Cartilage wear in the joints of the hand
Arthritis is a problem that causes a wearing away of normal joint surfaces. Joints are the points where two bones meet eachother. These junctions have special linings on the bones to allow motion at the joints. When this special lining (cartilage) is worn away, arthritis is the condition that results.
Finger and thumb arthritis is common because there are 27 bones in each hand! This means that there are many joints in the fingers that can develop arthritis. Furthermore, we are very dependent on our fingers for many normal activities. Any problem that affects these joints can limit many normal activities.
There are two types of arthritis that commonly affect the fingers and thumb. These are osteoarthritis and rheumatoid arthritis.
* Osteoarthritis
Osteoarthritis, also called degenerative joint disease and wear-and-tear arthritis, is the most common type of arthritis.
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In this condition, the normal cartilage is steadily worn away, exposing bare bone at the joints. The most commonly affected joints in the fingers are the knuckles of the mid-finger and fingertip (the PIP and DIP joints), and the joint at the base of the thumb.
* Rheumatoid Arthritis
Rheumatoid arthritis causes a different type of joint destruction. Rheumatoid arthritis is a systemic disease that can cause a number of problems. Among these, rheumatoid arthritis can cause inflammation of the lining of joints. The most commonly affected joints in the hand are the knuckles at the base of the fingers (the MCP joints).
What are the symptoms of finger and thumb arthritis?
Symptoms of hand arthritis include:
* Joint pain
* Swelling
* Stiffness
* Loss of motion
Patients with osteoarthritis often develop lumps or nodules around the knuckles of the fingers. These lumps are called Heberden's nodes (when around the more distant knuckle) or Bouchard's nodes (when around the closer knuckle), and actually consist of bone spurs, or osteophytes, around the joints. These knuckles often become enlarged, swollen, and stiff.
Patients with rheumatoid arthritis often have the aforementioned symptoms, but can also have more complex deformities of the hands. These include deformities such as a "Boutonniere" or "swan neck" deformity. The fingers may begin to shift from their normal position, and drift away from the thumb.
What are the treatments for finger and thumb arthritis?
Early treatments of finger and thumb arthritis are focused on managing the symptoms in an effort to avoid surgery. Treatment options include:
* Anti-Inflammatory Medications
These medications can help treat the pain of arthritis, and also help decrease inflammation and swelling around the joints.
* Cortisone Injections
Cortisone is a more powerful anti-inflammatory medication and can be useful in limited applications in the hand.
* Hand Therapy
Hand therapy, usually performed by an occupational therapist, is helpful to maintain motion and prevent stiffening of the joints.
* Ice & Heat Treatment
Joint stiffness and range of motion can be improved by ice and heat treatments.
* Splints
Splinting helps to relax and rest the joints. Splinting should be done for limited periods of time to allow for relief without allowing the joint to stiffen.
If these treatments fail, then surgery may be necessary. In the fingers, several procedures may be done, including removing the bone spurs, fusing the joint, and replacing the joint.
Surgery to treat thumb arthritis is a little different. The most commonly performed procedure to treat thumb arthritis is to remove a portion of the arthritic joint and bone. This space is then filled, usually with a tendon graft. This procedure helps maintain motion at the base of the thumb, and is very effective at relieving pain.
