Hand and Wrist Osteoarthritis in Ankara, Turkey

Hand and wrist osteoarthritis is a degenerative joint disease that develops as the cartilage in these joints gradually wears down over time. It is more common in older age and typically presents with pain, stiffness, and reduced range of motion. In early stages, symptoms can often be controlled with conservative treatment.

One of the most frequently affected areas is the thumb carpometacarpal (CMC) joint at the base of the thumb. It is more common in women, and repetitive hand use is an important risk factor. Osteoarthritis in this joint can reduce grip strength and make daily activities more difficult.

Diagnosis is based on the patient’s complaints and physical examination findings; on plain X-rays, joint space narrowing, osteophyte formation, and subchondral sclerosis may be seen. Rheumatologic tests may also be ordered for differential diagnosis. Clinical and radiologic correlation guides the treatment plan.

Treatment options include rest, splinting, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In advanced cases, surgical options may be considered, such as arthroplasty or fusion. The goal is to reduce pain and preserve function as much as possible.

What Is Hand and Wrist Osteoarthritis?

Hand and wrist osteoarthritis is a chronic joint condition caused by gradual wear and degeneration of the articular cartilage. It may develop due to aging, repetitive strain, prior trauma, or rheumatologic conditions. Pain, stiffness, swelling, and limited motion are among the most common symptoms. In advanced cases, joint deformity can occur. Treatment is planned step-by-step and may include medication, splinting, physical therapy, and, when necessary, surgical options.

Why Does Hand and Wrist Osteoarthritis Develop and Who Does It Affect?

Osteoarthritis is essentially the thinning and loss of cartilage, the natural “cushion” of a joint. In a healthy joint, cartilage provides a smooth, low-friction surface that allows bones to glide without rubbing. When this protective layer is lost, bony surfaces begin to contact each other. The body responds by forming bony outgrowths at joint margins (osteophytes), joint lubrication may decrease, and inflammation can develop in the area.

There is rarely a single cause. Most often, a combination of genetic predisposition, the aging process, and environmental factors plays a role. Individuals with a family history of hand OA are at higher risk. In addition, old fractures or ligament injuries that never fully recovered can later lead to osteoarthritis.

Key risk factors include:

• Increasing age
• Genetic predisposition
• Female sex
• Postmenopausal hormonal changes
• Previous wrist fractures
• Ligament injuries
• Occupations that overload the joint
• Rheumatologic diseases
• Obesity
• Joint infections

What Are the Symptoms of Hand and Wrist Osteoarthritis and How Does It Feel?

Many patients find it hard to describe their pain precisely because it can be aching, stabbing, or burning at different times. A classic story is morning stiffness and a “rusty” feeling in the hands. This stiffness often loosens with movement, but as the day goes on and the hand is used more, it can turn into fatigue-related pain.

Tasks that require gripping and twisting—such as opening a jar, turning a key, or forcing a door handle—can become particularly difficult. Swelling may be noticeable at the base of the thumb or around the wrist. In more advanced stages, patients may notice a crackling sensation or sound (crepitus) during movement, which can reflect severe cartilage loss and bone-on-bone contact.

Common symptoms include:

• Pain that worsens with activity
• Aching at rest
• Morning stiffness
• Limited joint motion
• Reduced grip strength
• Joint swelling
• Deformity changes
• Noises during movement
• Tenderness
• Muscle wasting

What Is Thumb Base Osteoarthritis (Rhizarthrosis) and Why Is It Important?

In hand surgery practice, the most common osteoarthritis pattern is at the base of the thumb—known as rhizarthrosis. This condition can have a major impact on hand function because the thumb is responsible for a large share of overall hand performance. The thumb’s ability to oppose the other fingers is what allows us to grasp and manipulate objects.

The CMC joint is saddle-shaped and highly mobile. But that same mobility also makes it vulnerable to wear. Especially in women, postmenopausal ligament laxity can allow the first metacarpal to shift abnormally on the trapezium, accelerating cartilage breakdown. Over time, the thumb base may become more prominent and the thumb can develop a “Z-shaped” deformity. At that stage, even fine tasks like buttoning or holding a needle can become challenging.

How Does Post-Traumatic Wrist Osteoarthritis (SLAC and SNAC) Develop?

Sometimes osteoarthritis is not primarily age-related, but linked to a fall or injury that happened years earlier and may have been underestimated. The wrist consists of eight small carpal bones that work together in a delicate balance. When key ligaments tear or a fracture fails to unite properly, wrist mechanics become disrupted.

Two of the most common post-traumatic pathways are scaphoid nonunion advanced collapse (SNAC)—when the scaphoid fracture does not heal—and scapholunate advanced collapse (SLAC)—when the scapholunate ligament is torn. In these situations, carpal bones shift from their normal alignment, load the joint unevenly, and cause rapid wear in specific joint zones. Patients may not even remember the original fall, but the wrist “does not forget,” and years later pain and stiffness can progressively appear. Treatment planning in these cases is often different and more complex than typical age-related OA.

How Is Hand and Wrist Osteoarthritis Diagnosed?

For a clinician, the most valuable diagnostic tools are the patient’s story and a detailed physical examination. Where the pain is located and which movements trigger it provide important clues. There are also specific clinical maneuvers. For example, compressing and rotating the thumb base to reproduce pain and grinding (the “grind test”) can strongly support the diagnosis.

