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Arthritis and Joint Degeneration

Wrist and TMC osteoarthritis — management of primary and post-traumatic degeneration (SLAC/SNAC), from conservative therapy to surgical salvage.

120 citationsUpdated Sep 2026

Overview

Osteoarthritis is a degenerative joint disease where current non-surgical managements do not alter the clinical course or arrest progression [6]. Radiographic evidence does not necessarily correlate with poor function [3], and experts recommend a stepwise approach starting with nonoperative treatment, followed by joint-preserving arthroscopic procedures for selected patients, and reserving joint replacement or resurfacing for cases where less invasive options fail [12]. Joint replacement is indicated for end-stage disease [6]. While early results indicate satisfactory short-term outcomes for joint preservation procedures, these have yet to show they can halt arthritic progression [1]. Joint replacement procedures relieve pain and improve function more than other current operative treatments but are limited by the inability of synthetic materials to duplicate the properties of articular cartilage [54]. Procedures that restore rather than replace the joint may offer advantages for young patients or those with less advanced disease [54].

Specific surgical indications vary by joint and patient profile. Autologous distal femoral condylar osteochondral grafting is an efficacious and particularly safe alternative in the short term for young patients with concerns about arthroplasty [23]. Shoulder hemiarthroplasty provides sustained good-to-excellent pain relief and functional improvement at five to ten years postoperatively in carefully selected patients with osteoarthritis [61]. Inflammatory arthritis remains the most common indication for total elbow arthroplasty in recent years, accompanied by an increase in the incidence of revision surgery [8]. For rheumatoid arthritis of the wrist, arthroplasty should be the preferred treatment over arthrodesis based on its higher expected gain in QALYs, though the minimal increase in utility suggests surgeons do not view arthroplasty as superior [122]. Surgical treatment of wrist osteoarthritis aims to eliminate pain while preserving motion in adjacent joints, with the specific procedure chosen based on the location of arthritis and patient factors [17].

Outcomes for specific joint interventions demonstrate varied efficacy. Proximal-row carpectomy should be considered after conservative measures fail, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur [27]. The Silastic replacement of the trapezium remains a good option for patients with painful trapeziometacarpal osteoarthritis that has not responded to nonoperative treatment [13]. Functional outcomes for thumb carpometacarpal joint prosthetic total joint replacement look promising compared to resection arthroplasty, but failure in terms of loosening and dislocation remains a concern [29]. With an implant survivorship of 90% at an average of 10 years postoperatively, silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic proximal interphalangeal joint [35]. Both arthroscopic and open approaches can result in excellent clinical outcomes for patients with symptomatic sternoclavicular arthritis [34].

Anatomy & Pathophysiology

Bony Anatomy

The wrist is the anatomic region between the forearm and the hand, encompassing the distal radioulnar, radiocarpal, and ulnocarpal joints along with eight carpal bones [71]. These bones are divided into a proximal row (scaphoid, lunate, triquetrum, pisiform) and a distal row (trapezium, trapezoid, capitate, hamate) [71]. The radiocarpal joints form where the distal radius articulates with the scaphoid and lunate via concave facets, while the triquetrum articulates with the triangular fibrocartilage [71]. The distal concave surfaces of the proximal row create midcarpal articulations with the distal row [71].

The distal radius features three articular components: the scaphoid and lunate fossae distally, and the sigmoid notch medially for ulnar articulation [75]. A ridge separates the scaphoid and lunate fossae, corresponding to the scapholunate interval [75]. The concave elliptical distal radius is oriented with an average 11-degree volar tilt in the sagittal plane and a 23-degree radial inclination in the frontal plane [75]. Radial length, measured from the radial styloid tip to the ulnar articular surface, averages 13 mm [75]. The scaphoid and lunate facets are separated by the scapholunate, or anterior-posterior, ridge [78]. The sigmoid notch along the ulnar border is a shallow concavity accommodating the ulnar head at the distal radioulnar joint [78].

The distal ulna is covered with hyaline cartilage on its dorsal, lateral, palmar, and distal surfaces [78]. The ulnar styloid projects distally, with the fovea at its base serving as the insertion site for the triangular fibrocartilaginous complex (TFCC) [78]. The distal ulnar convexity articulates at the lesser sigmoid notch of the distal radius, where the articular surface accommodates the ulnar head through two-thirds of its arc [71]. There is approximately a 20-degree inclination of the distal ulna at its articulation with the radius [71].

The scaphoid receives its primary vascular supply from a branch of the radial artery at the dorsal ridge, with smaller vessels entering the palmar tubercle to supply the distal 30% [78]. The lunate is broader palmarly than dorsally and possesses both dorsal and palmar vascular supplies in 80% of wrists, while 20% have only a palmar supply [78]. The triquetrum articulates distally with the hamate, radially with the lunate, and volarly with the pisiform [78]. It is stabilized to the ulnar fovea by the ulnotriquetral ligament [78]. The hamate consists of a body and a hook (hamulus), which serves as an attachment for the transverse carpal ligament and origins for the flexor digiti minimi and opponens digiti minimi [78].

The head of the capitate often relies on a retrograde vascular supply [78]. Two ridges separate its distal articular surface into three facets for articulation with the index, long, and ring finger metacarpals [78]. The trapezoid has two distal facets articulating with the index finger metacarpal [78]. The trapezium features a saddle-shaped articulation with the thumb metacarpal base and a palmar groove for the flexor carpi radialis (FCR), bordered laterally by a palmar tuberosity and the transverse carpal ligament attachment [78]. The pisiform is a sesamoid bone within the flexor carpi ulnaris (FCU) tendon and serves as the origin for the abductor digiti minimi [78].

Vascular Supply

The terminal branches of the radial, ulnar, and anterior interosseous arteries provide extraosseous blood supply to the carpus through three dorsal and three palmar transverse arterial arches with longitudinal connections [81]. The dorsal radiocarpal arch is located at the radiocarpal joint and supplies the lunate and triquetrum [81]. The dorsal intercarpal arch, the largest dorsal arch, lies between the proximal and distal carpal rows, supplying the distal row and, via anastomoses with the radiocarpal arch, the lunate and triquetrum [81]. The basal metacarpal arch is located at the metacarpal bases, is the most variable dorsal arch, and supplies the distal carpal row [81].

The palmar radiocarpal arch is situated at the radiocarpal joint level on the palmar surfaces of the lunate and triquetrum [81]. The palmar intercarpal arch lies between the carpal rows, is the most variable palmar arch, and does not contribute to nutrient vessels in the carpus [81]. The deep palmar arch is located at the metacarpal bases, is consistent, and communicates with the dorsal basal metacarpal arch and palmar metacarpal arteries [81].

Ligaments

The chondroligamentous supports attaching the distal radius and ulnar carpus to the distal ulna constitute the triangular fibrocartilage complex (TFCC) [71]. The TFCC includes the ulnar collateral ligament, dorsal and volar radioulnar ligaments, articular disc, meniscal homologue, extensor carpi ulnaris sheath, and ulnolunate and ulnotriquetral ligaments [71]. Specifically, the TFCC is formed by the central meniscus homolog, dorsal and volar radioulnar ligaments, the floor of the extensor carpi ulnaris (ECU) tendon sheath, and volar ulnocarpal ligaments [78]. It arises from the radial border of the distal radius and inserts into the base of the ulnar styloid and distal ulna through the ligamentum subcruentum [78]. The dorsal and volar radioulnar ligaments are the primary stabilizers of the distal radioulnar joint [78]. Only the peripheral 10% to 40% of the volar, ulnar, and dorsal TFCC has a vascular supply [78].

Interosseous ligaments connect the proximal carpal row via the scapholunate and lunotriquetral interosseous ligaments, and the distal row via ligaments connecting the trapezium to trapezoid, trapezoid to capitate, and capitate to hamate [71]. Extrinsic or crossing ligaments include the radial collateral ligament from the radial styloid to the scaphoid waist, the ulnar collateral ligament from the ulnar styloid base to the pisiform, and the transverse carpal ligament [71]. Volar extrinsic ligaments include the radioscapocapitate, radiolunotriquetral, and radioscapolunate ligaments on the radial side, and the ulnolunate and ulnotriquetral components of the TFCC on the ulnar side [71].

The dorsal radiocarpal ligament attaches along the dorsal radial articular margin of the lunate fossa, from the Lister tubercle to the lesser sigmoid notch [71]. It spans the lunotriquetral joint and inserts on the dorsal surface of the triquetrum [71]. The dorsal intercarpal ligament attaches to the distal, dorsal surface of the triquetrum and passes across the midcarpal joint to attach to the dorsal surfaces of the scaphoid waist and trapezoid [71]. Extrinsic carpal ligaments connect the radius or ulna to the carpus, with volar ligaments generally stronger than dorsal ligaments [76].

The radioscaphocapitate (RSC) ligament connects to the scaphoid waist, limiting ulnar translation of the carpus [76]. The long radiolunate ligament helps limit ulnar translocation, while the short radiolunate ligament controls lunate position [76]. The radioscapholunate ligament is a vascular conduit, not a true ligament, also known as the ligament of Testut [76]. The ulnolunate ligament attaches to the palmar radioulnar ligament and lunate [76]. The ulnocapitate ligament attaches to the ulnar head, originates from the volar margin of the ulnar fovea, and is the most superficial ulnocarpal ligament [76]. The ulnotriquetral ligament attaches to the palmar radioulnar ligament and triquetrum [76].

The dorsal radiocarpal ligament (DRC), or dorsal radiotriquetral ligament, has a trapezoidal shape passing from the dorsal rim of the distal radius to the lunate and triquetrum [76]. Fibers of the DRC insert onto the dorsal lunotriquetral interosseous ligament (LTIL) [76]. The scapholunate interosseous ligament (SLIL) is a major wrist stabilizer and the most commonly injured wrist ligament [76]. The SLIL is C-shaped, consisting of dorsal, palmar, and interosseous portions, with the dorsal portion being the strongest and thickest [76]. It provides a flexion force on the lunate due to its attachment to the scaphoid [76]. The LTIL is also C-shaped, with the volar portion being the thickest and strongest, providing an extension moment on the lunate via its attachment to the triquetrum [76].

The capitohamate ligament is a thick ligament, 5 × 5 mm in cross section, with extensions to the third or fourth metacarpals [76]. The dorsal intercarpal ligament (DIC) passes from the dorsal tubercle of the triquetrum to the distal pole of the scaphoid [76]. Along with the DRC, the DIC reinforces the elastic dorsal wrist capsule and helps stabilize the scapholunate articulation, contributing to the dorsal SLIL via deep fibers [76]. The space of Poirier is a relatively thin area on the palmar side of the carpus, between the radiolunotriquetral and radioscapocapitate ligaments, overlying the palmar surface of the lunate [71]. It is an area adjacent to the proximal capitate without ligamentous attachment, situated ulnar to the RSC ligament and radial to the long radiolunate in the floor of the carpal tunnel [76]. This weak area is vulnerable to instability; during a perilunate dislocation, the distal carpal row separates from the lunate through this space [76].

Specific extrinsic ligament origins and insertions include: the radial collateral ligament originating at the radius (0 mm from radial styloid) and inserting at the scaphoid waist and distal palmar trapezium [78]; the radioscaphocapitate ligament originating at the radius (4 mm from radial styloid) and inserting at the scaphoid waist and midpalmar capitate [78]; the radiolunatotriquetral ligament originating at the radius (10 mm from radial styloid) and inserting at the lunate ± triquetrum [78]; the radioscapholunate ligament originating at the mesocapsule with termination of the anterior interosseous nerve and artery and inserting at the ligament of Testut and Kuenz [78]; the short radiolunate ligament originating at the volar-ulnar margin of the radius and inserting at the lunate [78]; the ulnotriquetral ligament originating at the volar radioulnar ligament and inserting at the triquetrum [78]; the ulnolunate ligament originating at the volar radioulnar ligament and inserting at the lunate [78]; the ulnocapitate ligament originating at the volar margin of the ulnar head and inserting at the capitate [78]; the dorsal radiocarpal ligament originating at the dorsal radius at the Lister tubercle and inserting at the lunate and triquetrum [78]; and the dorsal intercarpal ligament originating at the triquetrum and inserting at the scaphoid, trapezoid, and capitate [78]. The extrinsic wrist ligaments include the dorsal intercarpal and dorsal radiocarpal ligaments, while intrinsic wrist ligaments include the SLIL and LTIL [78]. The SLIL is C-shaped in the sagittal plane, with the dorsal third being the thickest and strongest portion [78]. The volar portion of the lunotriquetral ligament is the thickest [78].

Biomechanics & Kinematics

The wrist functions as a two-joint system linking the hand (distal carpal row and metacarpals) to the forearm (radius and ulna) around the highly mobile proximal carpal row [79]. The two principal articulations are the radiocarpal and midcarpal joints, situated proximal and distal to the mobile proximal row [79]. The proximal carpal row has no muscular or tendinous attachments and acts as an intercalary segment [78]. The proximal row forms an intercalated segment between the distal row and distal radius, bound into a functional unit by the SLIL and LTIL [76]. The distal row is rigid, with little motion between its bones due to stout intercarpal ligaments, acting as a functional unit with the scaphoid bridging both rows [76].

Wrist motion planes include flexion, extension, radial deviation, ulnar deviation, and circumduction, with minimal carpal motion during pronosupination [76]. Approximately 62° of wrist extension occurs through the radiocarpal joint, and 62% of wrist flexion occurs through the midcarpal joint [76]. The midcarpal joint is mostly responsible for 20° of radial deviation and 40° of ulnar deviation [76]. It is also responsible for the “dart thrower’s motion,” involving movement from radial extension into ulnar flexion [76]. With wrist flexion, 60% of the motion is midcarpal and 40% is radiocarpal [78]. With wrist extension, 33% of the motion is midcarpal and 66% is radiocarpal [78].

