang mga hyaluronic acid o PRP injections ay naglalayong magbigay ng cushion sa kasukasuan, bagaman magkakaiba ang mga epekto. Ang mga paggamot na ito ay hindi nagbabalik ng arthritis ngunit maaaring mapabuti ang iyong kumportableng pakiramdam at function.

Ang operasyon ay itinuturing kapag ang conservative na paggamot ay hindi nagbigay ng sapat na pagpapabuti. Ang layunin ay bawasan ang sakit at ibalik ang stability. Ang mga opsyon ay kasama ang fusion, na nag-uugnay ng mga buto upang pigilan ang masakit na galaw, o replacement, na palitan ang mga nasirang ibabaw ng mga artificial na bahagi. Pinipili namin ang pinakamainam na opsyon batay sa partikular na kasukasuang kasangkot, sa iyong mga pangangailangan, at sa panganib ng mga komplikasyon. Walang iisang piniling opsyon para sa wrist osteoarthritis sa karamihan ng mga sitwasyon. Pinag-uusapan namin ang mga pagpipilian na ito sa iyo upang makabuo ng shared na desisyon.

Ano ang inaasahan

Ang iyong pulso ay malamang na maramdaman na matigas at masakit sa loob ng ilang linggo o buwan pagkatapos ng paggamot. Ang pagpapagaan ng sakit ang pinakakaraniwang layunin, at ang karamihan sa mga tao ay nakakakita ng malaking pagbaba ng kanilang mga sintomas na may tamang alaga. Kung walang paggamot, ang osteoarthritis na dulot ng pagkasira ay karaniwang nananatili o dahan-dahang lumalala sa paglipas ng panahon. Ang iyong mga sintomas ay maaaring umalis at bumalik, ngunit ang pinagmulang pinsala sa kasukasuan ay karaniwang umaunlad.

Kung pipili ka ng wrist fusion (pagkakaisa ng pulso), maaari kang maghanda sa maaasahang pagpapagaan ng sakit. Ang prosedurang ito ang pinakakaraniwang opsyon para sa pagliligtas sa severe arthritis (matinding osteoarthritis). Ito ay nagtatabili ng kasukasuan at nagpapababa ng kapansanan. Gayunpaman, limitado nito ang galaw ng iyong pulso sa lahat ng direksyon. Hindi mo maibabalik ang ganap na buong pag-andar ng iyong pulso. Karaniwang umuunlad ang iyong lakas ng hawak, ngunit baba ang saklaw ng iyong paggalaw.

Kung pipili ka ng joint replacement (palitan ng kasukasuan), ang layunin ay mas malaking galaw. Ang opsyong ito ay may mas mataas na panganib ng mga komplikasyon kaysa sa fusion. Maaari kang harapin ang mga isyu tulad ng pagkaluwag o ang pangangailangan para sa karagdagang operasyon. Kung mabigo ang palitan, ang paglipat sa fusion ay isang ligtas at epektibong backup na plano. Ang operasyong pangliligtas na ito ay maaasahan na nagpapabuti ng pag-andar at nagbibigay ng malaking pagpapagaan ng sakit. Sa kabilang banda, kung mabigo ang fusion, ang paglipat sa modernong palitan ay feasible (mungkahi) din.

Ang paggaling ay kinabibilangan ng isang panahon ng limitadong aktibidad. Ang pagsimula ng banayad na paggalaw nang maaga ay tumutulong sa iyo na mabawi ang functional motion (pag-andar na paggalaw) nang mas mabilis. Kailangan mo ng mas kaunting bisita sa therapy kung magsisimula ka nang maaga. Ang karamihan sa mga tao ay bumabalik sa mga pang-araw-araw na gawain na may babaang sakit, ngunit may ilang limitasyon na nananatili. Tinatayang 20% ng mga pasyente ay nananatiling hindi nasisiyahan sa kanilang resulta, habang 86% ay bumabalik sa buong tungkulin. Ang iyong surgeon (kirurgo) ay tutulong sa iyo na bigyang-kahulugan ang trade-off (balanse) sa pagitan ng galaw at katatagan. Ang desisyon ay nakadepende sa iyong antas ng aktibidad at paghahanda na tanggapin ang mga posibleng panganib sa revision (pagbabago).

