Joints and cartilage of the hand and wrist

Anatomy: joints, cartilage and stability

The hand and wrist consist of numerous joints that work together precisely. Articular surfaces are covered with hyaline cartilage - a smooth, elastic protective layer that minimizes friction and distributes loads. The joint capsule, ligaments and tendons guide and stabilize movement.

• Wrist (radiocarpal): connection between radius (radius) and proximal carpal row; Main load carrier when supporting.
• Metacarpal joint (midcarpal): between the proximal and distal carpal rows; important for range of motion.
• STT joint: scaphoid – trapezium – trapezoid; involved in power transmission when grasping.
• Thumb saddle joint (CMC I, rhizarthrosis localization): high mobility for opposition movements, therefore also particularly stressed.
• MCP, PIP, DIP joints of the fingers: allow bending/stretching and fine motor skills.
• TFCC (triangular fibrocartilage complex): important buffer and stabilizer on the ulnar side of the wrist.

Cartilage has no blood supply of its own; it is nourished through exercise and synovial fluid. Incorrect loading, instabilities or inflammation disrupt this metabolism and promote wear and tear (arthrosis) or painful irritations.

Typical symptoms of joint and cartilage diseases

• Pain on exertion and rest, start-up pain, morning stiffness
• Pressure pain over joint spaces (e.g. thumb saddle joint) and weakness in grip
• Swelling, warming, grinding/cracking (crepitation), restricted movement
• Feeling of instability, buckling, snapping
• Misalignments (increasing axial deviation of finger joints)
• In case of inflammation: redness, warmth; if nerves are involved: tingling, numbness

Symptoms often develop gradually. After accidents, they can begin abruptly and be associated with instability or cartilage damage.

Common clinical pictures at a glance

Wrist mechanics are complex. Different diseases affect different joints and structures. You can find detailed information on our detail pages:

• Rhizarthrosis (saddle joint of thumb): Pain when turning keys, opening bottle caps, gripping with tweezers.
• Finger osteoarthritis (DIP, PIP, MCP): knot formation, stiffness, stress-related pain.
• Radiocarpal osteoarthritis: pain on support, limited flexion/extension in the wrist.
• Midcarpal osteoarthritis: painful limitation of side bending, loss of strength.
• STT osteoarthritis: local pain radially proximal, discomfort when gripping forcefully.
• Unstable wrist kinematics: Ligament lesions (e.g. scapholunate) lead to incorrect movements and subsequent damage (SLAC/SNAC).
• Kienböck's disease: circulatory disorder of the lunate bone (lunate) with risk of collapse.
• Preiser's disease: circulatory disorder of the scaphoid bone with gradual pain.
• Nonunion after fractures: lack of bony healing affects joint guidance and cartilage.
• Rheumatoid arthritis of the hand: inflammatory joint destruction, tendon involvement, deformities.

Causes and risk factors

• Age and natural wear and tear of hyaline cartilage
• Incorrect or overloading (repeated pincer grips, hard physical work, vibration)
• Previous injuries: fractures (e.g. radius, scaphoid), ligament tears (scapholunate, lunotriquetral), misalignments
• Inflammatory systemic diseases (e.g. rheumatoid arthritis), crystal arthropathies
• Circulatory disorders of the wrist (Kienböck, Preiser)
• Metabolic factors (obesity, diabetes), smoking (microcirculation)
• Anatomical variations (ulnar variance) and instabilities that alter load distribution
• Hormonal influences (e.g. increased risk of rhizarthrosis after menopause)

Diagnostics: structured and gentle

We start with a careful anamnesis and functional examination. The location of pain, triggering movements, timing and previous injuries are important. Special tests help to narrow down the affected joints and ligaments.

• Clinical tests: Thumb saddle joint grind test, Watson test (scapholunate), ballottement (lunotriquetral), foveal sign (TFCC).
• Range of motion, strength measurement, swelling/effusion, axis assessment.
• X-ray in multiple planes; If instability is suspected, functional photographs may be taken.
• MRI for cartilage, ligaments, bone marrow edema; CT for the bony axis and monitoring of healing.
• Ultrasound for effusion and tendon assessment, if necessary infiltration control.
• Laboratory if inflammation or rheumatism is suspected.

Imaging is used specifically and according to the indication – as little as possible, as much as necessary.

Conservative therapy: the basis of every treatment

Our approach in Hamburg: conservative first. The aim is to relieve pain, improve function and slow progression - without unnecessary interventions.

