From the Guidelines
The recommended treatment for posttraumatic and degenerative arthritic changes within the carpus typically begins with conservative management before considering surgical options. Initial treatment includes oral NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation control, along with activity modification to reduce stress on the wrist, as suggested by the 2018 update of the EULAR recommendations for the management of hand osteoarthritis 1.
Key Conservative Management Strategies
- Wrist splinting or bracing, particularly at night or during aggravating activities, helps limit painful motion, with orthoses considered for symptom relief in patients with thumb base OA 1.
- Physical therapy focusing on gentle range of motion exercises and strengthening of surrounding muscles can improve function while maintaining joint mobility, with exercises recommended to improve function and muscle strength, as well as to reduce pain 1.
- Education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient, as part of a comprehensive approach to managing hand OA 1.
- Topical treatments, preferably topical NSAIDs, are recommended as the first pharmacological treatment of choice due to safety reasons 1.
- Chondroitin sulfate may be used in patients with hand OA for pain relief and improvement in functioning, although the evidence is not as strong as for other treatments 1.
- Intra-articular injections of glucocorticoids should not generally be used in patients with hand OA but may be considered in patients with painful interphalangeal joints, with caution and consideration of the potential risks and benefits 1.
Surgical Interventions
For patients with inadequate response to conservative measures after 3-6 months, surgical interventions may be considered, ranging from arthroscopic debridement for early disease to partial or complete wrist fusion for advanced arthritis, with trapeziectomy considered in patients with thumb base OA and arthrodesis or arthroplasty in patients with interphalangeal OA 1. The treatment approach should be tailored to the specific location and severity of arthritis within the carpus, the patient's age, occupation, and functional demands, as the carpus consists of multiple articulations that may require different management strategies.
Given the most recent and highest quality evidence from the 2018 update of the EULAR recommendations for the management of hand osteoarthritis 1, a conservative management approach is recommended as the first line of treatment, with surgical options considered for patients who do not respond adequately to conservative measures.
From the Research
Treatment Options for Posttraumatic and Degenerative Arthritis
The recommended treatment for posttraumatic and degenerative arthritic changes within the carpus depends on the stage and severity of the condition.
- For early stages, therapies to address symptoms include:
- For late stages, surgical options are recommended, including:
- Other surgical procedures that have been used to treat posttraumatic arthritis and degenerative changes in the wrist include:
- Capitolunate arthrodesis with tension band wire, which has been shown to provide significant pain relief and preserve wrist motion and force 3
- Modified Sauvé-Kapandji procedure with tenodesis of the flexor carpi ulnaris to the carpus, which has been used to treat chronic derangement of the distal radioulnar joint 4
- In addition to these surgical options, research has also focused on the role of inflammation in the development and progression of posttraumatic arthritis, and the potential for anticytokine therapy, such as inhibition of interleukin 1 (IL-1), to prevent or treat the condition 5
Considerations for Treatment
When considering treatment options for posttraumatic and degenerative arthritic changes in the carpus, it is essential to take into account the individual patient's needs and circumstances, including: