Arthritis, an inflammatory condition of joints and the soft tissue that surrounds them, occurs commonly in the hand and wrist. Its hallmarks are pain and loss of function.
Base of Thumb Arthritis
Arthritis in the basilar joint of the thumb is more common in women than in men and usually starts after age 40. In this condition, the cartilage covering the ends of the bones wears away causing bones to rub against each other. Previous injury may increase the probability of developing arthritis in this area.
Symptoms usually appear in activities that involve twisting objects with the thumb and forefinger such as opening doors or jars and turning keys. This type of arthritis may also be affected by changes in weather and humidity. Strength in the joint decreases, and swelling occurs as movement becomes more limited. Pressure applied to the joint may be painful.
When basilar joint arthritis is discovered early, response to non-surgical intervention is usually positive. Medication, placement of a splint and limiting movement of the joint may bring great improvement. Cases of greater severity may require surgery. A qualified surgeon can determine diagnosis and proper treatment on an individual basis.
MP Joint Arthritis
Metacarpophalangeal joints (MP Joints) serve as the “hinge” between bones in the hands and smaller bones in the finger. The function of these joints is mainly for gripping. Pain and deformity in these joints are commonly caused by injury, gout, rheumatoid arthritis, psoriasis and other diseases. These conditions ruin hand structure and muscles in addition to destroying the surface of the joint. Fingers may slowly turn toward the little finger side of the hand.
Nonsurgical intervention such as injection of medication, use of splints and change in daily activity may be recommended by your physician. Advanced cases may require surgery. One type of surgery is a “synovectomy”. During this procedure, inflamed synovium are removed from the joint and tendons that have slipped out of place are put back in place over the joint. The second type of surgery is joint replacement where the diseased joint is replaced with an artificial joint. The goal of all treatment is restoration of hand motion and relief from pain. Therapy for approximately six weeks following surgery is usually needed.
Rheumatoid arthritis can affect almost all parts of the body, particularly the tissues lining joints and tendons. The condition causes tissue to swell and cover the joints, thereby destroying bone and cartilage. Early symptoms may include feelings of fatigue shortly before the start of the pain and swelling. As the disease progresses, swelling may move to different joints and usually takes place in the same joint on both sides of the body. It can affect every organ in the body. In the hand, rheumatoid arthritis causes swelling at the wrist and large knuckles. This can destroy the ligaments that hold the hand together and result in deformities such as tendon dislocation or rupture, pressure of the nerves, and bumps or nodules over the joints of the hand.
Treatment using anti-inflammatory and cortisone-like medications may give some relief. Establishing limitations in order to avoid further pain and injury may give additional relief. Surgery is considered when other methods no longer work. Surgery may include removing swollen tissue and repair to the damaged tendon along with replacement of the large knuckle to increase function and decrease pain. Surgery is usually followed by a period of physical therapy and rehabilitation.
Trigger Finger occurs when a tendon develops a knot, or swelling of the lining through which the tendon must glide in order to function. When the tendon swells, it must still squeeze through this sheath, which causes pain, popping, or a feeling that the finger is “catching” as it attempts to bend. When this occurs inflammation and additional swelling is produced. The finger may become impossible to bend or straighten.
There is no clear-cut cause for trigger finger. It can be associated with arthritis, diabetes, or other medical conditions. Initial discomfort may be felt at the base of the finger or thumb. A thickening also may be detected in the same area. The finger then begins to lock in the “trigger” position.
Goals of treatment are to eliminate the locking of the finger and allow normal movement to return. Swelling must, therefore, be reduced to allow for gliding of the tendon. Anti-inflammatory medication, taken by mouth or injected into the area, may give some relief along with wearing a splint and altering activities to reduce aggravation to the area. Surgery may be recommended to open the area for the tendon to glide more freely in the sheath. There may be tenderness, discomfort and swelling following surgery, and motion therapy usually begins immediately following the same.