Arthritis of the Hand

Your hands and wrists are essential tools that allow you to work, play and perform everyday activities. How well the hand and wrist interact depends on the integrity and function of the ligaments, tendons, muscles, joints and bones.

Problems in any of these can affect upper extremity function, causing disruptions at home and work and negatively impacting quality of life.

The human hand itself is very complex and delicate in structure. Hand surgery requires a completely different surgical approach from a qualified hand and wrist surgeon whether treating fractures, arthritis or deformities. Hand surgery traditionally includes treatment of the entire hand, wrist and forearm.
Again, this whole region works as a single unit, and the dysfunction of a single part needs consideration of the whole. An additional year of training is required for those orthopaedic surgeons seeking certification in hand and wrist surgery.

At some time in life, you may experience hand and wrist pain.

The hand and wrist have multiple small joints that work together to produce motion, including the fine motion needed to thread a needle or tie a shoelace. When the joints are affected by arthritis, activities of daily living can be difficult. Arthritis can occur in many areas of the hand and wrist and can have more than one cause.

Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and further limits motion.

Simply defined, arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis and rheumatoid arthritis, but there are more than 100 different forms.

Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.

Disease

When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is much more common and generally affects older people. Also known as “wear and tear” arthritis, osteoarthritis causes cartilage to wear away. It appears in a predictable pattern in certain joints.

Rheumatoid arthritis is a chronic disease that can affect many parts of your body. It causes the joint lining (synovium) to swell, which causes pain and stiffness in the joint. Rheumatoid arthritis most often starts in the small joints of the hands and feet. It usually affects the same joints on both sides of the body.

Trauma

Fractures, particularly those that damage the joint surface, and dislocations are among the most common injuries that lead to arthritis. Even when properly treated, an injured joint is more likely to become arthritic over time.

Pain

Early symptoms of arthritis of the hand include joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping. The pain may not be present immediately, but may show up hours later or even the following day. Morning pain and stiffness are typical.

As the cartilage wears away and there is less material to provide shock absorption, the symptoms occur more frequently. In advanced disease, the joint pain may wake you up at night.

Pain might be made worse with use and relieved by rest. Many people with arthritis complain of increased joint pain with rainy weather. Activities that once were easy, such as opening a jar or starting the car, become difficult due to pain. To prevent pain at the arthritic joint, you might change the way you use your hand.

Swelling

Thumb extension deformity. This patient has lost mobility at the base of the thumb due to arthritis. The next joint closer to the tip of the thumb has become more mobile than normal to make up for the arthritic joint. Normally, the thumb does not come to a right angle with the rest of the hand.

When the affected joint is subject to greater stress than it can bear, it may swell in an attempt to prevent further joint use.
Changes in Surrounding Joints
In patients with advanced thumb base arthritis, the neighboring joints may become more mobile than normal.

Warmth

The arthritic joint may feel warm to touch. This is due to the body’s inflammatory response.

Crepitation and Looseness

There may be a sensation of grating or grinding in the affected joint (crepitation). This is caused by damaged cartilage surfaces rubbing against one another. If arthritis is due to damaged ligaments, the support structures of the joint may be unstable or “loose.” In advanced cases, the joint may appear larger than normal (hypertrophic). This is usually due to a combination of bone changes, loss of cartilage, and joint swelling.

Cysts

Mucous cyst of the index finger.
When arthritis affects the end joints of the fingers (DIP joints), small cysts (mucous cysts) may develop. The cysts may then cause ridging or dents in the nail plate of the affected finger.

Nonsurgical Treatment

In its early stages, arthritis at the base of the thumb will respond to nonsurgical treatment.

• Ice the joint for 5 to 15 minutes several times a day.
• Take an anti-inflammatory medication, such as aspirin or ibuprofen, to help reduce inflammation and swelling.
• Wear a supportive splint to limit the movement of your thumb, and allow the joint to rest and heal. The splint may protect both the wrist and the thumb. It may be worn overnight or intermittently during the day.

Because arthritis is a progressive, degenerative disease, the condition may worsen over time. The next phase in treatment involves injecting a steroid solution injection directly into the joint. This will usually provide relief for several months. However, these injections cannot be repeated indefinitely.

Surgical Treatment

When nonsurgical treatment is no longer effective, surgery is an option. The operation can be performed on an outpatient basis, and several different procedures can be used.

One option involves fusing the bones of the joint together. This, however, will limit movement.

Another option is to remove part of the joint and reconstruct it using either a tendon graft or an artificial substance.

You and your physician will discuss the options and select the one that is best for you.