Rheumatoid arthritis of the wrist and hand, affected joints are swollen from synovial thickening and movement is restricted.
Osteoarthritis of the Wrist
The commonest predisposing factors are comminuted fractures of the lower end of the radius with involvement of the articular surface, fracture of scaphoid bone complicated by avascular necrosis of the distal fragment, dislocation of the lunate bone, Keinbock’s disease of the lunate bone, and long established rheumatoid arthritis.
The predominant change is degeneration and wearing away of the articular cartilage lining the joint surfaces.
Osteoarthritis of the trapezio-metacarpal joint
This is a common affection in elderly women but it may also occur in younger persons, especially if is there (RSI) or has been a previous injury, the arthritis may impair the function of the thumb (70% of hand movement is controlled by the thumb).
This is an uncommon affection of the lunate bone characterised by temporary softening, fragmentation and liability to deformation. It tends to give rise, later, to osteoarthritis of the wrist.
Extra-Articular Disorders about the Wrist and Hand
If minor superficial infections are excluded there are six types to be considered:
- Nail fold infection (paronychia)
- Pulp space infection (whitlow, felon)
- Other subcutaneous infections
- Thenar space infection
- Mid-palmar space infection
- Tendon sheath infection
All types are caused by infection with pyogenic bacteria. Minor injury such as prick, abrasion or blister usually provides the route by which infection can enter. Without effective treatment infection may spread to adjacent tissue planes, occasionally it may give rise to spreading lymphangitis or to sepicaima. A ganglion is the commonest cystic swelling at the back of the wrist.
Dupuytren’s Contracture (Common RSI Disease)
This is an easily recognised condition characterised in the established phase by flexion contracture of one or more of the fingers from thickening and shortening of palmar aponeurosis.