In neutral ulnar variance, the radius bears 80% of the axial load transmitted through the radiocarpal joint, while the ulna bears 20% [76]. With axial loading through the neutral wrist, approximately 80% of forces are transmitted through the distal radius (60% scaphoid facet, 40% lunate facet) and 20% through the distal ulna [78]. During wrist flexion from neutral, the distal row flexes and ulnarly deviates slightly while the scaphoid pronates [76]. The proximal row flexes differentially, with more rotation through the scaphoid, followed by the triquetrum and lunate, and translates dorsally [76]. During wrist extension from neutral, the distal row extends and radially deviates slightly while the scaphoid supinates [76]. The proximal row extends differentially, with more motion in the scaphoid, followed by the triquetrum and lunate, and translates palmarly [76]. With ulnar deviation, the proximal row extends relative to the forearm/distal row, while with radial deviation, it flexes relative to the forearm/distal row [78]. The eight carpal bones comprise the most complex articular system in the human body [79].

Classification

Walch: This classification provides a useful frame of reference for assessing subluxation and glenoid morphology in primary glenohumeral osteoarthritis, though it does not allow perfect agreement among observers [112]. Radiographs and computed tomography scans demonstrate similar observer agreement when classifying glenoid morphology in glenohumeral arthritis [112].

Eaton–Glickel: This system classifies trapeziometacarpal and scaphotrapezial arthrosis and has been evaluated for interobserver agreement using the weighted s* statistic [155].

Burton: This classification system for trapeziometacarpal arthritis utilizes clinical signs, patient symptoms, and radiographs [152]. Stage I involves early degeneration of the trapeziometacarpal joint characterized by patient-reported pain, a positive grind test, and ligamentous laxity demonstrated by dorsoradial subluxation [152]. Stage II demonstrates increased instability, chronic subluxation, and degenerative changes evidenced by radiograph [152]. Stage III is a further progression of degeneration to involve the scaphotrapezial joint [152]. Stage IV is defined as either Stage II or III with metacarpophalangeal joint changes [152].

Eaton: This classification relies on radiographic changes only [152].

Kellgren and Lawrence: This scoring system grades disease as none (0), doubtful (1), minimal (2), moderate (3), or severe (4) based on radiological features including osteophyte formation, periarticular ossicles, joint cartilage narrowing, and subchondral bone sclerosis [174].

American Rheumatism Association: The 1958 revision of diagnostic criteria for rheumatoid arthritis was intended to aid in obtaining more uniformity in the classification of patients with rheumatoid arthritis [44]. This classification was used to classify patients as Stage II or III in a study of synovectomy and debridement [153].

Outerbridge: This classification is used to grade articular cartilage injuries in the hip joint [59].

Beck: This classification is used to grade articular cartilage injuries in the hip joint [59].

Acetabular Labrum Articular Disruption: This classification is used to grade articular cartilage injuries in the hip joint [59].

Samilson-Prieto: This classification is used for humeral osteophytes in dislocation arthropathy of the shoulder [139]. Using the "area index" and consistent radiological views makes future comparisons more reliable than the Samilson-Prieto classification alone for humeral osteophytes [139].

Other Considerations: A universal and definitive grading system for cartilage lesions is considered necessary, along with measurement devices for objective cartilage grading in questionable cases [98]. The SLAC pattern of arthritis does not represent the majority of the patterns of degeneration encountered in radiocarpal and midcarpal arthritis [21]. Isolated osteoarthritis of the scaphotrapeziotrapezoidal joint is the most prevalent pattern of wrist osteoarthritis [20]. Advanced osteoarthritis of the midcarpal joint without radiocarpal involvement may be more common than previously thought [20].

Clinical Presentation

General Osteoarthritis

Osteoarthritis is defined by a generally progressive loss of articular cartilage, accompanied by attempted cartilage repair, subchondral bone remodeling and sclerosis, and the frequent formation of subchondral bone cysts and marginal osteophytes [16]. The diagnosis requires the presence of symptoms and signs, which may include joint pain, restriction of motion, crepitus with motion, joint effusions, and deformity [16]. While degenerative joint disease is a focal process probably related to mechanical stresses rather than a generalized matrix deficiency [22], osteoarthritis can cause deterioration of any synovial joint [16]. It occurs most frequently in the foot, knee, hip, spine, and hand joints [16]. The onset and progression of the disease are accompanied by a complex system of microenvironmental dynamics involving the interaction of multiple cellular, molecular, and signaling pathways [32]. Although many OA-related biomarkers are currently available, none can be considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time [14]. Understanding OA physiopathology clarifies the core mechanisms by which minimally invasive interventions might halt and reverse the course of early-stage OA [9].

Shoulder (Glenohumeral and Acromioclavicular)

Asymptomatic acromioclavicular osteoarthritis remained asymptomatic in 90% of cases over 7 years [18]. Magnetic resonance imaging scans are not a reliable tool for predicting symptomatic acromioclavicular arthritis [25]. However, patients with edema on MRI were more likely to present pain than patients without edema, and subchondral bone edema on histologic examination was more frequent in patients in whom pain was present [57]. Radiographic acromioclavicular joint osteoarthritis is common in patients undergoing reverse shoulder arthroplasty [58]. For glenohumeral arthritis, early results indicate satisfactory short-term outcomes for joint preservation procedures, though these procedures have yet to show they can halt arthritic progression [1]. Arthroscopic debridement with capsular release may provide a window of improved symptoms and function before deterioration of the joint leads to a more significant operation, especially in younger patients with mild or moderate osteoarthritic changes [53]. This review describes the challenges associated with the diagnosis and management of glenohumeral arthritis and provides a treatment framework for use in these challenging patients [47].

Hand and Wrist

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 [20]. The SLAC pattern of arthritis does not represent the majority of the patterns of degeneration encountered [21]. Marked radiographic differences in modified Eaton score distinguish progressing from stable early carpometacarpal osteoarthritis, indicating that structural progression is a key marker of disease advancement [10]. The size of the opponens pollicis muscle may have a weak association with the diagnosis of early thumb carpometacarpal osteoarthritis [51]. Thumb adduction and extension provocative tests were more specific for basal joint arthrosis than was the elicitation of point tenderness at the joint [49].

Regarding treatment options, Silastic replacement of the trapezium remains a good option for patients with painful trapeziometacarpal osteoarthritis that has not responded to nonoperative treatment [13]. Dorsoradial capsulodesis for Stage I trapeziometacarpal joint arthrosis showed no midterm progression to advanced arthritis in the studied cohort [5]. Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis following trapeziometacarpal arthrodesis, intervention for these joints was rarely warranted [102]. Functional outcomes of thumb CMCJ prosthetic total joint replacement look promising compared to resection arthroplasty, but failure in terms of loosening and dislocation remains a concern [29].

