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Hand and Wrist Arthritis. Hand to Shoulder Care Mapleton Hill Orthopaedics, P.C. www.danielmastermd-handtoshoulder.com. Daniel Master, M.D. Mapleton Hill Orthopaedics, P.C. 975 North Street, Suite 201 Boulder, CO 80304 Ph: 303-440-7941. Overview. Thumb arthritis Finger arthritis

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hand and wrist arthritis

Hand and Wrist Arthritis

Hand to Shoulder Care

Mapleton Hill Orthopaedics, P.C.


Daniel Master, M.D.

Mapleton Hill Orthopaedics, P.C.

975 North Street, Suite 201

Boulder, CO 80304

Ph: 303-440-7941

  • Thumb arthritis
  • Finger arthritis
  • Wrist arthritis
    • Ulnar impaction
    • SLAC wrist
    • SNAC wrist
thumb arthritis
Thumb Arthritis

Thumb arthritis can affect the:

  • IP joint
  • MCP joint
  • CMC joint
thumb cmc arthritis
Thumb CMC Arthritis


  • Repetitive key pinch
  • Post-traumatic
thumb cmc arthritis1
Thumb CMC Arthritis

Signs and symptoms

  • Pain at base of thumb
  • Decreased ROM
  • Adducted thumb
  • “Shoulder” sign
  • Compensatory MCP hyperextension
thumb cmc treatment
Thumb CMC Treatment

Conservative treatments

  • NSAIDs
  • Thumb splinting
  • Hand therapy
  • Injections

114 patients

  • 3-4 weeks of continuous splinting
  • 76% of patients with early disease had improvement
  • 54% of patients with more advanced disease had improvement

The effectiveness of a manual therapy and exercise protocol in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial.Villafane JH, Cleland JA, Fernandez-de-Las-Penas C.J Orthop Sports Phys Ther. 2013 Apr;43(4):204-13.

  • 60 patients with thumb arthritis
  • Randomly assigned to four weeks of:
    • Therapy program (joint mobilization, neural mobilization, exercise)
    • Sham intervention
  • Follow-up at 1,2, and 3 months
  • Therapy group had less pain overall but no change in pressure pain threshold or pinch/grip strength

60 patients with thumb arthritis

  • Randomly divided into three groups:
    • Placebo
    • Steroid
    • Hylan
  • Follow-up at 2,4,12, and 26 weeks
  • Nostatistically significant differencesbetween groups
  • Trend towards improvement with Hylan
thumb cmc surgery
Thumb CMC Surgery
  • CMC interposition arthroplasty
    • Conventional techniques (LRTI, HTA)
    • Modern techniques (Tightrope suspensionplasty)
cmc interposition arthroplasty
CMC Interposition Arthroplasty

Step 1 (common to all)

  • Trapeziectomy

Step 2 (varies)

  • Suspension and interposition through a wide variety of techniques
cmc arthroplasty
CMC Arthroplasty


Tightrope Suspensionplasty

Implanted suture device for suspension

10 days in a cast

  • Temporary wire for suspension


  • Reliance on tendon healing
  • 6 weeks in a cast

21 patients followed for over 2 years

  • Comparable results to other techniques
  • BUT able to come out of cast after 10 days
  • No major complications
finger arthritis
Finger Arthritis

Finger arthritis can affect the:

  • DIP joint
  • PIP joint
  • MCP joint
finger arthritis1
Finger Arthritis

Conservative treatments

  • Splinting
  • NSAIDs
  • Injections
pip arthritis
PIP Arthritis

Surgical treatments

  • PIP joint arthroplasty
    • Silastic
    • Pyrocarbon
  • PIP joint fusion
pip joint arthroplasty
PIP Joint Arthroplasty


  • Constrained
    • single component
  • Can have ligamentous insufficiency
  • Inflammatory arthritis
  • Gold standard for PIP joint


  • Unconstrained
    • two separate components
  • Must have competent ligaments
pip joint fusion
PIP Joint Fusion
  • Single cannulated compression screw


  • Plate-screw construct
mcp arthritis
MCP Arthritis

MCP joint arthroplasty

  • Silastic – constrained
  • Pyrocarbon - unconstrained
mcp joint arthroplasty
MCP Joint Arthroplasty


  • Constrained
  • Can have ligamentous insufficiency
  • Inflammatory arthritis
  • Excellent long-term track record


  • Unconstrained
  • Must have competent ligaments
  • May allow for slightly better ROM in the MCP
wrist arthritis
Wrist Arthritis

