INJECTION THERAPY FOR OSTEOARTHRITIS OF WRIST
What is osteoarthritis (OA) of the wrist?
Osteoarthritis (OA) of the wrist is a long-term disorder that causes joint pain, stiffness, and edoema (at the wrist crease). Even routine daily tasks can become tough. Osteoarthritis becomes more common as people get older. It can happen for no apparent reason or as a result of a previous injury, such as a wrist fracture. There is a genetic relationship, which means that if one of your parents has osteoarthritis, you are more likely to get it.
Although there is no cure for OA, there are a number of therapy options that can help with your pain and stiffness in the short and long term. The mainstay of treatment is physiotherapy, activity moderation, wrist splints, and anti-inflammatories. An ultrasound guided steroid injection can considerably reduce your pain and stiffness if you have severe pain, symptoms that aren’t improving, and/or if your symptoms are keeping you up at night. This should always be followed by physiotherapy to help you regain your mobility and strength. An ultrasound-guided hyaluronic acid injection can also help you feel better and may even slow the progression of your disease.
What are the symptoms of wrist Osteoarthritis (OA)?
The symptoms of a cubital tunnel syndrome are:
- Pain, pins and needles and numbness on the inside of the elbow, forearm and wrist and hand – specifically into 4th (ring) and 5th (little) fingers
- Weakness in the hand, especially the 4th (ring) and 5th (little) fingers.
- Clumsiness and weak grip
If this sounds like your pain, read on…
What are some additional conditions that are Osteoarthritic (OA) pain of the wrist?
- Carpal tunnel syndrome
- DeQuervain’s tenosynovitis
- Osteoarthritis of the thumb
- Triangular fibrocartilage complex (TFCC) tear
- Scapholunate ligament injury
Osteoarthritis (OA) of the wrist vs carpal tunnel syndrome
Localized pain, stiffness, and edoema around the wrist joint are symptoms of wrist osteoarthritis. The ache is usually painful to the touch and is localised at the wrist crease. Carpal tunnel syndrome (CTS) can produce pain and stiffness in the wrist as well, but it is more commonly connected with hand symptoms. Pins and needles, numbness, and weakness in the hand, especially in the thumb, index, and middle finger, are common symptoms of CTS, which affects the median nerve (on the inside of the wrist). Symptoms are frequently more severe at night.
Anatomy of the wrist
The wrist complex is made up of nine bones that articulate to produce a series of tiny joints that move together to provide the wrist its great range of motion.
The radio-carpal joint, sometimes known as the ‘wrist joint proper,’ is the largest joint in the wrist. It is made up of the radius (long bone of the forearm) and the proximal carpal row (a group of four tiny bones in the wrist). Wrist extension (revving a motorcycle) and wrist flexion are the primary functions of this joint (downward curling of the wrist).
The proximal carpal row’s tiny bones are enumerated below and depicted in the image:
The entire wrist complex is encased in a thin but robust membrane around the joint that is lubricated with a lubricating substance called synovial fluid that permits the joints to move freely.
The radiocarpal and mid carpal joints act together to give the movements indicated in the image:
- Wrist extension e.g. revving a motorbike
- Wrist flexion e.g. curling of the wrist
- Radial deviation e.g. side flexing wrist towards the thumb
- Ulnar deviation e.g. side flexing wrist towards the little finger
The proximal carpal row of the wrist articulates with the wrist’s distal carpal row, forming the wrist’s mid carpal joint.
A further four tiny bones make up the distal carpal row, as illustrated in the figure:
The wrist joint is a typical source of discomfort and injury due to its complexity and the high functional demands placed on it during daily activities.
The radiocarpal joint is the most commonly arthritic joint. The following are some of the risk factors for radiocarpal joint osteoarthritis:
- Instability of the scapholunate joint (a small joint created by the scaphoid and the lunate bones of the proximal carpal row). Joint instability can occur if the ligamentous components within this joint are disrupted. This instability has been linked to an increase in aberrant radiocarpal joint mechanics, which can lead to wrist osteoarthritis (Johnson et al. 2013).
- Age – the incidence of wrist osteoarthritis rises with age.
- A previous hand/wrist injury, such as a broken bone, might change the mechanics of the wrist, making it more susceptible to osteoarthritis.
- During a fall, ligamentous injuries to the wrist increase the risk of osteoarthritis in the radiocarpal joint (Anderson et al. 2011 cited by Johnson et al. 2013).
- There is a hereditary link, which means that if one of your relatives has osteoarthritis, you are at a higher risk.
A layer of articular cartilage covers the surfaces of the wrist joints. Articular cartilage provides a frictionless, smooth surface for joint movement. The joint’s articular cartilage can get thinner. Osteoarthritis develops as the articular cartilage breaks down over time. Inflammation of the synovium is usually associated with osteoarthritic joints. Synovitis is the medical term for inflammation of the synovium. Synovitis has been linked to a higher incidence of deterioration in joints.
How is osteoarthritis of the wrist diagnosed?
A professional assessment is required to diagnose wrist joint osteoarthritis, which can be conducted by your physiotherapist. It’s critical to have a precise diagnosis so that your doctor can prescribe the best treatment option for you.
