What is it?
There are two principle types of arthritis. Osteoarthritis is a wear and tear type arthritis where the cartilage that normally lines joint surfaces thins, exposing the underlying bone and producing pain. The second type of arthritis is inflammatory arthritis that results from the normally protective cells in the blood beginning to target structures within the joint, leading to their destructions and produce pain and limitation in function. Both types of arthritis can affect all hand joints although Osteoarthritis typically affects the base of the thumb (1st carpometacarpal joint) and the end finger joints (distal interphalangeal joints) and inflammatory arthritis tends to affect the knuckle joints (metacarpophalangeal joints) and the first joints in the finger (proximal interphalangeal joints).
What are the symptoms?
In any type of arthritis, pain tends to be the principle symptom. Deformity of the hand and restriction in movements are also a feature. The deformities tend to be more obvious in inflammatory arthritis.
How is it diagnosed?
Following a thorough history and examination, you will require xrays of you hand and wrist. If an inflammatory arthritis is suspected then you may also require some blood tests to help identify the underlying cause.
How is it treated?
A number of patients will come to needing surgery but the majority will be treated non-operatively initially. Painkillers, splints and activity modification will control the symptoms in most cases. Steroid injections into the joints will help control the inflammation in the joints, often for months at a time. For patients with an inflammatory arthritis, medication prescribed by a consultant Rheumatologist can often control the disease, particularly if diagnosed early.
Once the above measures fail to control a patient’s pain or the deformities in the hands and fingers are causing a real limitation in the patient’s function, an operation may be the best way forward.
What does surgery involve?
There are three principle methods of treating arthritis in the hand joints. The first of these is a fusion where the two bone surfaces forming a joint are surgically joined together so that a joint no longer exists between them. By eliminating the movement in that joint you also get rid of the pain that the exposed surfaces were causing. The joints most often treated in this way are the end joints in the fingers (distal interphalangeal) and the first thumb joint (metacarpophalangeal).
The second option is a joint replacement. This is where the arthritic joint surfaces are removed and replaced by an artificial joint. In the hand this can be either a soft (silicone) or a hard (metal or Pyrocarbon) joint replacement. This is the treatment of choice for joints where maintaining movement is critical. The joints treated with a replacement tend to be the knuckle joints (metacarpophalangeal joints) and the first finger joints (proximal interphalangeal joints).
The final option is where a small portion of the joint surfaces are removed to ensure that they are no longer in contact. This is referred to as a resection arthroplasty. This is a useful way of treating some types of arthritis such as that at the base of the thumb (STT arthritis).