Arthritis is a relatively common yet serious condition in which the cartilage of the joints deteriorates and results in direct contact between the bones. In a healthy joint the cartilage allows the interacting bone surfaces to fit together as a set and move smoothly. When the cartilage wears out the fit of the joint becomes irregular with the effect most noticeable in the hands and fingers. Arthritis of the hand and wrist is painful and potentially disabling.
Common symptoms
The most common symptoms are pain, swelling and difficulty using the hand for routine, daily activities. Patients may also notice a deformity as their fingers drift away from the thumb and toward the outside of the hand. These conditions will generally worsen over time and as the disease progresses patients may experience pain even during rest. A loss of strength occurs in the hand, fingers and thumb. In the most severe cases, a bump will develop at the base of the joint where it has moved out of position.
Treatments and Therapies
We have a variety of treatment options depending on the nature and severity of the condition. In less-severe cases, simply changing daily activity or splinting can alleviate the problem. Pain medication and anti-inflammatory drug injections may be recommended. If these treatments do not work surgical repair of the joint may be necessary.
We can reduce and often eliminate pain, realign the position of the thumb and fingers and improve the overall function of the hand using a variety of surgical techniques. Consult with your doctor to decide the best course of treatment.
Medications
Anti-inflammatory drugs such as aspirin may help relieve pain and reduce swelling. However, their actual benefits are unclear since they are generally used in association with other treatments. You should always consult a doctor before taking any medication. We advise against using anti-inflammatory medications when the source of pain is something other than inflammation. Side effects can result from long term use.
Splinting
We splint the wrist and thumb to provide temporary relief from symptoms. Splints allow the arthritic joint to rest and keep it from moving. As a result, inflammation is often decreased and the surrounding area is allowed to heal.
Splints should be worn on a part-time basis during heavy activities that bring on or worsen pain or during flare-ups. Wearing splints full-time, unless prescribed by your hand surgeon, may result in stiffness in the immobilized joint. Ideally, a splint should be custom-fitted.
A wrist splint is not a substitute for good work place design and proper body mechanics. Some experts advise against wearing a wrist splint while working because doing so can strain tendons in the hand.
Cortisone Injections
Cortisone shots are injections of a naturally-occurring steroid that can provide temporary relief from arthritis symptoms. Injections can be administered directly to the affected area, helping to relieve swelling and pain. Side effects are generally minimal. Up to three injections may be given, each providing between a few weeks and a few months of effective pain management. However, individual patient results may vary.
Arthroplasty
Joint replacement in the hand
Candidates for arthroplasty — hand, wrist or elbow joint replacement — suffer from pain, stiffness and loss of function due to arthritis. However, these procedures are not limited to joints worn out by years of wear-and-tear. Improperly-healed injuries, chronic illnesses and congenital deformities that cause pain and loss of mobility may require surgical replacement.
Surgery is usually considered when other treatments have not provided adequate relief of symptoms. Surgery can be a very effective way to take away the pain of arthritis and regain the use of joints that do not need to bear heavy loads. Joint replacement surgery may restore your mobility while improving your ability to perform daily activities without pain. Results may be superior to bone fusion, another treatment which limits movement in the joint.
In certain scenarios soft tissue arthroplasty is recommended over traditional joint replacement. Soft tissue arthroplasty involves replacing a small support bone with a tendon that acts as a cushion to keep the bones separated. As healing progresses a flexible connection much like a natural joint forms between the bones.
Wrist Arthroscopy
Arthroscopy, which literally means “to look within a joint,” is a surgical procedure used to visualize, diagnose and treat problems inside a joint. In an arthroscopic examination, a small incision is made and a pencil-sized instrument containing a small lens, camera and lighting system is inserted into the joint. Three-dimensional images of the joint are projected on a television monitor, enabling the surgeon to examine the area and identify the condition. The surgeon then uses tiny probes, forceps, knives and shavers to correct many problems at the same time.
Diagnostic arthroscopy may be used if your pain is unresponsive to non-surgical treatment or the cause cannot be identified. Arthroscopy allows detailed anatomic inspection and results in a more accurate diagnosis. Several conditions can be diagnosed and treated using arthroscopic surgery including ligament injuries, ganglion cysts and fractures. Arthroscopy may also be used to smooth the bone surfaces and remove inflamed tissue.
After surgery it is important to keep the area around the incision clean and dry to prevent infection. The joint will need to be elevated for the first few days. Rehabilitation exercises will be taught to regain range of motion, rebuild strength and reduce swelling. Applying ice will also help prevent swelling.
