by: Dr. Chris Judson
Our hands and wrists have multiple small joints that function together and allow us to perform numerous activities with our hands, from heavy gripping to fine motions. Normally, these joints move easily due to cartilage that covers the ends of the bones, allowing them to glide smoothly over one another.
Types of Arthritis
Arthritis results when this cartilage surface is disturbed. There are a number of different types of arthritis, the most common of which are osteoarthritis and rheumatoid arthritis.
- Osteoarthritis, also known as “wear and tear” arthritis, tends to worsen with age. In the hands, the most common locations for arthritis include the distal interphalangeal (DIP) joints at the tips of the fingers and the base of the thumb joint. In addition, osteoarthritis can occur secondary to an injury that results in abnormal stress across a joint. This may include a fracture that never healed properly and now results in an uneven joint surface.
- Rheumatoid arthritis is less common and results from inflammation of the lining of the joint, causing pain and swelling in multiple joints in the body. This is an autoimmune condition, the symptoms of which include pain and stiffness. Many patients report increased stiffness in the morning when they wake up. In addition, pain will often worsen with increased use of the hands and may limit someone from doing certain tasks, such as opening a jar.
There are a number of additional symptoms of arthritis. Swelling may occur in the affected joints, and some patients can develop cysts next to the joint. In the hand, these are often seen at the DIP joints next to the fingernails and are called mucous cysts.
During a physician’s evaluation for suspicion of arthritis, the patient’s hands are checked for signs of arthritis, range of motion of the joints, and changes in surrounding joints. As there are a number of joints that are very close to one another in the hand, special exam maneuvers may be used to determine which specific joint is contributing most to the pain. An x-ray is often taken to better determine the extent and location of arthritis.
Many treatments are possible for arthritis in the hands. Each patient’s situation needs to be approached differently depending on their age and demands on their hands, the location and severity of arthritis, and their own goals.
- Starting with non-operative measures is usually most appropriate. These include medications such as anti-inflammatories, which can decrease the pain from inflammation. Unfortunately, there are no medications that have been proven to restore cartilage that has already been damaged.
- Often, the use of splints can help to keep the affected joint in a more comfortable position and to relieve pain during activities.
- Injections of steroidal drugs can be performed to decrease inflammation and pain in the joints and can last various lengths of time, from weeks to months.
Surgical treatments can be an option for decreasing pain and improving function when non-operative measures have failed to provide relief. In some joints with milder arthritis, there may be an option to preserve the joint. In cases of more severe arthritis, joint replacement or fusion are usually chosen. A fusion procedure means that the joint will no longer move, therefore eliminating the pain that occurs with motion at the damaged joint. This is most appropriate for joints that already have limited range of motion or for people who do a lot of heavy activities with the hands.
Alternatively, joint replacements can be performed for many of the joints in the hands to relieve pain but also to allow for range of motion. These include metal and plastic joint replacements, as well as using nearby tissues, such as tendons, to reconstruct the joint. The ideal type of surgical treatment varies for each patient and the specific pattern of arthritis, and these can be discussed with your orthopedic specialist.