Osteoarthritis of the Hand
What is arthritis?
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, but it is most
noticeable when it affects the hands and fingers. Each hand has 19
bones, plus 8 small bones and the two forearm bones that form the wrist.
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 of the hand
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 (see Figure 1):
• at the base of the thumb, where the thumb and wrist
come together (the trapezio-metacarpal, or basilar, 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)
It also often develops in the wrist.
Signs and symptoms of arthritis of the hand
Stiffness, swelling, and pain are symptoms common to all forms of
arthritis in the hand. With osteoarthritis, bony nodules may develop at
the middle, or PIP, joint of the finger (Bouchard’s nodes), and at
the end-joints, or DIP, of the finger (Heberden’s nodes) (see
Figure 2). A deep, aching pain at the base of the thumb is typical of
osteoarthritis of the basilar joint. Swelling and a bump at the base of
the thumb where it joins the wrist may also be observed. Grip and pinch
strength may be diminished, causing difficulty with activities such as
opening jars or turning keys. Pain, swelling, stiffness, and diminished
strength are also seen with osteoarthritis of the wrist.
How is osteoarthritis diagnosed?
Your doctor will examine you and determine whether you have similar
symptoms in other joints and assess the impact of the arthritis on your
life and activities. The clinical appearance of the hands and fingers
helps to diagnose the type of arthritis. X-rays will also show certain
characteristics of osteoarthritis, 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.
Treatment for osteoarthritis of the hand
Treatment is designed to relieve pain and restore function.
Anti-inflammatory or other analgesic medication may be of benefit in
relieving pain. Brief periods of rest may help if the arthritis has
flared up. You may also be advised to wear finger or wrist splints at
night and for selected activities. Often soft sleeves may be of some
benefit when the rigid splints are too restrictive, especially when the
arthritis is affecting the joint at the base of your thumb. Heat
modalities in the form of warm wax or paraffin baths might help, and
when severe swelling is present, cold modalities may be of help. It is
important to maintain motion in the fingers and use the hand as
productively as possible. Hand therapy is often helpful with these
exercises, splints, and modalities. A cortisone injection can often
provide relief of symptoms, but does not cure the arthritis. 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. One type of surgery is joint fusion, in which the
arthritic surface is removed and the 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
functioning. Another approach is 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. Which type of surgery is used depends on the
particular joint(s) involved, your activities, and your own needs. Your
hand surgeon can help you decide which type of surgery is the most
appropriate for you.
Figure 1: Joints commonly affected by
osteoarthritis
Figure 2: Bumps of finger joints with
osteoarthritis
© 2006 American Society for Surgery of the
Hand
Developed by the ASSH Public Education Committee
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