Arthritis of the distal radioulnar joint can be primary or secondary to inflammatory, congenital, or post-traumatic conditions [50]. In a cross-sectional study from Japan, 12% of patients had primary osteoarthritis of the distal radioulnar joint [50]. The prevalence of primary osteoarthritis of the distal radioulnar joint was 13% in a European study with patients over 50 years old [50]. Radiographic abnormalities in the distal radioulnar joint developed in 78% of patients with rheumatoid arthritis [50]. Patients with distal radioulnar joint osteoarthritis may complain of ulnar wrist pain, loss of grip strength, and stiffness [50]. Symptoms may be worse when there is instability of the distal ulna or other conditions that can cause ulnar wrist pain, such as ulnocarpal impaction, tendonitis, and lesions of the triangular fibrocartilaginous complex or lunotriquetral ligament [50]. An important complication of osteoarthritis of the distal radioulnar joint is extensor tendon rupture [50]. Arthritis of the distal radioulnar joint could also be a radiological finding without much clinical importance, and the majority of patients may be asymptomatic [50]. Initial management of symptomatic distal radioulnar joint arthritis is nonsurgical, with surgery reserved for patients with refractory pain [48].

Elbow and Sternoclavicular

The most common symptoms of sternoclavicular joint osteoarthritis were pain, tenderness, and swelling of the joint [46]. Diagnostic imaging for sternoclavicular joint osteoarthritis was computed tomography in 58.3% of cases or a magnetic resonance imaging scan in 41.7% of cases [46].

Inflammatory and Other Arthritides

Early diagnosis and treatment are important for preventing joint destruction in rheumatoid arthritis [2]. In patients with suspected inflammatory arthritis, routine ultrasound use in newly referred patients seems to be associated with significantly earlier diagnosis and DMARD initiation [95]. The revised diagnostic criteria for rheumatoid arthritis are hoped to aid in obtaining more uniformity in the classification of patients with rheumatoid arthritis and should be reviewed in two or three years [44]. While joint involvement in familial Mediterranean fever is typically transient, permanent joint damage can occur, particularly in older children at onset [11]. The diagnosis of familial Mediterranean fever is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain, as there are no specific laboratory aids [96]. The final diagnosis of palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [15]. Specific exfoliative cytological patterns can be readily recognized in fluids aspirated from joints in a variety of arthritides, supporting the technique as a valuable diagnostic aid [99]. The findings of synovial chondromatosis with secondary subluxation of the hip stress the importance of early diagnosis and proper treatment [33]. Physicians should be aware of Charcot joint disease presentation in patients with insensate joints to avoid overtreatment [101]. Rotator cuff tears represent a spectrum of disease progressing from tendinitis to cuff arthropathy, with prevalence increasing significantly with age [55].

Investigations

MRI: Magnetic resonance imaging is the modality of choice for radiographically occult fractures of the hand and wrist [77]. Its primary advantages over CT and radiography include superior tissue characterization of soft tissues, such as wrist ligaments and hand synovium, and the absence of ionizing radiation [77]. Modern systems operate at 1.5T or 3T, with 3T preferred for hand and wrist imaging, particularly for small fields of view [77]. Recently approved 7T MRI holds potential as a powerful tool for these regions as applications develop [77]. Contrast enhancement is commonly used to distinguish solid from cystic soft-tissue lesions and to visualize erosions and synovial burden in rheumatologic imaging [77]. While MR arthrography evaluates triangular fibrocartilage and intercarpal ligament tears, it is generally unnecessary given the availability of high-field MRI [77].

MRI serves as a noninvasive tool for cartilage imaging, overcoming radiographic shortcomings by detecting preclinical disease and subtle early abnormalities for lesion description, treatment planning, and outcome measurement [26]. For wrist ligament evaluation, a static magnetic field strength of at least 1.5 T using a dedicated wrist coil is recommended to analyze interosseous, intrinsic, and extrinsic ligament insertions [87]. The volar extrinsic, SL interosseous, dorsal intercarpal, and LT ligaments are best visualized using 1 mm slices with no interslice gap in the coronal plane [87]. The DRC and intercarpal ligaments require both coronal and sagittal images [87]. Concomitant cartilage-sensitive imaging is integrative for assessment and surgical management, as cartilage integrity influences clinical decisions, especially in SLAC wrist [87]. Real-time MRI investigates dynamic instabilities, though its routine clinical use remains undetermined [87].

In inflammatory arthritis, MRI provides earlier detection of synovitis and erosive bone changes associated with rheumatoid arthritis than radiographs [89]. It detects additional marrow abnormalities in osteonecrosis, such as in the lunate with Kienböck disease or the scaphoid after fracture [89]. Asymmetry of marrow signal in proximal and distal fragments of a fractured scaphoid suggests proximal pole ischemia [89]. MRI has a limited role in carpal tunnel syndrome evaluation, although axial T2-weighted imaging displays masses within the carpal tunnel and median nerve edema or swelling [89]. Tenosynovitis and tendon injuries in the wrist and hand are also assessable with MRI [89]. Early MRI reduces uncertainty and streamlines care for suspected scaphoid fractures [91].

CT: Computed tomography enables 3D analysis of carpal dysfunction [87]. In shoulder osteoarthritis, CT scans accurately reveal the extent and pattern of bone erosion, with glenoid retroversion increased in patients with severe arthritis compared to normal subjects [183].

Plain radiography: If MRI is unavailable for suspected scaphoid fractures, repeated X-rays are required two weeks later, as bone shifting and resorption at the fracture line can make the fracture more apparent [91]. In the wrist, the pisotriquetral joint space in osteoarthritic patients is significantly narrowed compared with healthy wrists [67]. Marked radiographic differences in the modified Eaton score distinguish progressing from stable OA, indicating that structural progression is a key marker of disease advancement [10].

Arthroscopy: Arthroscopy is considered by many to be the diagnostic intervention of choice for determining the degree of wrist injury. It assesses cartilage condition (normal or degenerative), the ability to reduce the carpus, and any associated injuries [87].

Dynamic Fluoroscopy: Dynamic fluoroscopy demonstrates abnormal motion between the scaphoid and lunate and changes in midcarpal joint kinematics [87].

Other Considerations: Contrary to previous reports, the SLAC pattern of arthritis does not represent the majority of degeneration patterns encountered [21]. Early thumb CMC OA and discomfort may lead to diminished loading across the basal joint, producing focal disuse osteopenia [69]. The thumb adduction and extension provocative tests are more specific for basal joint arthrosis than elicitation of point tenderness at the joint [49].

In the shoulder, MRI is more reproducible for assessing glenoid version in osteoarthritis and provides excellent intraobserver and interobserver reliability [157]. Asymptomatic AC-OA remained asymptomatic in 90% of cases over 7 years [18]. Patients with edema on MRI were more likely to present pain than those without, and subchondral bone edema on histologic examination was more frequent in patients with pain [57]. Radiographic ACJ osteoarthritis is common in patients undergoing reverse shoulder arthroplasty [58]. The incidence of Outerbridge grade II-IV lesions in the glenohumeral joint is estimated at 5% during arthroscopic evaluation [59].

