Hand & Wrist Osteoarthritis
Osteoarthritis is a degeneration of the gliding surfaces of a joint, resulting in pain and stiffness. It can affect any joint and in the hand is most common at the base of the thumb and the joints of the fingers
Finger Joint Arthritis
Arthritis affecting these joints causes pain when using the hand and can limit the movement of the fingers. Non operative treatment will always be tried first, with a combination of pain relief and possibly splinting to improve the symptoms. If these simple measures fail, surgery can be helpful. Usually the only investigation required will be a plain x-ray examination.
The options for surgery are either to fuse the joint or replace it. Joint fusion is an excellent solution for the pain but of course comes at the cost of losing all movement. This is the best option for the joint at the end of the finger (the distal interphalangeal joint) where the functional loss from fusion is minimal.
Joint replacement is usually the preferred option for the surgical treatment of the other finger joints, the metacarpophalangeal and proximal interphalangeal joints. The joint replacement can be either metal and plastic, or a silicone material. Joint replacement surgery has good outcomes for pain and preserves some joint movement but the new joint will often not have a fully normal range of motion.
Base of Thumb Arthritis
Osteoarthritis of the first carpometacarpal joint – or base of thumb arthritis – is common. The thumb is important in most aspects of hand function, and actions like gripping and pinching places very large forces across this joint. Plain x-ray imaging is necessary to confirm the diagnosis.
Again, non-operative treatment will always be tried first. Splinting of the thumb can help control pain and still be very functional, depending on a persons activities. A steroid injection can also help to improve the symptoms, although the underlying problem will remain.
If these simple measures do not control the pain, then surgery is recommended. The most common procedure for this condition is called a trapeziectomy. It involves removing the trapezium, the bone in the wrist joint at the base of the thumb. This removes the painful joint surface and is an excellent procedure for pain relief. It can however cause a significant loss of strength. Other options for people with a high functional demand on their hands include fusion of the joint or a form of joint replacement where an artificial spacer is inserted in place of the diseased joint. There is a lengthy recovery period of 3-6 months after surgical treatment of base of thumb arthritis.