A formative interview is the first step in developing a diagnosis. This includes gathering information about how your pain began and what aggravates and relieves your symptoms. A battery of clinical tests, including wrist joint palpation (feeling) and wrist range of motion and strength, are also performed.
You may be referred for an x-ray if your clinician suspects you have osteoarthritic abnormalities in your wrist joint (see above image). For the assessment and diagnosis of bone and joint problems, including osteoarthritis, an x-ray is considered the gold standard imaging tool.
It can detect the presence of osteoarthritis in a joint as well as the severity of arthritic progression. If your physiotherapist suspects an underlying systemic inflammatory illness like rheumatoid arthritis, you may be referred for a series of blood tests (Lee et al, 2013).
Despite the fact that x-ray is an excellent tool for diagnosing osteoarthritis, many individuals experience symptoms that are unrelated to the degree of osteoarthritis visible on x-ray. When synovitis is present, individuals often have more discomfort than they expect. On an X-ray, synovitis is not visible.
Diagnostic musculoskeletal ultrasonography is a highly effective dynamic imaging tool that is frequently used to assess the existence of synovitis in osteoarthritis patients. Diagnostic musculoskeletal ultrasonography has been found to be a useful method for assessing arthritic joint changes associated with osteoarthritis, rheumatoid arthritis, and synovitis, according to research (Wakefiled et al, 2000 & Kaeley et al, 2020).
Joint Injections has a staff of highly trained clinicians that are both physiotherapists and musculoskeletal sonography specialists. During your initial evaluation, your doctor will conduct a thorough examination of your wrist, including clinical tests and diagnostic imaging.
How do we treat osteoarthritis of the wrist?
The vast majority of individuals with wrist osteoarthritis reacted effectively to physiotherapy treatment and learned to manage their illness on their own. It is critical that you maintain your flexibility and strength in order to keep your joint healthy.
The following are frequent physiotherapy exercises for osteoarthritis of the wrist:
- Wrist joint stretches to maintain and increase range of movement
- Wrist and grip strengthening exercises
- Joint manipulation and soft tissue release techniques are also used to increase your joint movement and ease pain
- We may use some taping techniques and/or recommend the use of a wrist brace.
Here are a few pointers you might want to try for yourself (we would always recommend you get your wrist fully assessed before embarking on too much self-management)
- Rest from activities that aggravate your symptoms. If this is not possible try to modify how you complete these tasks. This may involve taking regular breaks.
- Try some gentle wrist stretches
- Try using a wrist support when lifting and carrying heavy objects such as suitcases or shopping.
- Keep you joint warm – wear gloves in the winter or use a hot water bottle to warm up your wrist.
- Increase your grip strength by squeezing a stress ball or a tennis ball.
- Over-the-counter pain medication such as paracetamol or a nonsteroidal anti-inflammatory gel such as Voltarol can be used to reduce pain. Ask your pharmacist before starting any medication.
Injection therapy for OA of Wrist
Wrist joint osteoarthritis can be treated with injection therapy to relieve pain and inflammation. It’s a good idea to try it if you’ve tried everything else and still can’t get rid of your symptoms, or if you’ve tried everything else and can’t seem to get relief.
- Pain has persisted for over 3 months
- Pain is limiting you from embarking in a physiotherapy rehabilitation
- Pain is limiting you from completing activities of daily living including work and sporting activities
- Pain is affecting your sleep
All injection techniques are carried out at Joint Injections under ultrasound guidance. To accurately and effectively guide a needle directly to the source of your pain, dynamic, real-time ultrasound imaging is used. Ultrasound guided injections are more accurate, have fewer side effects, and are more effective at reducing pain than land marked injections, according to research.
Joint injection’s clinicians have all performed ultrasound-guided injections for wrist osteoarthritis. On all ultrasound-guided injections, Joint injections offers a same-day service. You do not need to bring a prescription or a doctor’s referral. Your clinician is a licenced independent prescriber who can provide you with the most effective medication.
For the treatment of osteoarthritis of the wrist, there are two main injection options:
Ultrasound-guided corticosteroid injection
A corticosteroid injection is a safe and effective injection option for reducing swelling caused by arthritis in the wrist joint (Lee et al., 2013). Under ultrasound guidance, a corticosteroid and a short-acting local anaesthetic are injected into your wrist joint. A corticosteroid injection (also called a steroid injection) is a powerful anti-inflammatory medication that has been used in musculoskeletal medicine for decades. It allows you to effectively rehabilitate your wrist in a pain-free environment. According to current evidence, a corticosteroid injection provides excellent pain relief for an average of 10-12 weeks, but the pain relief often lasts longer.
Ultrasound-guided hyaluronic acid injection
Hyaluronic acid is a man-made synthetic version of the natural lubricant found in joints. It has an anti-inflammatory effect and is a good way to relieve pain and inflammation in arthritic joints. For the treatment of osteoarthritis, it is a viable alternative to corticosteroid injections (Gigante et al., 2010). Hyaluronic acid injections are also combined with a short-acting local anaesthetic to make the injection process more comfortable.
It is highly recommended that you begin physiotherapy 10-14 days after the injection in order to achieve the best possible results.
Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all hand and wrist disorders, including OA of Wrist. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.