What is Arthritis?
Arthritis, is a disorder in the cartilage at the tips of the long metacarpal and phalanx bones of the hand. These cartilaginous cushions act to protect the bones from rubbing against one another, so when they begin to wear away, there is bone-on-bone contact, which causes irritation. In addition, the lack of cartilage causes an increase in the creation of synovial fluid, which under normally circumstances allows the cartilage in the joints to move freely against one another, but in cases of arthritis can cause swelling, inflammation and irritation. Bone spurs may also be formed as a response to the direct contact between bones, which also leads to pain and discomfort.
What causes Arthritis?
The most common cause of arthritis to the hand is osteoarthritis or degenerative arthritis from wear and tear as the cartilage breaks down with ageing. Inflammatory arthritis conditions represent a more aggressive arthritis affecting younger people and is usually an autoimmune condition where one’s own body attacks the cartilage. This is seen in conditions such as Rheumatoid Arthritis and Lupus. Traumatic arthritis can occur following a fracture where the break goes into the joint and doesn’t heal in the right position, leading to premature wearing out of the cartilage.
Symptoms of Arthritis
Due to the nature of two unprotected bone tips grinding against one another, pain is a hugely common indicator of arthritis. As with many hand injuries, this pain may only be present with use, and recede when you are at rest, but that is not always the case, and sometimes presents as a dull ache, not unlike muscle pain in other parts of the upper extremity. In addition to pain, the irritation and inflammation caused by arthritis can lead to stiffness and difficulty moving the hand or bending the fingers, which may present in similar ways to tendon injuries. This stiffness is most often worst at morning, after a long period of inactivity. The inflammation associated with arthritis can, in addition, cause the joints of the hands and the knuckles of the fingers to become enlarged, which is one of the better known outward signs of arthritis. This enlargement can be associated with and often caused by the growth of bone spurs, as well as the presence of cysts, which are related to the overproduction of synovial fluid.
How can I know if I have Arthritis?
A comprehensive history of your arthritis will need to be taken by the doctor in order to determine the severity and trajectory of your affliction. An accompanying physical examination will also be essential in locating the problem areas and determining their relationships to other parts of the hand. Inflammation, pain and stiffness, as well as the relative deformities of your hand caused by arthritis, will be discovered and recorded by the doctor. This will then allow a trajectory of treatment to be developed.
Blood tests are also helpful in determining the exact kind of arthritis that is affecting you, such as if you have rheumatoid arthritis, or some other form that may need to be treated differently. X-rays and MRI are also important to allow the doctor to get a good look inside your hand and determine the severity of the arthritis on the structures that cannot be seen by the naked eye.
Treatment of Arthritis
Oral medication may be prescribed to you if your arthritis is only mild to moderate. These will be pain-control medications, like acetaminophen, or anti-inflammatory NSAIDs to cut down on the inflammation that leads to the pain. If your pain and discomfort become persistent despite these treatments, the doctor may find it necessary to inject you with Celestone or a related steroid. Either treatment method will be accompanied with physical therapy, which may also include recommendations as to lifestyle modification to make your daily routine less painful. In certain inflammatory conditions, a rheumatologist will likely use stronger chemotherapy medications.
The most commonly seen surgical treatment for arthritis of fingers is joint fusion at the DIP joint, or the joint closest to the nail. This procedure, exactly as it sounds, involves the surgical fusion of two parts of a joint to prevent movement, which will eliminate the associated pain. The tips of the two conjoining bones are filed in a way that allows them to sit together like puzzle pieces, after which a screw or pins are used to hold them rigidly in place for the duration of the healing process. This surgery will reduce mobility in the affected joint, but will reduce pain such that the reduction in function comes at a reasonable price.
For the knuckle joints of the fingers at the base of the finger and at the middle joints, a joint replacement procedure with a metal, pyrocarbon implant or a Silicone implant are frequently performed.
For arthritis at the base of the thumb, a trapezial resection is commonly performed and the space is filled with a tendon ball or the joint is suspended with a Mini Tight Rope.