Osteoarthritis of the Hand
Osteoarthritis is a degenerative joint disease that causes the cartilage that covers the bone surfaces at the joints to wear out. It may be caused by simple “wear and tear” on joints, or it may develop after an injury.
In the hand, osteoarthritis most develops in three areas:
- At the base of the thumb, where the thumb and the wrist come together (trapezio-metacarpal, or basilar joint)
- At the end of the joint closest to the finger tip (the distal interphalangeal or DP joint)
- At the middle joint of a finger (proximal interphalangeal or PIP joint)
It often develops in the wrist as well.
Signs and Symptoms of Hand Osteoarthritis
Common symptoms include:
- Stiffness, pain, and swelling
- Bony nodules at the middle joint (Bouchard’s nodes), at the end-joints, or DIP of the finger (Heberden’s nodes)
- Deep, aching pain at the base of the thumb
- Swelling and a bump at the base of the thumb
- Diminished grip and pinch strength
- Pain, swelling, stiffness, and diminished strength in the wrist
How is Hand Osteoarthritis Diagnosed?
Your hand doctor will examine you to determine whether you have similar symptoms in other joints and assess the impact of arthritis on your life and activities.
The appearance of your hands and fingers will help your doctor diagnose the type of arthritis. X-rays will also reveal certain characteristics of osteoarthritis such as narrowing of the joint space, the formation of bony outgrowths (osteophytes or “nodes”), and the development of dense, hard areas of bone along the joint margins.
Treatment of Hand Osteoarthritis
Anti-inflammatory or other analgesic medication may help relieve pain. Your doctor may also advise you to wear wrist splints at night and for selected activities. Soft sleeves may be of some benefit when rigid splints are too restrictive, especially when arthritis affects the joint at the base of your thumb. Heat modalities such as warm wax or paraffin baths might help with swelling.
You will need to use your hands as productively as possible to maintain motion in the fingers. Hand therapy may also be helpful.
A cortisone injection can often provide relief of symptoms, but does not cure the arthritis.
Hand Surgery for Osteoarthritis
Your hand surgeon will usually not advise surgery unless more conservative treatments fail. He may recommend surgery when you either have too much pain or too little function. The goal is to restore as much function as possible and to eliminate pain or reduce it to a tolerable level.
Joint fusion is one type of surgery in which the arthritic surface is removed and the bones on each side of the joint are fused together, eliminating motion from the problem joint. It may also be used to relieve pain and correct the deformity that interferes with function.
Joint reconstruction is another approach, in which degenerated joint surface is removed in order to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. The degenerated portion may be replaced with rolled-up soft tissue, such as a tendon, or with a joint replacement implant.
The type of surgery you undergo depends on the particular joint(s) involved, your activities, and your own needs. Your hand surgeon will help you decide which surgery will be most helpful.
If you’re suffering from hand osteoarthritis, call (561) 241-4758 to make an appointment with South Florida Hand and Orthopaedic Center.