Wrist and Hand Osteoarthritis

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Clinically Relevant Anatomy

The wrist and hand are composed of 27 bones: 8 bones of the wrist, 5 metacarpals and 14 bones of the phalanges. In this degenerative disorder, the articular cartilage wears away, exposing the bones. Cartilage is an elastic connective tissue whose purpose is to allow for a smooth, gliding motion between joints¹.

Pathological Process

Osteoarthritis is a disorder of the entire synovial joint organ and involves more structures than articular cartilage. The tissue changes that occur in the hand and wrist are a result of imbalance between catabolic and anabolic repair activity². Current evidence states that the subchondral bone may be the primary etiologic agent in osteoarthritis and joint cartilage is simply the final target of the process. Periarticular bone changes occur very early in the development of OA and these changes can be segregated into distinct patterns based on the anatomic location and pathogenic mechanisms⁶. There is a progressive increase in subchondral plate thickness, alterations in the architecture of subchondral trabecular bone, formation of new bone at joint margins (osteophytes), and development of sub chondral bone cysts. Once the pathology reaches the articular cartilage, the cartilage thins and the joint space narrows. This causes sclerosis of the subchondral bone due to the new mechanical load placed on the affected joint².

Clinical Presentation

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Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Key Evidence

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Resources

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Case Studies

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References

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