Treatment

Non-Operative

An initial trial of nonsurgical management is usually warranted for articular cartilage injuries, consisting of rest, activity modification, anti-inflammatory medications, physical therapy, bracing treatment, or injections [92]. Nonoperative treatment is almost always initiated for primary and posttraumatic elbow arthritis [149], and initial management of symptomatic distal radioulnar joint arthritis is nonsurgical [48]. For shoulder osteoarthritis, nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease [123]. In thumb carpometacarpal osteoarthritis, a non-pharmacological treatment gap exists, with most patients reporting no pain or mild pain and having not received non-pharmacological treatment prior to surgical consultation [133]. Healthcare professionals should support patients with thumb base osteoarthritis in a self-management programme to optimise outcome [105], ensuring the programme is individualised to patients to ensure the relevance of the information and treatment [105]. Treatment for degenerative osteoarthritis of the digits is tailored to the individual’s age and occupation to optimize outcome [93].

While intra-articular TNFi therapy appears to have equal efficacy to intra-articular steroids for rheumatoid arthritis, the optimal dose and frequency of injections is yet unknown [113]. Existing literature demonstrates anti-inflammatory properties of orthobiologics, but no treatment has clearly demonstrated significant joint preservation properties, including the ability to reverse progression of osteoarthritis [106]. Improvements in controlling synovitis in rheumatoid arthritis have not resulted in comparable reductions in disability measured by HAQ [104]. There is no evidence to guide clinicians about the individual or combined effectiveness of nonpharmacological interventions for individuals with persistent acromioclavicular joint osteoarthritis [110]. Further research is needed to determine the efficacy of physical therapy for patients with moderate glenohumeral arthritis and the utility of preoperative physical therapy for improving postoperative outcomes [114]. Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care [127].

Operative

Indications: Joint replacement is indicated for end-stage osteoarthritis disease [6]. Arthroplasty is indicated for fibrous or bony ankylosis of the elbow, partial ankylosis with insufficient motion, or pain as a disabling factor in patients aged 20 to 50 [107]. For glenohumeral osteoarthritis in young patients, experts recommend a stepwise approach starting with nonoperative treatment, followed by joint-preserving arthroscopic procedures for selected patients, and reserving joint replacement or resurfacing for cases where less invasive options fail [12]. Treatment for Kienböck’s disease is stage-dependent, ranging from nonoperative management in early stages to revascularization, unloading procedures, or arthrodesis in advanced stages [125]. Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop [38].

Surgical Approach / Technique: Surgical treatment for wrist osteoarthritis aims to eliminate pain while preserving motion in adjacent joints, with the specific procedure chosen based on the location of arthritis and patient factors [17]. In most scenarios, there is no single preferred option for wrist osteoarthritis management [66]. Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications [109]. Proximal-row carpectomy should be considered after conservative measures fail for diseases of the proximal row, as mild degenerative arthritis is not a contraindication [27]. Progressive degenerative arthritis of the radial capitate articulation did not occur following proximal-row carpectomy [27]. Both arthroscopic and open approaches can result in excellent clinical outcomes for patients with symptomatic sternoclavicular joint arthritis [34]. Arthroscopic approaches to glenohumeral arthritis using various joint-preserving procedures reduce pain, improve function, and improve clinical outcome scores in the short- to mid-term follow-up period [37]. Autologous distal femoral osteochondral grafting (AD) is an efficacious and particularly safe alternative in the short term for young patients with concerns about arthroplasty [23]. Silastic replacement of the trapezium remains a good option for patients with painful trapeziometacarpal osteoarthritis that has not responded to nonoperative treatment [13].

Other Considerations: Surgical management for articular cartilage injuries should focus on removing inflammatory mediators and restoring the osteochondral unit [92]. Surgical options for articular cartilage injuries include arthroscopic débridement, bone marrow stimulation, osteochondral autograft transfer, osteochondral allograft transplantation, autologous chondrocyte implantation, and various newer, emerging techniques [92]. Current clinical treatments for articular cartilage defects have limited ability to repair tissue and often result in mechanically inferior cartilage [108]. None of the current experimental methods for facilitating cartilage repair have been shown to stimulate the formation of tissue that duplicates the structure, composition, mechanical properties, and durability of articular cartilage or to improve function and relieve symptoms predictably in osteoarthritic joints [115]. Surgical treatments for mild trapezial-metacarpal arthrosis are supported primarily by inferences from cadaveric studies and by small retrospective case series using non-validated, physician-rated outcome measures [36]. A systematic review provided evidence of the efficacy of various surgical interventions for trapeziometacarpal osteoarthritis, with some interventions showing moderate-to-large superior effects compared with others [111].

Complications

Joint Degeneration and Structural Progression

Osteoarthritis is defined by a generally progressive loss of articular cartilage, accompanied by attempted repair, remodeling, and sclerosis of subchondral bone, as well as the formation of subchondral bone cysts and marginal osteophytes [16]. The degeneration of articular cartilage is an integral part of the clinical syndrome of osteoarthritis [16]. Structural changes are quantifiable; for instance, the stiffening of 38 percent from a normal to an early arthritic condition was accompanied by a trabecular contiguity change from 0.7 to 0.8 [70]. In specific inflammatory contexts, permanent joint damage can occur in familial Mediterranean fever, particularly in older children at onset [11]. The progressive nature of cervical rheumatoid disease can result in the recurrence of long-tract symptoms due to further subaxial subluxation distal to the original fusion site, as observed in three patients [63]. Regarding meniscal pathology, significant changes were found within the synovial fluid, meniscal tissue, and tibial subchondral bone of knees with anterior meniscal root tears when compared with controls [160]. However, no significant changes were identified in the tibial articular cartilage when comparing the tear groups with controls in untreated anterior meniscal root tears [160].

Surgical Complications and Outcomes

Thumb CMCJ Prosthetic Replacement: Failure in terms of loosening and dislocation remains a concern for thumb CMCJ prosthetic total joint replacement [29]. Unplanned early reoperation rates following thumb basal joint arthroplasty are lower than those published previously [40]. Revision surgery for failed trapeziometacarpal joint arthritis can result in satisfactory long-term outcomes, particularly when metacarpophalangeal joint pathology is addressed and complications are avoided [64]. Bone-preserving arthroplasty with abductor pollicis longus tenodesis showed satisfying results in patients presenting with early-stage trapeziometacarpal osteoarthritis [65].

Radial Head Arthroplasty: Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis for radial head arthroplasty [150].

PIP Joint Arthroplasty: With an implant survivorship of 90% at an average of 10 years postoperatively, silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic PIP joint [35].

CMC Arthroplasty: Results for a large series of suture button suspensionplasty for CMC arthroplasty with intermediate follow-up revealed excellent clinical outcomes and low complication rates [126].

