Arthritis of hand

What is Arthritis of hand?

Hand is formed of multiple small joints and all them work together to produce composite movement. The cartilage at the ends of bones in normal joints is essential for smooth gliding of the joints. In patients with arthritis, the cartilage is gradually lost, leading to pain, stiffness and swelling of joints. Arthritis could be due to wear and tear (osteoarthritis) or due to inflammatory disease (Rheumatoid, Psoriasis, Gout etc) that affects one or more joints of the hand. It usually affects multiple joints of both hands.

Osteoarthritis usually affects bone and joints due to ageing, after injury, repetitive movement (overuse) and has a slow and gradual onset.  It is the most common type of arthritis and is common in women and those with family history of arthritis.

Rheumatoid arthritis is caused by our body’s immune system damaging affected joints of hand.

Rheumatoid arthritis affects commonly adults in the age 20 to 40 years and is three times more common in women.

 

What are the symptoms of Arthritis of hand?

The symptoms and signs of arthritis of hand are pain, swelling, stiffness and tenderness in the hand.  Pain is experienced when you perform activities like gripping or grasping using your hand. Pain usually occurs after the activity. You cannot perform simple activities like opening a jar and starting a car due to pain. However, in advanced stages pain can be present even at rest and could wake you up from sleep. Swelling and stiffness are present in the affected joints of the hand. With the time, the affected joint may gradually deform. Because of the pain, you may use your hand less leading to stiffness, muscle weakness and limitation in the function of the hand. Your affected joint is usually tender and sometimes warm to touch. You may also feel grinding or grating sensation in the hand. Small cysts can develop in the end joints of the fingers due to arthritis. These cysts could compress your nail bed leading to ridges or dents on the nail plates of the involved finger with a cyst.

 

How is it diagnosed?

Your orthopaedic surgeon diagnoses the arthritis of the hand after examining your hand. He will ask you for an X-ray to confirm the diagnosis and to assess the severity. He may ask for further investigations (CT scan or MRI scan) based on the initial assessment.

 

What happens if nothing is done?

If arthritis of hand is not treated, the pain, swelling and stiffness will progress affecting the function of the hand. In end stage the deformity will gradually increase leading to either dislocation/subluxation of joint or spontaneous fusion.

 

How is it treated?

Arthritis is a disease, which cannot be cured permanently. However, it can be managed with a number of treatments that can alleviate your pain and symptoms. It can be treated surgically and non-surgically. Non-surgical treatment options involve activity modification, splint use, painkillers, anti-inflammatory medicines, warm or cold therapy, steroid injection and hand therapy.

 Surgery is indicated in-

  • Persistent pain inspite of conservative treatment
  • Loss of function
  • Deformity
  • Joint subluxation or dislocation
  • Painful cysts.

 

What are the non-operative treatments?

  • Activity modification- you should limit the activities that can provoke pain. Repeated use of the affected joint should be avoided.
  • Immobilisation- your surgeon can give you a splint to wear to protect the hand from injury. It supports the joint and relieves the stress on the joints during frequent use. They are worn during the activities that hurt the joints most. However permanent use of splints could lead to stiffness and muscle wasting due to disuse.
  • Cold application- Application of ice packs helps to reduce pain and swelling of the wrist.
  • Steroid injection– steroid injection (cortisone) in the affected area relieves pain and swelling caused by inflammation. However, the relief could be temporary.
  • Medicines- Paracetamol, codeine and/or anti-inflammatory medicines such as ibuprofen, aspirin, etc. are prescribed to relieve pain and swelling of the hand. Local applications of anti-inflammatory medicines also relieve the symptoms.
  • Cold or warm therapy- application of ‘’contrast soaks’’ of cold or warm water directly to the affected area can reduce swelling.
  • Hand therapy- is essential to maintain mobility and function of your hand.
  • DMARDs/Biologics- in case of rheumatoid arthritis, DMARDs or disease modifying anti-rheumatic drugs and/or biologics are prescribed to control the disease process. It should be taken only under the advice of your rheumatologists.

 

What does the operation involve?

The main goal of the surgery is to provide long-term relief from pain and restoration of normal function and normal range of motion of the hand. The operation is usually conducted as a day case and some procedures could be done under local anaesthesia.

  • The operation has following options-
  1. Joint fusion- this procedure is also known as arthrodesis, in which the affected joint is fused. Following this surgery, you will not be able to bend or move this joint. Pins, screws or plates are used to keep the bones in position during healing. Arthritis of the last joint of the finger is treated by this technique.
  2. Joint replacement surgery- the affected joints of the hand are replaced by artificial joints in their positions. The results of newer generation of joint replacement are encouraging and are similar to hip and knee replacements (miniature version) with metal and plastic parts used to replace the damaged cartilage and bones of the hand.
  3. Denervation – Minimal evidence that it’s effective in reducing pain. However, the deformity remains the same.
  • The skin is closed using absorbable sutures. The operation takes usually 1-2 hours and the majority of the patients are discharged on the same day.

 

What happens after surgery?

  • The local anaesthetic wears off in 4 to 12 hours after surgery. Patients are given painkillers before the pain starts i.e. on return to home. It is continued for at least 48 hours after the first dose. Thus, most of our patients report little pain.
  • The joint is protected in a plaster for 1-2 weeks and you see your surgeon at 2weeks for wound check and hand therapy.
  • Based on the procedure, you might have to wear a splint and continue with exercises as suggested by the therapists and surgeon.
  • The wound should be massaged (typically after 2 weeks) using the moisturizing cream by the patient 3 times a day for 3 months once the wound is well healed. This reduces the scar sensitivity and scar-related complications (tenderness) and helps scar to mature.
  • Physical therapy of hand is essential to restore the range of motion, normal function and strength of the hand.

 

Are there any risks of surgery?

  • Bleeding
  • Infection
  • Damage to nerves vessels and tendons
  • Stiffness
  • Hardware problems
  • Non-union
  • Fracture
  • Dislocation
  • Misalignment
  • Persistence of symptoms

 

What are the results of the operation?

Most patients have excellent pain relief and regain good function and range of motion of the hand. The results of the operation are excellent with high success rates and minimal complications.

 

When can I return to driving and work?

You can return to normal work and driving after 4 weeks to three months. It depends on your age, your job, duration of arthritis and type of surgery performed.  Your surgeon can give you a better estimation for this.

 Arthritis of hand_1

  1. 78 year old lady with severe arthritis affecting multiple joints of her hand, however the middle finger was the most painful one preventing her using her hand. B. Joint replacement (PIPJ) restored pain free movement and function back to her hand.

 

Arthritis of hand_2

 

  1. 80 Year old lady with severe arthritis affecting fingertip joint (DIP –distal inter-phalangeal) and was finding it very difficult to grip. B. The joint is fused with a screw buried inside the bone, this restored the function and grip back.

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