Wrist and Finger Osteoarthritis in Vienna
Leaning on the hand, opening a bottle: the wrist makes itself felt. In the morning the fingers are stiff, and hard nodules stand out at the joints. I find out which joints are affected and discuss the treatment that fits with you.
In short
In osteoarthritis of the wrist the cartilage between the radius and the carpal bones is worn; in finger osteoarthritis the same process affects the small finger joints. Typical are start-up pain, pain when leaning on the hand and turning it, a weakening grip and hard nodules on the fingers. At the wrist an old injury is often behind it. Treatment is conservative first: splint, physiotherapy and exercise therapy, ultrasound-guided injection, PRP therapy, magnetic field therapy. I speak about a procedure only once that no longer carries.
What is wrist osteoarthritis?
Osteoarthritis means that the layer of cartilage between two bones becomes thinner and disappears in places. At the wrist this concerns the junction between the radius and the carpus as well as the joints between the carpal bones. In the fingers it hits the small joints: at the end joints as Heberden's osteoarthritis, at the middle joints as Bouchard's osteoarthritis. There the osteoarthritis runs in families and usually affects several joints. Wear of the thumb saddle joint is called thumb base osteoarthritis (rhizarthrosis) and is treated separately.
At the wrist, the wear rarely arises without a history. If a tear of the scapholunate ligament between the scaphoid and the lunate is left untreated, the carpal bones shift against each other; the cartilage is loaded unevenly and wears away. This course is called a SLAC wrist. If a scaphoid fracture does not unite, a SNAC wrist develops through the same mechanism. A distal radius fracture that has healed in a poor position also loads the joint surface unfavourably. This is why I treat fresh ligament injuries of the wrist early.
Typical symptoms
- Start-up pain — the first movements after a period of rest hurt, and afterwards it becomes easier.
- Pain when leaning on the hand and turning it — pushing up from the floor, opening a bottle, turning a key.
- Loss of grip strength — objects slip away, and a firm handshake is difficult.
- Stiffness and hard nodules on the fingers — in the morning the fist closes only after a few movements.
- Grating and loss of movement — bending the wrist backwards is difficult.
- Inflammatory, active phases — the joint is swollen, warm and painful at rest.
How I make the diagnosis
It begins with a detailed conversation: how long the symptoms have been there, which movement brings them on, whether there was an accident — including one that goes back a long way. Then I examine the hand and wrist, test movement, strength and stability, and assign the tenderness to a joint. Ultrasound is available in the practice: for effusion, tendons and soft tissue, and for the targeted injection. The state of the bone is shown by the X-ray; X-ray and MRI are not in the building, I arrange them where needed and go through the images with you.
Treatment: conservative first
Osteoarthritis cannot be reversed. The aim is therefore to relieve the pain, preserve movement and keep the hand usable in daily life. I proceed step by step:
- Splint and orthosis — gives relief during periods of load and in an active flare; on the fingers, small night splints.
- Physiotherapy and exercise therapy — grip techniques that spare the joints, work on movement and strength; both take place in the same building at the Orthozentrum Döbling.
- Ultrasound-guided injection — under vision the medication reaches exactly where it is meant to act.
- PRP therapy — possible for cartilage complaints; I discuss its limits openly with you beforehand.
- Magnetic field therapy — alongside, when irritation and swelling are in the foreground.
- Adjusting the load — not sparing the hand but loading it differently: movement without impact and without constant weight-bearing.
When an operation is necessary
Whether an operation is sensible depends on the findings and on how much you are suffering, not on the X-ray alone. I operate when the conservative options are exhausted and the hand no longer plays along.
At the wrist I start minimally invasive wherever that works: with arthroscopy (keyhole inspection of the joint) cartilage and ligaments can be assessed directly, loose bodies removed and irritated tissue cleared. If a ligament injury is the cause and the cartilage still intact, a ligament reconstruction can influence the course. If the cartilage is worn over a large area, the point is to shut off the painful part of the joint and preserve as much movement as possible: partial fusion of individual carpal joints, removal of a damaged row of bones, fusion or joint replacement. An overview is given by the page on hand surgery in Vienna.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. More on this on the page private practice: process and reimbursement.
Whether and which procedure comes into question for you I do not decide from the image alone: the findings, your work, your sport and what you expect of your hand belong to it. The next step I settle together with you.
Frequently asked
Frequently asked questions about wrist and finger osteoarthritis
The typical sign is start-up pain: the first movements after a period of rest hurt, and afterwards it becomes easier. Added to this are pain when leaning on the hand and when turning it, a weakening grip and sometimes a grating in the joint. Certainty comes only from the examination with an X-ray, because tendon and ligament problems cause similar symptoms.
Both are osteoarthritis of the finger joints, and they differ only in place. Heberden's osteoarthritis affects the end joints directly beneath the nail, Bouchard's osteoarthritis the middle joints. In both, bony outgrowths form at the joint margin that can be felt as hard nodules. Wear of the thumb saddle joint carries a name of its own: rhizarthrosis.
Both terms describe how an old injury ends in osteoarthritis of the wrist. In a SLAC wrist the ligament between the scaphoid and the lunate is torn and has not healed, in a SNAC wrist a scaphoid fracture has not united. In both cases the carpal bones shift, the cartilage is loaded unevenly and wears down in a typical order.
An orthosis gives relief during periods of load and in active flares, because it holds the joint still and prevents faulty loading. It is not a permanent state: if the wrist is spared for too long, it loses movement and strength. I therefore set how long the splint is worn, and combine it with exercises.
In PRP therapy I prepare your own blood and place the platelet-rich portion into the joint under ultrasound control. It comes into question for cartilage complaints and irritated tendon attachments. It does not build new cartilage, and the scientific evidence is inconsistent. Whether it makes sense in your case is something I discuss openly with you.
No. Many patients manage well with a splint, physiotherapy and exercise therapy, an injection and adjusted loading. A procedure only comes into question once these options are exhausted and pain or loss of strength govern daily life. What counts is your symptoms, not the finding on the X-ray alone.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.