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Arthritis of the Hand

A joint is comprised of two boney surfaces, which are covered by cartilage – allowing for smooth gliding surfaces with low friction. Ligaments connect bone ends and provide stability in joints. For a variety of reasons, the cartilaginous surfaces may become irregular or “wear out” and lead to motion loss, pain, and deformity. The presence of a painful joint with abnormal cartilage (worn out or damaged cartilage) is termed “arthritis.” Arthritis may be secondary to degenerative process (e.g.: osteoarthritis), inflammatory conditions (e.g. rheumatoid arthritis, scleroderma, or lupus), gout, infections, or trauma. The cause of degenerative arthritis (osteoarthritis) is not exactly understood, but it is thought to be in part associated with heredity factors and normal “wear and tear.” Non-operative treatment for arthritis of the hand and wrist may include supportive means, but surgery is often indicated when symptoms are not relieved adequately with non-operative methods and interfere significantly with daily activities. The goal of surgery is to relieve pain while preserving function.

• Thumb carpometacarpal joint arthritis. There are three joints in the thumb: the carpometacarpal (CMC) joint, the metacarpophalangeal (MP) joint, and interphalangeal (IP) joint. The combination of these joints allows for a wide arc of thumb motions. At the base of the thumb is a unique, saddle-shaped joint termed the CMC joint. Numerous muscles about the thumb are responsible for its unique motions of opposition, abduction, and adduction. This joint is the most common site of osteoarthritis of the hand. Symptoms of thumb CMC arthritis include pain, deformity, and limitation of thumb motion.
• Finger distal interphalangeal joint arthritis. There are three joints in each finger: the metacarpal phalangeal (MP) joint, the proximal interphalangeal (PIP) joint, and the distal interphalangeal (DIP) joint. In older patients, osteoarthritis commonly involves the DIP joint of the fingers. Findings of finger DIP joint osteoarthritis include tender bony deformities associated with arthritic spurs (Heberden’s nodes), joint angular deformities, swelling, redness, and pain.
• Rheumatoid Arthritis of the Hand. Rheumatoid arthritis is an autoimmune condition, which commonly involves the upper extremity – particularly the wrist and digits. This condition involves inflammation of the joint lining (synovium), as well as tissue which surrounds tendons (tenosynovium). As inflammation progresses, destruction of the ligaments and cartilage also occur, which results in joint deformity, pain, and loss of function. For early Rheumatoid arthritis, management with medications is critical to minimize progression. The medical management is best undertaken or coordinated by an Internist or Rheumatologist. For patients with significant joint and/or soft tissue involvement associated with functional impairment and pain, surgical intervention may be indicated.
• Wrist arthritis. Degenerative and/or post traumatic arthritis of the wrist is a common condition, especially in middle-aged and older individuals; however this is also a common result of severe wrist injuries in all ages. Prior injuries may cause disruption of critical wrist ligaments, which may also result in the development of arthritis. Old, un-united fractures involving the Scaphoid bone (wrist bone) are also common causes of wrist arthritis. For mild symptoms, non-operative management may be beneficial; however, for more chronic and/or severe arthritis surgical reconstructions may be indicated.

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