Kailan makipag-ugnayan sa isang doktor

Kumonsulta sa iyong doktor kung mayroon kang patuloy na sakit sa pulso na hindi gumagaling kahit magpahinga. Humingi ng pagsusuri ng espesyalista kung napapansin mo ang kahinaan, kawalan ng katatagan, o pakiramdam ng pagkakabara o pagbagsak. Maaaring makagambala ang mga sintomas na ito sa iyong tulog o trabaho. Humingi ng tulong para sa anumang biglaang paglala ng iyong kondisyon. Susuriin ng iyong doktor kung mayroon kang arthritis na dulot ng pagkasira. Tatalakayin nila kung ang pagsasama ng pulso o pagpapalit ng kasukasuan ang angkop para sa iyo. Magkaroon ng kaalaman na parehong mayroong mga panganib ang dalawang opsyon. Ang pagsasama ng pulso ay nag-aalok ng maaasahang pagpapagaan ng sakit ngunit limitado ang galaw. Ang pagpapalit ng kasukasuan ay pinapanatili ang galaw ngunit may mas mataas na rate ng komplikasyon. Gabayin ka ng iyong doktor sa mga pagpipiliang ito batay sa iyong tiyak na pangangailangan.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

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

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[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

[17] Radioscapholunate Fusion for Radiocarpal Osteoarthritis: Prognostic Factors of Clinical and Radiographic Outcomes. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1688939

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

[19] Clinical Outcomes of Arthrodesis and Arthroplasty for the Treatment of Posttraumatic Wrist Arthritis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.013

[20] Classifications in Brief: Watson and Ballet Classification of Scapholunate Advanced Collapse Wrist Arthritis. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000451

[21] Arthrodesis of the Wrist with Bioabsorbable Fixation in Patients with Rheumatoid Arthritis. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0806

[23] Long‐term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis. International Journal of Rheumatic Diseases. 2018. DOI: 10.1111/1756-185x.13340

[24] Revision rate and long-term outcome after partial wrist denervation in wrist osteoarthritis. Journal of Hand Surgery (European Volume). 2026. DOI: 10.1177/17531934261425490

[25] The treatment of arthritis of the wrist. The Bone & Joint Journal. 2015. DOI: 10.1302/0301-620x.97b10.35717

[26] A Minimal Wrist Arthroplasty for Early Wrist Osteoarthritis. Journal of Wrist Surgery. 2013. DOI: 10.1055/s-0033-1338255

[27] Reproducibility of radiographic classification of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413484629

[28] Scaphoid Nonunion Advanced Collapse Classifications: A Reliability Study. Journal of Hand and Microsurgery. 2012. DOI: 10.1007/s12593-012-0062-2

[29] Collaboration in Hand Surgery: Experiences From Silicone Arthroplasty in Rheumatoid Arthritis, Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness, Wrist and Radius Injury Surgical Trial, and Surgery of the Ulnar Nerve. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-20-00102

[30] A Reliability Study of Multiplanar Radiographs for the Evaluation of SNAC Wrist Arthritis. HAND. 2020. DOI: 10.1177/1558944720937359

[31] Delayed-Onset Ulnar Neuropathy at the Wrist Associated With Distal Radioulnar Joint Arthritis After Radius Malunion: Report of Two Cases. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.11.005

[34] Computer-aided three-dimensional analysis of carpal alignment in scaphoid nonunion advanced collapse wrists: A comparative study with scapholunate advanced collapse and healthy wrists. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08652-6

[36] Update on the surgical treatment for rheumatoid arthritis of the wrist and hand. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.12.002

[39] Long-term effects of neuromuscular exercise therapy and the need for surgical conversion in wrist osteoarthritis: 24-month results from a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09463-5

[40] Impairment of electrical activation of wrist flexor and extensor muscles during gripping and functional activities in the early stage of hand osteoarthritis: A cross-sectional study. Journal of Hand Therapy. 2021. DOI: 10.1016/j.jht.2019.12.010

[44] The Simmen Classification of Wrist Destruction in Rheumatoid Arthritis. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0196

[46] Proximal Row Carpectomy Versus Four-Corner Arthrodesis as a Treatment for SLAC (Scapholunate Advanced Collapse) Wrist. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408087116

[49] Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography. Arthritis Research & Therapy. 2008. DOI: 10.1186/ar2378

[50] Joint Space Height Correlates with Arthroscopic Grading of Wrist Arthritis. HAND. 2013. DOI: 10.1007/s11552-013-9522-9

[51] Long-Term Results of Arthroscopic Wrist Synovectomy in Rheumatoid Arthritis. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.022

[52] Quantitative 3-D CT Demonstrates Distal Row Pronation and Translation and Radiolunate Arthritis in the SNAC Wrist. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.22.01350

[53] Validity of a computer-assisted manual segmentation software to quantify wrist erosion volume using computed tomography scans in rheumatoid arthritis. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-265

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