Arthritis Fundamentals

Arthritis is the name of any of 300 inflammatory joint disorders. The two most common types to affect the hand and wrist are osteoarthritis and rheumatoid arthritis.

Osteoarthritis, or degenerative joint disease, most commonly affects the elderly. In this type of arthritis, the joints degenerate due to aging. The cartilage begins to erode, causing the bones to grind against one another.

Rheumatoid arthritis is a chronic inflammatory condition that causes pain, stiffness, and swelling in the joints. Additionally, the joint lining (synovium) becomes inflamed, painful and swollen. The disease can damage the cartilage, bones, tendons and ligaments, as well as cause inflammation in the blood vessels and outer lining of the heart and lungs.

Rheumatoid arthritis often results in deformities of the hand and the destruction of smaller joints. It typically affects a disproportionate number of women and requires long-term management, as it flares and recedes over time.

What are the causes and common symptoms of arthritis?

A number of factors are thought to cause the development of arthritis. Mechanical considerations-for example, joint stability and alignment affect the distribution of forces across the joint and therefore impact the joint's longevity. Traumatic injuries and infections resulting in joint irregularities and heavy usage are risk factors. Some people inherit the tendency to develop degenerative arthritis, although this genetic predisposition is not well understood. Typically, these individuals are affected at an earlier age. The cause of rheumatoid arthritis is unknown, although genetic factors are thought to be critical.

Common symptoms of arthritis are stiffness, swelling and the loss of motion. In arthritis of the wrist, it become difficult to bend the wrist, since the wrist becomes increasingly tender and swollen. Over time, patients with arthritis of the wrist have significant loss of function of the hand, including the fingers and thumb. A common symptom of arthritis of the wrist is diminished grip strength, which often results in an unnatural rotation of the wrist. Osteoarthritis of the hand is characterized by bony nodules in the finger joints. Rheumatoid arthritis includes the following:

  • Spindle-shaped swelling of multiple joints, with some more swollen than others
  • A boggy mass over the back of the hand
  • The grinding of bone against bone
  • Drift of the fingers away from the thumb
  • Contracture of the fingers
  • Swan neck deformity

What are the benefits of treatment?

Arthritis treatments are aimed at relieving painful symptoms in the wrist or hand and controlling inflammation.

First-line treatment for early arthritis involves conservative measures including activity modification, splinting, heat/ice and anti-inflammatory medications. Joint injections with a cortisone preparation can provide improvement in symptoms. In many cases, these injections may be repeated at several month intervals.

When conservative measures no longer alleviate the pain or when deformity prevents functional use of the hang, surgery is recommended. Alleviation of pain is the primary indication for surgery. As a general rule, joint motions is not improved following surgery and in many cases is lessened in the pursuit of pain relief. Joint can either be removed (resection arthroplasty) fused (arthrodesis) or replaced with prosthetic arthroplasty. Particular advantages and disadvantages of the procedures differ for each joint.

How can I manage at home during recovery from the procedure?

Protocols vary but generally the first post-operative dressings must be kept intact and usually covered during showering. This will be changed to a removable split at the appropriate time. In general, any finger not operated upon can be freed up to allow for better ability to perform.