Potential causes

  • Age-related degenerative changes
  • Anatomic variations
  • Unrecognized injury to
    • Ligament
    • Bone
anatomic variations
Anatomic Variations
  • Ulnar positive variance
    • i.e. the ulna bone is too long
  • Increased pressure along the ulnar wrist
  • Ulnar impaction syndrome
    • Ulnar-sided wrist arthritis
    • Degenerative TFCC injury
ulnar impaction syndrome
Ulnar Impaction Syndrome

Conservative treatments

  • Casting for 4 weeks
  • NSAIDs
  • Corticosteroid injections
  • Activity modification

The rate of triangular fibrocartilage injuries requiring surgical intervention.Park MJ, Jagadish A, Yao J.Orthopedics. 2010 Nov 2;33(11):806.

  • 84 patients with ulnar-sided wrist pain
  • All patients treated with short-arm casting for 4 weeks
  • 57%of patients did not require surgery
  • 43% required surgery
ulnar impaction syndrome1
Ulnar Impaction Syndrome

Surgical treatments

  • Arthroscopic TFCC debridement or repair
  • Lunate chondroplasty
  • Feldon wafer procedure
  • Ulnar shortening osteotomy (USO)
  • Salvage operations
tfcc debridement or repair
TFCC Debridement or Repair
  • 2mm incisions
  • Small joint camera for visualization
  • Shaver for debridement
  • Suture device for peripheral repairs
lunate chondroplasty
Lunate Chondroplasty
  • Puncture subchondral plate of lunate
  • Promote fibrocartilage formation
  • Biologic joint resurfacing
feldon wafer procedure
Feldon Wafer Procedure
  • Arthroscopic or open excision of distal ulnar head
  • Decreased pressure on ulnar wrist
ulnar shortening osteotomy
Ulnar Shortening Osteotomy
  • Surgical osteotomy of ulna
  • Remove a wafer of bone
  • Compress with plate and screws
  • Excellent long-term results
salvage operations
Salvage Operations
  • Distal ulna resection (Darrach resection)
  • Hemi-resection arthroplasty (Bower’s arthroplasty)
  • Distal radio-ulnar joint fusion (Sauve-Kapandji procedure)
wrist injury
Wrist Injury

Ligament injury

  • Scapholunate interosseous ligament (SLIL)
  • Holds scaphoid and lunate together

Bone injury

  • Scaphoid fracture
  • Crucial for normal wrist biomechanics
wrist injury1
Wrist Injury
  • Ligament or bone injury
  • If recognized  repair early
  • If unrecognized  SLAC or SNAC arthritis

Stage II

Stage IV

Stage I

Stage III

slac and snac wrist
SLAC and SNAC Wrist

Conservative treatments

  • Splinting
  • NSAIDs
  • Corticosteroid injection
slac and snac wrist1
SLAC and SNAC Wrist

Surgical treatments

  • PIN neurectomy
  • Proximal row carpectomy (PRC)
  • Scaphoid excision and four-corner fusion
pin neurectomy
PIN Neurectomy
  • Resection of a nerve on the top of the wrist which only innervates the joint capsule
  • Therefore, no sensory deficit from resection
  • Can provide pain relief without a major operation
pin neurectomy1
PIN Neurectomy
  • Dorsal approach
  • Resect 1cm segment of nerve
proximal row carpectomy
Proximal Row Carpectomy
  • Excise the proximal row
  • Capitate then articulates with radius
  • Excellent pain relief without the need for bony healing
four corner fusion
Four Corner Fusion
  • Excise the scaphoid only
  • Fuse the following four bones:
    • Lunate
    • Triquetrum
    • Capitate
    • Hamate
  • All load now transmitted across the radio-lunate joint
four corner fusion1
Four-Corner Fusion
  • Excise scaphoid
  • Fuse capito-lunate and triquetro-hamate joints
total wrist arthroplasty
Total Wrist Arthroplasty


  • End-stage rheumatoid arthritis
  • Low-demand patient (lifetime restriction on weight bearing)
total wrist arthoplasty
Total Wrist Arthoplasty
  • Fuse and resurface the proximal carpal row
  • Resurface distal radius
total wrist fusion
Total Wrist Fusion


  • End-stage arthritis
  • High demand patients
    • Once healed, no limitations on weight-bearing
total wrist fusion1
Total Wrist Fusion
  • Dorsal approach
  • Fusion of radio-carpal and mid-carpal joints
  • Dorsal spanning plate application