Hand & Wrist
Arthritis of the Hand
Arthritis is not a single disease, but a name for joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. It is most common among women and occurs more frequently as people get older.
A healthy joint consists of two smooth, cartilage-covered bone surfaces that fit together and move smoothly against one another. Arthritis is diagnosed when these smooth surfaces become irregular, don’t fit properly together, and essentially “wear out.”
Arthritis can affect any joint in your body, but it is most noticeable in the hands and fingers. A common form of arthritis that affects the hand is osteoarthritis, a degenerative joint disease that most often develops in three sites:
- Base of your thumb, where the thumb and wrist come together (trapeziometacarpal or basilar joint)
- End joint closest to your finger tip (distal interphalangeal or DIP joint)
- Middle joint of your finger (proximal interphalangeal or PIP joint)
The most common symptoms of osteoarthritis are stiffness, swelling, and pain. Bony nodules may develop at the middle (PIP) and end (DIP) joints of the finger. A deep, aching pain at the base of your thumb is typical of osteoarthritis in the basilar joint. Swelling and a bump at the base of the thumb may also be observed. Grip and pinch strength may be diminished, causing difficulty with activities such as opening jars or turning keys.
Your doctor will conduct a physical examination and determine whether you have similar symptoms in other joints. The appearance of your hands and fingers can often help diagnose the type of arthritis. X-rays will also show certain characteristics of osteoarthritis such as narrowing of the joint space, formation of bony outgrowths (osteophytes or nodes), and the development of dense, hard areas of bone along the joint margins. Your doctor will also want to discuss the impact that your symptoms are having on your life and activities.
With osteoarthritis, it is important to maintain motion in the fingers and use the hand as productively as possible. Non-surgical treatments to relieve pain and restore function include:
- Anti-inflammatory or other analgesic medication
- Brief periods of rest
- Finger or wrist splints worn at night and for select activities
- Soft sleeves may be of some benefit when rigid splints are too restrictive, especially when the arthritis is affecting the joint at the base of your thumb
- Heat modalities like warm wax or paraffin baths
- Hand therapy
- Cortisone injections
If non-surgical treatments fail and you are experiencing too much pain or too little function, surgery may be considered. In most cases, the patient knows best and will tell his/her doctor when it is time for surgery. The goal of surgery is to restore as much function as possible and eliminate pain or reduce it to a tolerable level. There are two types of surgery:
- Joint Fusion Surgery – The arthritic surface is removed and bones on each side of the joint are fused together, eliminating motion from the problem joint. Joint fusion may be used to relieve pain and correct deformities that interfere with function.
- Joint Reconstruction – The degenerated joint surface is removed in order to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. Once the degenerated portion of the joint surface is removed, it may be replaced with soft tissue or with a joint replacement implant.