• Education & activity adjustment: joint-friendly techniques, break management, everyday aids.
• Splints/Orthoses: e.g. B. Thumb saddle joint orthosis, wrist immobilization for acute irritating conditions; limited in time, combined with an exercise program.
• Hand therapy/occupational therapy: mobility, coordination, strengthening stabilizers, sensorimotor training.
• Physiotherapy: manual joint mobilization in the pain-free area, soft tissue techniques, self-exercises.
• Medication: primarily topical NSAIDs (e.g. diclofenac gel), if necessary oral NSAIDs for a limited period of time; individual risk-benefit assessment.
• Pain modulation: cold for acute inflammation, heat for muscle tension; Taping in individual cases.
• Workplace/ergonomics advice: thickened handles, non-slip aids, avoidance of pincer grips.

Conservative measures are combined individually and evaluated regularly. Consistent implementation in everyday life is crucial for success.

Injections and regenerative options: consider carefully

Targeted infiltrations can reduce pain and improve participation in everyday life. They do not replace basic therapy, but can supplement it. We provide transparent advice about benefits, risks and data.

• Cortisone injections: can provide short-term relief of inflammation and pain (weeks to a few months); limited in frequency and dose.
• Hyaluronic acid: partly helpful for the thumb saddle joint in studies; Effect varies from person to person, reimbursement varies.
• PRP (autologous blood plasma): for hand and wrist diseases with still limited evidence; Decision on a case-by-case basis.
• Imaging-guided injections (ultrasound): increase precision and safety.

Regenerative procedures are not a replacement for bony-mechanical corrections in cases of instability or misalignment. Indication always individual, without promise of salvation.

Surgical options – when conservative is not enough

Operations are considered when conservative measures have been exhausted or mechanical causes cannot be remedied in any other way. The choice of procedure depends on the joint, stage and individual goals.

• Joint preservation: ligament reconstructions/stabilizations, arthroscopic debridements, TFCC treatments, bony corrections (e.g. osteotomies).
• Arthrodeses (partial or full fusion): pain-reducing in advanced osteoarthritis; Strength and everyday life are often possible, with a reduced range of motion.
• Procedures for rhizarthrosis: trapezectomy with/without bandoplasty/suspension; Alternatives depending on patient goals.
• Proximal serial carpiectomy or partial fusions (e.g. four-way fusion) in SLAC/SNAC stages.
• Replacement operations in selected joints (e.g. MCP for rheumatoid arthritis).

The decision is made after detailed information about the benefits, risks, follow-up treatment and realistic goals - individually and without guarantees.

Course and prognosis

Many joint and cartilage diseases progress in episodes. Consistent conservative therapy can reduce pain, maintain function and have a beneficial effect on the course. After operations, structured rehabilitation and patience are important. Prognosis is individual and depends on the stage, the cause (e.g. instability, circulatory disorder) and concomitant diseases.

Self-help and prevention in everyday life

• Short, frequent breaks instead of long, stressful blocks of activity.
• Avoid pincer grips; Use tools with larger, non-slip handles.
• Cold packs for acute swelling (with a cloth, 10-15 minutes), heat for muscular tension.
• Carry out targeted home exercises from hand therapy regularly.
• Increase stress slowly and pay attention to warning signals.
• Quitting smoking supports microcirculation; A balanced diet promotes regeneration.
• Early clarification after a fall/trauma to prevent subsequent damage.

When should you see a doctor?

• Severe, persistent pain, significant swelling or redness of the joint
• Acute misalignment, blockage, snapping or instability feeling after trauma
• Fever or general feeling of illness in combination with joint pain
• Increasing numbness/tingling, waking up at night due to pain
• No improvement despite consistent protection and basic measures over 2-3 weeks

Your personal consultation in Hamburg

In our orthopedic specialist practice at Dorotheenstrasse 48, 22301 Hamburg, we provide you with personal, evidence-based advice. We will plan an individual, conservative treatment path with you and discuss further measures if necessary. The aim is to achieve a sustainable, everyday improvement in your hand function.

In-depth information on individual clinical pictures

Here you can access our detailed guide pages on joint and cartilage diseases of the hand:

• Rhizarthrosis – thumb saddle joint
• Finger osteoarthritis (DIP, PIP, MCP)
• Radiocarpal osteoarthritis
• Midcarpal osteoarthritis
• STT osteoarthritis
• Unstable wrist kinematics
• Kienböck's disease
• Preiser's disease
• Nonunions after fractures
• Rheumatoid arthritis of the hand