Imaging helps determine the stage of disease. Plain radiographs are usually sufficient and can show joint space narrowing, osteophytes, and subchondral sclerosis. If ligament injury is suspected or more detail is needed for surgical planning, MRI or CT may be requested.

Diagnostic tools may include:

• Detailed medical history
• Physical examination
• Provocative clinical tests
• Plain X-rays
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)
• Diagnostic injections

Is Non-Surgical Treatment for Hand and Wrist Osteoarthritis Possible?

Not every patient with osteoarthritis needs surgery. In fact, first-line management is usually non-surgical. In early and moderate stages, the goal is to control pain, slow progression, and preserve function. Patient education matters a lot: avoiding overload, using ergonomic adaptations (e.g., thicker pen grips or kitchen tools), and pacing activities can make a meaningful difference.

Night splints can keep the joint in a neutral position and help reduce inflammation. Pain-relieving and anti-inflammatory medications can ease flare-ups. In addition, regenerative medicine approaches have become more widely discussed in conservative care.

Common non-surgical methods include:

• Resting splints
• Pain-relief medications
• Ergonomic modifications
• Physical therapy
• Steroid injections
• PRP therapy
• Stem cell–based approaches
• Hyaluronic acid injections
• Exosome-based approaches

What Can Regenerative Medicine and Stem Cell Therapy Offer for Osteoarthritis?

Regenerative approaches aim to harness the body’s natural healing potential. While corticosteroid injections may quickly reduce inflammation, they do not repair tissue and frequent use can harm tendons. Regenerative methods focus more on biologic support.

Two commonly discussed options are PRP and adipose-derived cell-based preparations. PRP involves drawing blood, processing it to concentrate platelets, and injecting the platelet-rich plasma—which contains growth factors—into the affected joint to support repair signaling.

Another approach uses cells and biologic fractions derived from adipose tissue. Fat is harvested with a small liposuction procedure and processed to obtain stromal vascular fraction (SVF), which contains various regenerative cell populations. When injected into the joint, these biologic components are intended to modulate inflammation and support tissue healing. In some patients, such treatments may help extend a more comfortable period and delay surgery.

How Is the Decision Made for Surgical Treatment in Hand and Wrist Osteoarthritis?

If you have tried conservative measures—splints, therapy, lifestyle changes, and injections—but pain persists, surgical options may be discussed. In practice, the severity of the patient’s symptoms and functional limitation often matters more than the X-ray appearance alone.

If pain disrupts sleep, the patient hesitates to lift a cup of coffee, or avoids using the hand altogether, it may be time to consider surgery. The most appropriate procedure is individualized based on age, occupation, expectations, and bone quality.

Situations that may point toward surgery include:

• Pain that wakes the patient at night
• Difficulty with daily activities
• Failure of conservative treatment
• Progressive deformity
• Significant loss of grip strength
• Severe joint “locking”
• Risk of tendon rupture

What Are “Suspension” and “Cushion” Techniques for Thumb Base Osteoarthritis?

A widely used surgical concept for thumb CMC osteoarthritis is removing the trapezium bone (trapeziectomy), which is the main pain generator. It can sound alarming, but reconstructive techniques are used to maintain thumb position and function afterward.

After the trapezium is removed, the goal is to prevent collapse and excessive shortening. One method uses a portion of a wrist tendon to create a supportive ligament-like structure. The remaining tendon segment can be rolled into a soft-tissue “cushion” (sometimes described as an “anchovy” configuration) and placed into the space where the bone was removed. This helps prevent painful bone contact while preserving thumb mobility.

Another modern approach is “suspensionplasty,” where after trapeziectomy, the first metacarpal is supported relative to the index metacarpal using special sutures or small implants. This maintains spacing, reduces collapse, and the body gradually fills the area with scar tissue. These techniques can restore practical function—such as opening jars and writing—while reducing pain.

What Is Proximal Row Carpectomy (PRC) for Wrist Osteoarthritis?

When wrist osteoarthritis is advanced but preserving some motion is still desired, proximal row carpectomy (PRC) can be a very effective procedure. The carpal bones are arranged in two rows, and arthritis often begins in the proximal row.

In PRC, the three proximal row bones (scaphoid, lunate, and triquetrum) are removed. This allows the remaining distal row to articulate with the radius to form a new functional joint surface. The wrist may become slightly shorter and the range of motion may decrease, but pain relief is often significant, and many patients can continue bending and using the wrist. It can be an especially practical “salvage” option for patients who do not need heavy manual demands.

Potential advantages of PRC include:

• Preservation of some range of motion
• Significant pain relief
• Relatively shorter recovery period
• No metal implants in many cases
• No bone nonunion risk
• Maintenance of functional grip strength

Why Are Recovery and Physical Therapy So Important?

A common principle in hand surgery is: the operation is only half the work—the other half is rehabilitation. The hand is prone to swelling, stiffness, and adhesions if immobilized too long.

In the early post-operative phase, splints help protect healing tissues and control edema. However, controlled early movement is essential to reduce adhesions and preserve tendon gliding. As soon as wound healing allows, a structured program—ideally with an experienced hand therapist—helps restore motion and gradually rebuild strength.

Core rehabilitation steps often include:

• Edema control and wound care
• Protection with splinting
• Passive range-of-motion exercises
• Active-assisted movement
• Scar massage and management
• Sensory re-education
• Strengthening exercises
• Return-to-work simulations