FINGER ARTHRITIS
This is a condition resulting from an increase in pressure on the median nerve at the wrist. This nerve is responsible for supplying feeling to the thumb, index, middle and occasionally ring fingers.
WHAT CAUSES 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 SIGNS AND 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 THE OPERATION 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).
AFTERCARE
Following the operation you will normally have a bulky dressing covering your wound for 48hours. This is then replaced with a sticky dressing at 48hours until 10 days following your operation. At 10 days your stitches will be removed.
RETURN TO WORK
This depends on the nature of your work. For a sedentary occupation the average time off work is 2 weeks, for a light manual occupation 4 weeks and for heavy manual work this can be as long as 6 weeks.
DRIVING
It is possible to drive within 6-7 days of your operation but it is normally best to leave this until your stitches have been removed at 10 days.
RETURN TO SPORT
This depends on the intensity of the sport but in most cases a return by 6 weeks is the norm. However more physically demanding sports can require as much as 3 months off.
COMPLICATIONS
Like with any surgery there are a number of small risks associated with this operation.
Infection (1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Swelling and Stiffness can remain for many months following surgery. It is important to elevate the limb and keep all joints that are not immobilised with a splint, active.
Scar Sensitivity is often a problem with surgery in the hand, particularly the palm. This is often self-limiting and daily massage of the scar can shorten the duration of the symptoms. The sensitivity does settle is all cases with time.
Nerve Injury is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome. Injury to the Median nerve itself is extremely rare and can in the worst case, result in permanent weakness or numbness in the hand.
Pillar Pain is the name given to the pain experienced on either side of the scar when pushing on the palm. This often remains until the ligament that has been released heals over. It is the norm for this to settle within 3 months of the operation.
Recurrence is an unusual complication. You may however find that the symptoms recur some time after the original operation having completely settled initially. In this rare event a second operation may be necessary.
Residual Numbness is a problem when the symptoms have been present for a long time prior to the operation. If you have complete numbness in your fingers prior to surgery there is a risk that the feeling may not completely return. This is due to scarring in the nerve from the prolonged pressure. It is important to note however that it can take up to 18 months for the feeling to completely return.
Complex Regional Pain Syndrome is an extremely rare (1%) complication that can follow any injury or surgery to a limb. In this situation the nerves in the arm over-react to the point where the hand becomes very painful, swollen and sensitive. This condition does improve with time but can be problematic for many months (see section on Complex Regional Pain Syndrome).