Post-Traumatic Arthritis

Arthritis technically is "inflammation of the joint." Sometimes, this occurs following an injury to a joint or the tissues around it. Many people are familiar with the ACL, or anterior cruciate ligament, in the knee. If that is damaged and not treated, a person will go on to have arthritis in that knee. Similarly, if the meniscus--or shock absorber in the knee--is damaged, the cartilage can wear as well. Fractures, or broken bones, that either crack into the cartilage or do not heal properly can cause inflammation in the joint as well.


Post-traumatic arthritis in the hand, wrist, and elbow can occur from any of these issues.


One of the most common areas of post-traumatic arthritis is the wrist. The scaphoid bone is considered the "leader" of the eight small bones in the wrist; they all move in concert with each other to allow smooth motion in different directions. Injuries to and around the scaphoid bone in the wrist affect movement of all of the bones in the wrist. Because of this, an untreated scaphoid non-union (scaphoid fracture that does not heal), scaphoid malunion (scaphoid fracture that heals in the wrong position), or rupture of the ligament attaching the scaphoid to the lunate (scapholunate ligament), can lead to arthritis in the wrist. The last of these often is referred to as a "wrist sprain," which is misleading, because it can be quite a significant injury and is as difficult or more difficult to treat than a broken bone!


Untreated scapholunate ligament tears lead to something called scapholunate advanced collapse (SLAC) arthritis. Scaphoid fracture nonunions lead to scaphoid non-union advanced collapse (SNAC) arthritis. Multiple joints in the wrist can be affected by each of these problems. The main difference is the order in which each joint is affected over time.




This advanced post-traumatic arthritis of the wrist can be treated in various ways. Non-operative treatment might include NSAIDs, brace/splint use, hand therapy, activity modification (changing what and how you do things), and/or steroid injections. Severe pain or pain that no longer responds to the non-operative options can be treated with surgery. These surgeries are called "salvage procedures" because they do not make things "normal again," but involves trying to save whatever is possible while making the pain better. Surgery might involve shaving off a spike of bone (radial styloidectomy), removing certain bones in the wrist (proximal row carpectomy), or removing the scaphoid and fusing other bones in the wrist together (scaphoidectomy and four corner arthrodesis/fusion). The surgery is decided based on the extent of arthritis and your personal goals.


Certainly, the ideal is to avoid post-traumatic arthritis by having injuries evaluated and addressed early, but unfortunately, sometimes this can result no matter what we do.