Arthritis of the Hand
What is it?
Arthritis causes damage to the normal cartilage that covers the ends of bones where joints are formed. There are two broad types of arthritis.
1. Osteoarthritis, more commonly known as wear and tear arthritis. This is caused by use of the joint or sometimes by an injury. The cartilage initially splits and becomes rough and thin. Later on it wears through completely and the bone ends rub together. This may be felt as a grating sensation. The finger and thumb joints are commonly affected with this type of arthritis.
2. Inflammatory arthritis, an example of this is rheumatoid arthritis. The body’s own immune system damages the joints and surrounding tissues including ligaments and tendons. There is typically more swelling and stiffness in the mornings with an inflammatory arthritis
What are the symptoms?
Most patients will present with pain, stiffness and a variable amount of swelling. Later on deformities will develop. There will be a reduction in how much you are able to do with your hand. You may have to give up hobbies or sports because of pain, stiffness and lack of grip.
Diagnosis can often be made from the clinical history (the account of events and symptoms from the patient) and the clinical examination. Patients will usually need further investigations in terms of X-rays and some will require special scans – ultrasound, CT or MRI.
If an inflammatory arthritis is suspected you will require a series of blood tests and would require an opinion from a special doctor called a Rheumatologist.
In Osteoarthritis the mainstay of treatment is activity modification, analgesics, anti inflammatory medication, Hand Therapy and sometimes splints. These treatments are very useful in the early stages of the arthritis.
Steroid Injection - can be useful in selected cases and may give several weeks/months relief of symptoms. One or occasionally two injections are advised because of the risk of cartilage damage with further injections.
Joint Fusion - this involves stiffening or fusion the joint in the position of maximal function. It is a good way of improving pain but does eliminate all movement in the fused joint. The fusion is normally performed with wires, screws and sometimes plates. The hand functions surprisingly well provided the surrounding joints are functioning.
Joint Replacement - this can be performed in very selected cases where both movement and pain relief are required and the patient is prepared to accept the limitations and risk associated with joint replacement surgery. Most of the joints in the hand can be replaced with a variety of joint replacements available including silicone (plastic), pyrocarbon ( similar to ceramic), metal and plastic ( similar to knee replacements). Certain types of joint replacements are more suitable to inflammatory (rheumatoid) arthritis.
Soft Tissue Reconstructive Surgery - this may be appropriate in certain cases of inflammatory arthritis where there is deformity and preservation of the underlying joint cartilage. Tendons may need to be realigned and ligaments repaired or reconstructed. The rehabilitation after these procedures is quite involved and prolonged.
The decision making around joint replacements and soft tissue reconstructions in the hand is complicated and many factors have to be taken into account. These will all be discussed with you at your consultation. You may also need a Hand Therapy assessment to identify specific functional deficits and to discuss the post-surgery rehabilitation.