Shoulder Arthroplasty: Patients undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty for glenohumeral arthritis had no difference in short-term complication rates with a lower risk of revision surgery at both 2-year and 5-year follow-up when compared to hemiarthroplasty [168]. Early results for glenohumeral joint preservation procedures indicate satisfactory short-term outcomes, though these procedures have yet to show they can halt arthritic progression [1]. Arthroscopic management of glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [37].

Cartilage Restoration: Follow-up x-rays showed no subchondral bone lesions after calcified cartilage zone debridement with hyaluronic acid–based scaffold and bone marrow aspirate concentrate [41].

Diagnostic and Prognostic Factors

Clinical experience and literature analysis do not support the commonly held assumption that untreated distal radial fractures lead to symptomatic osteoarthritis [39]. Data on total joint arthroplasty trends in rheumatoid arthritis likely reflect skewed utilization of biologic disease-modifying antirheumatic drugs in patients with more severe disease and prolonged periods of joint degeneration because of prior treatment failure [68].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for the resumption of desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for the stabilization of pain, strength, and final functional outcomes.

Rehabilitation protocol: The provided evidence does not detail specific physiotherapy phasing, immobilisation duration, weight-bearing or range-of-motion progression schedules, or sling and brace removal timing.

Functional milestones: Arthroscopic debridement serves as an efficacious and particularly safe alternative in the short term for young patients with concerns about arthroplasty [23]. An arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period [37]. At the minimum 2-year follow-up, volar plate interposition arthroplasty provided satisfactory results in terms of pain relief and functional preservation for finger joints with posttraumatic arthritis [176]. Hemi- and total arthroplasties for the distal radioulnar joint have shown increased function, better patient-rated outcome measures, reduced pain, and high satisfaction that persist over time [179]. Favorable outcomes of suture button suspensionplasty in the treatment of thumb carpometacarpal joint osteoarthritis, including improvement in range of motion and pain relief, remain durable over time [182].

Other Considerations: Early results for glenohumeral joint preservation procedures indicate satisfactory short-term outcomes [1]. Glenohumeral joint preservation procedures have yet to show they can halt arthritic progression [1]. In a cohort of eight cases involving discoid menisci, results were excellent in eight cases, with one rated as good and one developing osteoarthritis but remaining asymptomatic [4]. Marked radiographic differences in modified Eaton score distinguish progressing from stable carpometacarpal osteoarthritis [10]. Structural progression is a key marker of disease advancement in early carpometacarpal osteoarthritis [10]. None of the currently available osteoarthritis-related biomarkers can be considered as a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease [14]. Asymptomatic acromioclavicular osteoarthritis diagnosed by MRI remained asymptomatic in 90% of patients over 7 years [18]. MRI serves as a noninvasive tool that overcomes the shortcomings of radiography by detecting preclinical disease and subtle early abnormalities in articular cartilage [26]. Further research is required in anatomic and biomechanic studies, experience in inflammatory arthropathy, and long-term survivorship to improve outcomes for total wrist arthroplasty [31]. Early diagnosis and proper treatment of synovial chondromatosis of the hip are important [33]. Silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic proximal interphalangeal joint [35]. With an implant survivorship of 90% at an average of 10 years postoperatively, silicone implant arthroplasty is used for symptomatic osteoarthritic proximal interphalangeal joints [35]. Further long-term studies are encouraged for total replacement of the distal radioulnar joint [62]. Revision surgery for failed trapeziometacarpal joint arthritis surgery can result in satisfactory long-term outcomes particularly when metacarpophalangeal joint pathology is addressed and complications are avoided [64]. Data on total joint arthroplasty trends in rheumatoid arthritis likely reflect skewed utilization of bDMARDs in patients with more severe disease and prolonged periods of joint degeneration because of prior treatment failure [68]. Resection arthroplasties for the unstable and arthritic distal radioulnar joint have good overall outcomes with limitations in active patients [179]. Further studies with extended follow-up are needed to gauge long-term success for day-case shoulder arthroplasty [180]. Most patients with juvenile idiopathic arthritis benefit from total elbow arthroplasty for a long term with satisfactory clinical outcomes and implant durability [181]. Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease [185].

