HAND: JOINT AND BONE PROBLEMS
Arthritis literally means “inflamed joint.” Normally a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. Arthritis results when these smooth surfaces become irregular and don’t fit together well anymore and essentially “wear out.” Arthritis can affect any joint in the body. Arthritis of the hand can be both painful and disabling. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis.
Osteoarthritis is the most common cause of arthritis seen in this practice. Osteoarthritis is a degenerative joint disease in which the cushioning cartilage that covers the bone surfaces at the joints begins to wear out. It may be caused by simple “wear and tear” on joints, or it may develop after an injury to a joint. In the hand, osteoarthritis most often develops in three sites:
- at the base of the thumb (basal joint)
- at the end joint closest to the finger tip (the distal interphalangeal or DIP joint)
- at the middle joint of a finger (the proximal interphalangeal or PIP joint)
Arthritis of the hand irrespective of the cause, presents with stiffness, swelling, and pain over the involved joint. Grip and pinch strength may be diminished, causing difficulty with activities such as opening jars or turning keys.
An X-ray will required to show certain characteristics of arthritis, such as narrowing of the joint space, the formation of bony outgrowths (osteophytes or “nodes”), and the development of dense, hard areas of bone along the joint margins. Blood tests or referral to a rheumatologist may required to exclude other causes of arthritis.
Treatment of Arthritis
Treatment is designed to relieve pain and restore function. The initial treatment is non surgical and includes
- Anti-inflammatory or other analgesic medication
- Finger or wrist splints at night and for selected activities.
- Hand therapy
- Activity modification
- Steroid injection into the joint
Surgery is usually not advised unless these more conservative treatments fail.
Surgery is indicated when the patient either has too much pain or too little function. In most cases, the patient knows best and actually tells the doctor when it is time for surgery. The goal is to restore as much function as possible and to eliminate the pain or reduce it to a tolerable level.
The type of surgery used depends on the particular joint(s) involved, your activities, and your own needs. The surgeon can help you decide which type of surgery is the most appropriate for you. The surgical options include:
- Arthrodesis or joint fusion
- Arthroplasty or Joint reconstruction, in which 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 rolled-up soft tissue, such as a tendon, or with a joint replacement implant.
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