Wrist Arthritis on X-ray: Imaging Findings

Wrist osteoarthritis can follow a scaphoid or distal radius fracture that has not united or has healed out of alignment, ligament disruption, or avascular necrosis of a carpal bone. These changes can alter joint loading. Clinical examination and radiographs help identify the affected joints; the cause alone does not determine a severity grade.

Scapholunate advanced collapse (SLAC) originates from chronic scapholunate ligament injury with the arthrosis beginning at the radial styloid-scaphoid articulation and progressing to the entire radioscaphoid and then midcarpal joint while the radiolunate joint is preserved. Scaphoid nonunion advanced collapse (SNAC) results from a chronic scaphoid fracture nonunion with a similar progression pattern but starting at the distal scaphoid-radius articulation. The distinction lies in whether a scapholunate gap or a scaphoid fracture nonunion is identified as the inciting lesion.

Plain radiographs reveal established joint space narrowing, osteophytes, subchondral sclerosis, and cysts but underestimate early cartilage loss. MRI directly visualizes cartilage thinning, bone marrow edema indicating active subchondral stress, synovial proliferation, and ligamentous contributions to the arthritis pattern. In inflammatory arthritis, gadolinium-enhanced MRI detects early synovitis and erosions before radiographic changes appear, enabling earlier disease-modifying treatment.