Key Evidence

• [L4] Early results indicate satisfactory short-term outcomes, though these procedures have yet to show they can halt arthritic progression. [1] (10.1155/2012/160923)
• [L3] Early diagnosis and treatment are important for preventing joint destruction. [2] (10.1186/s13018-018-0866-2)
• [L4] The results were excellent in eight of these cases, with one rated as good and one developing osteoarthritis but remaining asymptomatic. [4] (10.2106/00004623-195032030-00019)
• [L4] This intervention showed no midterm progression to advanced arthritis in this cohort. [5] (10.1177/15589447211017221)
• [L5] Current non-surgical managements for osteoarthritis do not change the clinical course or arrest disease progression, while joint replacement is indicated for end-stage disease. [6] (10.1530/eor-2025-0050)
• [L2] Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed. [7] (10.1007/s00167-014-3114-2)
• [L2] However, inflammatory arthritis remains the most common indication in recent years, accompanied by an increase in the incidence of revision surgery. [8] (10.1302/2058-5241.5.190036)
• [L5] The understanding of OA physiopathology clarifies the core mechanisms by which minimally invasive interventions might be able to halt and reverse the course of early stage OA. [9] (10.1016/j.reth.2020.07.007)
• [L3] Marked radiographic differences in modified Eaton score distinguish progressing from stable OA, indicating that structural progression is a key marker of disease advancement. [10] (10.1016/j.jhsg.2025.100795)
• [L4] While joint involvement is typically transient, this report emphasizes that permanent joint damage can occur, particularly in older children at onset. [11] (10.2106/00004623-197557020-00023)
• [L5] Experts recommend a stepwise approach starting with nonoperative treatment, followed by joint-preserving arthroscopic procedures for selected patients, and reserving joint replacement or resurfacing for cases where less invasive options fail. [12] (10.1016/j.jse.2011.11.011)
• [L4] The procedure remains a good option for patients with painful TM osteoarthritis that has not responded to nonoperative treatment. [13] (10.1177/1753193411419433)
• [L5] Although many OA-related biomarkers are currently available, none can be considered as a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time. [14] (10.1186/1471-2474-16-s1-s2)
• [L5] [16] (10.2106/00004623-199704000-00022)
• [L4] Surgical treatment aims to eliminate pain while preserving motion in adjacent joints, with the specific procedure chosen based on the location of arthritis and patient factors. [17] (10.1016/j.jhsa.2007.02.003)
• [L2] Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. [18] (10.1016/j.jse.2019.04.004)
• [L4] There were no differences in the need for secondary intervention based on the severity of radiographic osteoarthritis or baseline shoulder dysfunction. [19] (10.1016/j.jse.2020.08.008)
• [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. [20] (10.1177/17531934241275450)
• [L3] Contrary to previous reports, the SLAC pattern of arthritis does not represent the majority of the patterns of degeneration encountered. [21] (10.5435/jaaosglobal-d-17-00017)
• [L1] AD is an efficacious and particularly safe alternative in the short term for young patients with concerns about arthroplasty. [23] (10.1016/j.arthro.2014.11.012)
• [L3] [25] (10.1177/1758573217724080)
• [L5] MRI is evolving as a complete answer to cartilage-imaging requirements for lesion description, treatment planning, and outcome measurement, serving as a noninvasive tool that overcomes the shortcomings of radiography by detecting preclinical disease and subtle early abnormalities. [26] (10.2106/jbjs.rvw.15.00093)
• [L4] It should be considered after conservative measures fail, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur. [27] (10.2106/00004623-197759040-00004)
• [Paper] Proper indication relies on identifying and simultaneously correcting malalignment and/or traumatic changes in affected joints. [28] (10.1016/j.injury.2008.01.041)
• [L1] Functional outcomes look promising compared to resection arthroplasty, but failure in terms of loosening and dislocation remains a concern. [29] (10.1302/2058-5241.6.200152)
• [L4] The International Consensus Meeting recommended that disease-modifying antirheumatic drugs should be halted prior to elective total joint arthroplasty based on their half-life, with cessation performed under the direction of the treating physician. [30] (10.1016/j.arth.2017.11.031)
• [L5] Further research is required in anatomic and biomechanic studies, experience in inflammatory arthropathy, and long-term survivorship to improve outcomes. [31] (10.1177/17531934231209638)
• [L4] [32] (10.1186/s13018-025-06399-3)
• [Case_report] The findings stress the importance of early diagnosis and proper treatment of synovial chondromatosis of the hip. [33] (10.2106/00004623-199173090-00019)
• [L5] Both arthroscopic and open approaches can result in excellent clinical outcomes for patients with symptomatic SC arthritis. [34] (10.1016/j.arthro.2020.02.023)
• [L4] With an implant survivorship of 90% at average of 10 years postoperatively, silicone implant arthroplasty remains the treatment of choice for the symptomatic osteoarthritic PIP joint. [35] (10.1016/j.jhsa.2013.11.008)
• [L5] Surgical treatments for mild osteoarthritis are supported primarily by inferences from cadaveric studies and by small retrospective case series using non-validated, physician-rated outcome measures. [36] (10.1016/j.jhsa.2012.08.034)
• [L5] Clinical studies report that an arthroscopic approach to glenohumeral arthritis using various joint-preserving procedures reduces pain, improves function, and improves clinical outcome scores in the short- to mid-term follow-up period. [37] (10.5435/jaaos-d-17-00214)
• [L4] Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop. [38] (10.2106/00004623-198567030-00013)
• [L5] Clinical experience and literature analysis do not support the commonly held assumption that untreated distal radial fractures lead to symptomatic osteoarthritis. [39] (10.1177/17531934241265839)
• [L4] These rates are lower than those published previously and should be considered by patients and surgeons when planning thumb BJA. [40] (10.1016/j.jhsg.2019.10.003)
• [L5] Follow-up x-rays showed no subchondral bone lesions after this new procedure. [41] (10.1016/j.eats.2025.103733)
• [L5] The revised criteria are hoped to aid in obtaining more uniformity in the classification of patients with rheumatoid arthritis and should be reviewed in two or three years. [44] (10.2106/00004623-195941040-00023)
• [L4] [46] (10.1016/j.jse.2024.12.044)
• [L5] This review describes the challenges associated with the diagnosis and management of glenohumeral arthritis and provides a treatment framework for use in these challenging patients. [47] (10.1016/j.jse.2007.03.011)
• [L5] Initial management of symptomatic DRUJ arthritis is nonsurgical, with surgery reserved for patients with refractory pain. [48] (10.5435/00124635-201210000-00002)
• [L2] Further, these provocative tests were more specific for basal joint arthrosis than was the elicitation of point tenderness at the joint. [49] (10.1016/j.jhsa.2015.04.012)
• [L4] [50] (10.1177/1753193419867843)
• [L3] The size of OPP may have a weak association with the diagnosis of early OA. [51] (10.1016/j.jhsa.2021.07.021)
• [L4] Arthroscopic debridement with capsular release may provide a window of improved symptoms and function before deterioration of the joint leads to a more significant operation, especially in younger patients with mild or moderate osteoarthritic changes. [53] (10.1016/j.arthro.2006.11.016)
• [L5] Joint replacement procedures relieve pain and improve function more than other current operative treatments but are limited by the inability of synthetic materials to duplicate the properties of articular cartilage; procedures that restore rather than replace the joint may offer advantages for young patients or those with less advanced disease. [54] (10.2106/00004623-199409000-00019)
• [L4] Patients with edema on MRI were more likely to present pain than patients without edema, and subchondral bone edema on histologic examination was more frequent in patients with pain. [57] (10.1016/j.jseint.2020.03.007)
• [L3] Radiographic ACJ osteoarthritis is common in patients undergoing RSA. [58] (10.1016/j.jseint.2021.11.008)
• [L5] [59] (10.1016/j.csm.2017.02.002)
• [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. [60] (10.1016/j.jht.2013.12.002)
• [L4] Shoulder hemiarthroplasty provides sustained good-to-excellent pain relief and functional improvement at five to ten years postoperatively in carefully selected patients with osteoarthritis. [61] (10.2106/jbjs.f.00980)
• [L4] Further longterm studies are encouraged. [62] (10.1177/15589447241233362)
• [L4] The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site. [63] (10.2106/00004623-198163080-00003)
