Arthritis of the Wrist and Hand
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.
What are the risks of treatment?
Risks include stiffness (common), nerve injury, infection (rare) and bleeding. Arthritis surgery is very successful and rewarding in more than 90% of patients.
How do I prepare for surgery?
Many surgical procedure for the hand are now performed on an outpatient basis, requiring only local anesthesia. Other procedures, however, require a night's stay.
Always ask your surgeon for complete pre-operative instructions. Typically, these may include:
- Complete any pre-operative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
- Call the appropriate surgery center to verify your appointment time.
- Refrain from eating or drinking anything after midnight the night before surgery.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Refrain from taking diabetic pills or insulin.
- Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
- Leave valuables and money at home.
- Wear loose-fitting, comfortable clothing.
What happens during surgery?
Surgical option include a variety of reconstructive procedures, as well as joint fusion (making a joint solid) and joint replacement.
Reconstructive surgery for degenerative arthritis involving the base of the thumb is commonly performed and highly effective at relieving pain as well as improving motion and overall thumb function. It involves removing the arthritic bone and replacing it with an unneeded, rolled-up tendon from that region.
Joint fusion is utilized for the treatment of arthritis in many hand and wrist joints. The distal interphalangeal joint at the tip of the finger is frequently affected by degenerative arthritis. Fusion stabilizes and straightens the joint, eliminating pain. Joint replacement is indicated for low-demand patients, particularly those with rheumatoid arthritis involving the metacarpophalangeal joints at the base of the fingers. In these, individuals joint replacements may improve the functional arc of motion making the fingers more useful. Pain is improved as is use of the hand. However, these artificial joints do not provide the same stability afforded by a joint fusion and will, in time, wear down.
What happens after surgery?
Once you return home, rest and elevate your affected joint and apply ice and a compressive wrap to reduce swelling and pain. Be sure to move your arm frequently and keep it dry.
Ask your surgeon for complete post-operative instructions, as protocols vary fro the multitude of procedures available.
How long is the recovery period after surgery?
Recovery time varies, however it typically lasts for several weeks. The first stage typically requires splinting for 4-6 weeks, followed by regaining motion and strength for 4-8 weeks.
What is the rehab after surgery?
Living with arthritis requires pain management and lifestyle adjustments. Patients usually require occupational and recreational changes to their lifestyle. Gentle physiotherapy may also be helpful, as can whirlpool treatments and application of heat. Additionally, many people benefit from hot wax treatments, in which the hands are exercised gently within a bowl of soft, warm wax. Heat increases the flow of blood and nutrients to the infected joints. The application of ice packs to the joints before and after motion can also be beneficial.
The goal of rehab is to increase your range of motion. Your motivation and participation are vital to the success of rehabilitation. If surgery is required, a highly organized program of therapy will aid in regaining maximum function.
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.
How frequently should I schedule follow up appointments with my doctor following surgery?
The first post-operative visit will take place 10-14 days following surgery, and often the surgeon will see the patient one more time in another two to three weeks.
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