A normal joint consists of two smooth, cartilage-covered bone surfaces that fit each other closely and move smoothly against each other.
Types of arthritis
Arthritis means “inflammed joint”.
In arthritis, smooth cartilage surfaces of joint become irregular and essentially “wear out.” Arthritis can affect any joint in the body, including the hands and fingers. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis.
Osteoarthritis of the hand
Osteoarthritis is a degenerative joint disease in which the cushioning cartilage that covers the bone surfaces at the joints begins to wear out. It may be caused by simple “wear and tear” on joints which appears later in life (Primary osteoarthritis), or it may develop after an injury to a joint (post-traumatic arthritis).
In the hand, osteoarthritis most often develops in:
- at the base of the thumb (trapezio-metacarpal, or basilar joint)
- at the end joint closest to the finger tip (the distal interphalangeal or DIP joint)
- at the middle joint of a finger (the proximal interphalangeal or PIP joint)
- in the wrist.
Signs and symptoms
- Stiffness, swelling, and pain
- Bony nodules may develop at the PIP joint (Bouchard’s nodes) and at the end-joints, or DIP joint (Heberden’s nodes). Swelling and a bump at the base of the thumb in basal joint arthritis
- Grip and pinch strength may be diminished
- The clinical appearance helps to diagnose the type of arthritis.
- X-rays will also show certain characteristics of osteoarthritis, such as narrowing of the joint space, the formation of bony spurs (osteophytes or “nodes”), and the development of dense, hard areas of bone along the joint margins (sclerosis).
The aim of treatment is to relieve pain and restore function. Anti-inflammatory or other analgesic medication may be of benefit in relieving pain. Brief periods of rest may help during acute flared up. Wearing finger or wrist splints at night and for selected activities helps rest the joint. Heat modalities such as warm wax or paraffin baths might help, and when severe swelling is present, cold modalities may be of help.
A cortisone injection can often provide relief of symptoms, but does not cure the arthritis.
Surgery is usually not advised unless these more conservative treatments fail. Surgery is indicated when the patient either has too much pain or too little function. The goals are to eliminate or reduce pain and to restore as much function as possible. Options are:
Joint fusion. The arthritic surface is removed and the bones on each side of the joint are fused together, eliminating motion and thus pain . It also corrects deformity that interfere with functioning.
Arthroplasty or joint reconstruction. The degenerated joint surface is removed and is replaced with rolled-up soft tissue, such as a tendon (soft tissue interposition arthroplasty) , or with a joint replacement implant (silicone spacer or surface replacement).