OSTEOARTHRITIS OF THE HANDS & FINGERS

Each hand is made up of nineteen major bones including eight small ones and two from the forearm that make up the wrist. At the point where the bones meet, a joint is formed that is usually composed of two smooth surfaces covered with cartilage that work as a unit. Arthritis, which literally means "inflamed joint," occurs when the surfaces of these joints no longer line up perfectly. 

While arthritis can painfully disable any joint in the body, when it presents itself in the hand or in fingers it feels rather serious because those joints are used so often. Arthritis can come from infections, gout, and psoriasis, but the most common forms are osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis, which is caused by an injury. 

When the cartilage that covers the surfaces of the bones in any joint begins to wear out, it is referred to as osteoarthritis. Osteoarthritis is a degenerative joint disease that presents itself from overuse of the joints or because of an injury to the joint. Osteoarthritis typically presents itself in the wrist. However, with respect to the hand, it often shows up in one of three places:

• In the trapezio-metacarpal or basilar joint, where the thumb meets the wrist
• In the distal interphalangeal or DIP joint, closest to the end of the finger
• In the proximal interphalangeal or PIP joint, in the middle of the finger

No matter the type, arthritis causes the joints to be stiff, swollen, and painful. In the case of osteoarthritis in the middle of the finger (i.e., the PIP joint) bony nodules called Bouchard's nodes may present themselves. If osteoarthritis is in the joints near the fingertips (i.e., the DIP joints), the nodules are called Heberden's nodes.

If the basilar joint, at the base of the thumb, has osteoarthritis, a deep aching pain is usually felt in the joint. The joint may, in addition, show swelling or a bump. Osteoarthritis often results in a weakened pinch or grip, so turning keys or opening jars may be difficult. If the joints in the wrist have osteoarthritis, wrist strength may be affected, and the wrist may be painful to move, stiff, or swollen.

To see if you have osteoarthritis, your hand surgeon will do an examination of your joints. The appearance of your hands and fingers will be checked, and x-rays may be taken to see if the space between the joints has shrunk or if bony outgrowths in the form of nodes or osteophytes have formed. X-rays can also indicate whether the bones near the ends of the joints have begun to form denser areas of harder bone. 

The goal of any treatment for hand or finger osteoarthritis is to eliminate pain so as to facilitate the ability to resume daily activity. To reduce the pain, anti-inflammatory or analgesic medicines may be used. Additionally, brief periods of rest for the affected joints may help if there is an occasional flare up of symptoms. The use of wrist or finger splints may help. The use of splints is not an option, soft sleeves may be used.

Heat treatments using warm wax or paraffin can sometimes help with the pain or stiffness. However, if the swelling is excessive, cold packs may be applied. The goal in any treatment is to keep the fingers and joints in the hand as flexible as possible so that they can be fully functional once again. With proper therapy, exercise, splint use, and hot or cold treatments, it is often possible to resume typical activity.

In more severe cases, cortisone may be injected. While this relieves the symptoms, it does not cure the arthritis. When the before mentioned treatments fail to provide relief, surgery is considered.

If the amount of pain is too great, or if the arthritis is keeping the hand or fingers from being used, your hand surgeon may suggest surgery. The goal of surgery would be to restore the use of the hand and eliminate or reduce the pain.

There are two types of surgical procedures used to treat osteoarthritis in the hand or fingers. There is joint fusion, a procedure that involves removal of the surfaces of the joints that have arthritis are removed. This surgery results in the joint losing all ability to move or bend, but it can eliminate pain and also fix any deformities.

The other surgery is joint reconstruction which involves removing the face of the joint that is no longer smooth. The purpose of this procedure is to get rid of the rough and irregular contact between the bones that causes pain and limits the joint's ability to move. After removing the bad part of the joint's surface, either a joint replacement is implanted or the joint is lined with other soft tissue, such as a tendon.

The type of surgery that will work best for your case depends on which joint needs treatment. One of our hand surgeons will discuss these matters with you fully, and help you decide the best way to treat your hand or finger osteoarthritis.