• [L4] Revision surgery, however, can result in satisfactory long-term outcomes particularly when metacarpophalangeal joint pathology is addressed and complications are avoided. [64] (10.1016/j.jhsa.2018.10.025)
• [L4] Although a larger study population and a longer follow-up period are needed to draw conclusions, bone-preserving arthroplasty with APL tenodesis showed satisfying results in patients presenting with early-stage osteoarthritis. [65] (10.1016/j.jhsg.2021.03.003)
• [L5] Despite advancements in management, in most scenarios there is no single preferred option for wrist osteoarthritis. [66] (10.1177/17531934241296758)
• [L4] The pisotriquetral joint space in osteoarthritic patient wrists was significantly narrowed compared with healthy wrists. [67] (10.1177/1558944716677542)
• [L4] These data likely reflect skewed utilization of bDMARDs in rheumatoid arthritis patients with more severe disease and prolonged periods of joint degeneration because of prior treatment failure. [68] (10.5435/jaaosglobal-d-22-00209)
• [L2] Early thumb CMC OA and discomfort may lead to diminished loading across the basal joint, producing focal disuse osteopenia. [69] (10.1016/j.jhsa.2017.09.004)
• [L4] The stiffening of 38 percent from a normal to an early arthritic condition was accompanied by a trabecular contiguity change from 0.7 to 0.8. [70] (10.2106/00004623-197456020-00010)
• [L2] In patients with suspected inflammatory arthritis, routine US use in newly referred patients seems to be associated with significantly earlier diagnosis and DMARD initiation. [95] (10.1186/s12891-017-1850-4)
• [L4] The diagnosis is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain, as there are no specific laboratory aids. [96] (10.2106/00004623-196547080-00016)
• [L4] A universal and definitive grading system for lesions is necessary, and measurement devices are needed for objective cartilage grading in questionable cases. [98] (10.1007/s00402-009-0868-y)
• [L4] Specific exfoliative cytological patterns can be readily recognized in fluids aspirated from joints in a variety of arthritides, supporting the technique as a valuable diagnostic aid. [99] (10.2106/00004623-197658030-00019)
• [Case_report] Physicians should be aware of this presentation in patients with insensate joints to avoid overtreatment. [101] (10.2106/00004623-199274090-00017)
• [L4] Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis, intervention for these joints was rarely warranted. [102] (10.1016/j.jhsa.2008.09.022)
• [L4] However, these improvements in controlling synovitis have not resulted in comparable reductions in disability measured by HAQ. [104] (10.1186/s12891-016-0897-y)
• [L1] [105] (10.1177/17531934241313206)
• [L5] Existing literature demonstrates anti-inflammatory properties of orthobiologics, but no treatment has clearly demonstrated significant joint preservation properties, including the ability to reverse progression of osteoarthritis. [106] (10.1136/jisakos-2019-000377)
• [L4] Current clinical treatments for articular cartilage defects have limited ability to repair tissue and often result in mechanically inferior cartilage; emerging regenerative approaches and strategies informing future treatment options are discussed to address these limitations. [108] (10.3389/fbioe.2021.770655)
• [L3] Arthroplasty should be used as an alternative to arthrodesis in the treatment of posttraumatic wrist arthritis, given the proper patient selection and indications. [109] (10.1016/j.jhsa.2013.02.013)
• [L1] Currently, there is no evidence to guide clinicians about the individual or combined effectiveness of nonpharmacological interventions for individuals with persistent acromioclavicular joint osteoarthritis. [110] (10.1177/1758573219840673)
• [L1] This systematic review provided evidence of the efficacy of various surgical interventions for trapeziometacarpal osteoarthritis, with some interventions showing moderate-to-large superior effects compared with others. [111] (10.1016/j.jhsg.2021.02.003)
• [L3] The Walch classification provides a useful frame of reference when assessing subluxation and glenoid morphology in primary glenohumeral osteoarthritis, but it does not allow perfect agreement among observers. [112] (10.1016/j.jse.2017.02.015)
• [L1] Intra-articular TNFi therapy appears to have equal efficacy to IA steroids, though the optimal dose and frequency of injections is yet unknown. [113] (10.1186/s12891-021-04651-5)
• [L4] Further research is needed to determine the efficacy of physical therapy for patients with moderate arthritis as well as the utility of preoperative physical therapy for improving postoperative outcomes. [114] (10.1016/j.jse.2024.03.042)
• [Letter] The authors argue that a joint registry is necessary to evaluate implant survivorship across multiple surgeons before a randomized controlled trial can be justified, ensuring progress is based on robust data free from bias. [119] (10.1177/17531934211008364)
• [L4] On the basis of its higher expected gain in QALYs, arthroplasty should be the preferred treatment, though the minimal increase in utility over arthrodesis suggests surgeons do not view arthroplasty as superior. [122] (10.1016/j.jhsa.2008.06.022)
• [L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. [123] (10.1155/2013/370231)
• [L5] Treatment is stage-dependent, ranging from nonoperative management in early stages to revascularization, unloading procedures, or arthrodesis in advanced stages. [125] (10.5435/00124635-200103000-00006)
• [L4] Results for a large series of SBS for CMC arthroplasty with intermediate follow-up revealed excellent clinical outcomes and low complication rates. [126] (10.1016/j.jhsg.2019.11.002)
• [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. [127] (10.1016/j.csm.2014.01.001)
• [L5] The meeting formalized a cooperative study to begin in 1975 focusing on criteria for evaluating total hip and metacarpophalangeal joint replacement surgery and uniform listing of their complications. [131] (10.2106/00004623-197557040-00031)
• [L4] The results show a non-pharmacological treatment gap in OA care, with most patients reporting no pain or mild pain and having not received non-pharmacological treatment prior to surgical consultation. [133] (10.1186/s12891-019-2567-3)
• [L4] The evidence regarding MCP arthroplasty for OA consists of retrospective cohorts with small sample sizes and relatively short evaluations. [138] (10.1016/j.jhsa.2015.05.019)
• [L4] The authors conclude that using this index and consistent radiological views makes future comparisons more reliable than the Samilson-Prieto classification alone. [139] (10.1016/j.jse.2007.06.001)
• [L5] Nonoperative treatment is almost always initiated although surgical treatment may be indicated in cases refractory to conservative management. [149] (10.1155/2013/473259)
• [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. [150] (10.1016/j.jse.2010.05.022)
• [L5] [152] (10.1007/s11552-007-9068-9)
• [L3] [155] (10.1016/j.jhsa.2015.12.028)
• [L3] MRI is more reproducible in the assessment of glenoid version in osteoarthritis and provides excellent intraobserver and interobserver reliability. [157] (10.1016/j.jse.2012.10.036)
• [L5] [160] (10.1177/2325967117702452)
• [L3] Patients undergoing TSA or RTSA for glenohumeral arthritis had no difference in short-term complication rates with a lower risk of revision surgery at both 2-year and 5-year follow-up when compared to HA. [168] (10.1177/24715492231207482)
• [L4] [174] (10.1177/1753193408090098)
• [L4] At the minimum 2-year follow-up, volar plate interposition arthroplasty provided satisfactory results in terms of pain relief and functional preservation for finger joints with posttraumatic arthritis. [176] (10.1016/j.jhsa.2007.10.020)
• [L5] Resection arthroplasties have good overall outcomes with limitations in active patients, while hemi- and total arthroplasties have shown increased function, better patient-rated outcome measures, reduced pain, and high satisfaction that persist over time. [179] (10.1016/j.hcl.2020.07.008)
• [L2] Further studies with extended follow-up are needed to gauge long-term success. [180] (10.1177/17585732221079582)
• [L4] However, most benefit from the intervention for a long term with satisfactory clinical outcomes and implant durability. [181] (10.1016/j.jse.2014.03.012)
• [L4] Favorable outcomes (improvement in range of motion and pain relief) of SBS remain durable over time. [182] (10.1016/j.jhsa.2017.03.011)
• [L3] Glenoid retroversion is increased in patients with severe arthritis compared to normal subjects, and computerized tomographic scans accurately reveal the extent and pattern of bone erosion. [183] (10.2106/00004623-199274070-00009)
• [L2] Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. [185] (10.1016/j.jse.2016.07.022)

See Also

• Wrist Osteoarthritis
• Carpal Tunnel and Nerve Compression

References

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