ARTHRITIS OF THE HAND
The hand and wrist have multiple small joints that work together in unison to create complex and intricate movement such as threading a needle, tying a shoelace or doing shirt buttons. The joints can lock together to create a strong hand that can swing a hammer or lift a heavy suitcase. When these joints are affected by arthritis, activities of daily living can be difficult due to pain, stiffness and weakness. Arthritis can occur in many areas of the hand and wrist and can have more than one cause. Arthritis can occur with age or as a result of fracture or infection that damage the joint surface.
Simply defined, arthritis is inflammation of one or more of your joints. The most common types of arthritis are osteoarthritis generally associated with ageing and rheumatoid arthritis, but there are several other types.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. Cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining called synovium.In early stages, the shiny smooth cartilage that covers the joint surface starts to break down. Eventually all cartilage is lost and the resulting friction of bone on bone can change the shape of the affected bones. This causes more pain and further limits motion.
When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis.
Osteoarthritis (OA) is much more common and generally affects older people. Also known as “wear and tear” arthritis, osteoarthritis causes cartilage to wear away. It appears in a predictable pattern in certain joints. Common joints that are affected by OA are the thumb basal joint and the end joints of the fingers.
Rheumatoid arthritis (RA) is a chronic disease that can affect many parts of your body. It causes the joint lining (synovium) to swell, which causes pain, stiffness and joint destruction. RA can occur at any age most often starts in the small joints of the hands and feet. It usually affects the same joints on both sides of the body. Early signs are stiffness of the hands on waking and swelling of the knuckles and wrist.
Fractures, particularly those that damage the joint surface, and dislocations are among the most common injuries that can lead to arthritis. Even when properly treated, an injured joint is more likely to become arthritic over time as joint cartilage does not heal well.
Fractures within the finger joints.
Early symptoms of arthritis of the hand include joint pain that may feel “dull,” or a “burning” sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping. The pain may not be present immediately, but may show up hours later or even the following day. Morning pain and stiffness are typical. Pain is made worse by activity and relieved by rest or splinting.
As arthritis advances, the joints may even hurt when rested or in damp, cold weather. In advanced disease, the joint pain may wake you up at night.
In early stages the arthritic joint starts to swell due to inflammation of the joint lining membrane (synovitis). The swelling does diminish with rest and medication. The swelling in RA is more dramatic and usually does not resolve with rest. Over time with development of bone spurs and thickening of the ligaments, the joint becomes permanently enlarged.
WARMTH AND CREPITATION
The arthritic joint may feel warm to touch due to the inflammation within. Additionally, there may be a sensation of grating or grinding with movement of the affected joint (crepitation). This is caused by damaged joint surfaces rubbing against one another. If arthritis is due to damaged ligaments, the support structures of the joint may be unstable or feel unusually “loose.”
When arthritis affects the end joints of the fingers small lumps can form at the base of the nail cysts. These are filled with clear, jelly-like fluid and are called mucous cysts. Pressure on the nail can created a ridge in the nail adjacent to the cyst.
A doctor can diagnose arthritis of the hand from the history of symptoms, by examining the hand and by taking x-rays. Specialized studies, such as magnetic resonance imaging (MRI) may be needed. Sometimes a whole body bone scan is helpful if multiple joints are involved as they are sensitive in picking up inflammation in the body.
Blood tests are necessary if RA or other inflammatory diseases are suspected.
Arthritis does not have to result in a painful or sedentary life. It is important to seek help early so that treatment can begin and you can return to doing what matters most to you.
The majority of patients with arthritis can be managed without surgery. Treatment options for arthritis of the hand and wrist include medication, splinting, injections, and surgery. Your doctor will decide the treatment based on:
- Your age and activity level
- Severity of the arthritis
- Which hand is involved and how it affects your work or hobbies
Medications treat symptoms but cannot restore joint cartilage or reverse joint damage. The most common medications for arthritis are non-steroidal anti-inflammatories (NSAIDs) that are available without prescription such as ibuprofen. Paracetamol can also be useful for relieving pain associated with arthritis.Some patients find benefit from taking dietary supplements such as glucosamine and chondroitin.
Steroid injection into a joint can provide pain relief for weeks to months. The injections can be repeated, but only a limited number of times, due to possible side effects, such as lightening of the skin and weakening of the tendons and ligaments.
Splinting is effective in arthritis by resting the joint while allowing use of the rest of the hand. Splints are typically worn during periods when the joints hurt. Wearing the splint for too long can lead to muscle deterioration (atrophy).
When other treatment methods fail or function is lost, surgery can be helpful. There are several treatment options that are discussed and tailored to each person. In early stages the joint can be cleared of inflammatory tissue (debridement). In later stages some form of joint reconstruction is performed. Generally if stability is desired, arthrodesis is performed where the joint surfaces are removed and the bones are fused together. If mobility is desired, the arthritic surfaces are removed and replaced with tissue or artificial joints (arthroplasty).
In the initial recovery period the hand and wrist are often immobilized in a splint for a few weeks. This is followed by rehabilitation with a hand therapist to work on regaining movement, function and strength in the hand.
The recovery time varies with the type of surgery performed and individual factors. However, people usually can return to most desired activities by about three months.