Hand Arthritis

Joint arthritis occurs when the protective cartilage layer wears away. The joint then becomes more painful and loses motion.

Pathology

Joint arthritis occurs when the protective cartilage layer wears away. The joint then becomes more painful and loses motion. The most common joints involved in hand arthritis are the small distal interphalangeal joints of the fingers. The second joint most frequent in developing arthritis is the joint at the base of the thumb, particularly in females in their late 40’s and older. Activities that are most commonly affected by basilar thumb arthritis include opening jars, door knobs and pinching activities including turning keys. When all of the cartilage wears away, a grinding bone against bone feeling will be felt and can be demonstrated on exam. The four signs of arthritis on x-rays is the loss of joint cartilage resulting in joint space loss, increased density of the bone just inside the cartilage area called sub-chondral sclerosis, spur formation at the ends of the joint and cysts formation just under the sub-chondral sclerosis. The three most common causes of arthritis are: osteoarthritis, post-traumatic arthritis and inflammatory arthritis. Osteoarthritis is simply wear and tear as the body ages and primarily affects patients in their 60’s but the basilar thumb joint is an exception particularly in women. Post-traumatic arthritis is a consequence of a joint fracture or dislocation causing joint cartilage damage and loss of the cartilage cushioning effect. Inflammatory arthritis with rheumatoid arthritis being the most representative, can present in younger individuals including in early childhood and result in joint destruction with the associated deformities called mallet, Boutonniere and Swan neck deformities. The inflammatory arthritis conditions require special laboratory blood tests to make the correct diagnosis. The other two types of arthritis can be diagnosed by simple the history, physical examination and x-ray findings.

Treatment

Treatment of arthritis begins with a non-surgical program that includes a therapist working on gentle range of motion exercises, thermal modalities, splinting during the inflammatory period in rheumatoid arthritis or for protection and strengthening once motion is achieved. Oral anti-inflammatory medication and cortisone injections in the joint helpcontrol the inflammation and resultant pain. Activity modifications take pressure off the joint and ergonomic adaptations are also helpful. For basilar thumb arthritis, a supportive splint can be worn to help perform more powerful activities.
When conservative nonoperative measures fail, surgical treatment is considered. If the arthritis is located at the base of the thumb four procedures have been described:

  1. LRTI which is the removal of the arthritic carpal bonecalled the trapezium and reconstructing the space with a tendon transfer used as a stabilizer and spacer.
  2. Putting a spacer in the joint when only the CMC bone is affected.
  3. Replacing the articular surface with a joint implant or
  4. Fusing the joint. Option number 1 has the longest track record and is the first choice at ROC when all four articular surfaces of the trapezium is affected.

the DIPJ and the arthritis is mild to moderate with painful cysts or spurs, simple excision of the ”arthritic spurs or cysts” is performed. In the DIPJ, the smallest joint of the finger, if the arthritis is severe with associated deformity, the joint is fused. Function is good after a fusion of that joint. In the proximal interphalangeal joints which are the middle joint of the fingers, a joint replacement with the use of an implant. Choosing the correct surgical procedure that best fits the patient is based on the patient’s activity demands. All of these procedures are performed on an outpatient basis. A splint is usually used after surgery to help support the operated hand initially. When the time is right, hand therapists get involved to help the recovery process. Patients are back to most activities by 3 months. Tasks that require more strength and power take slightly longer to return.