The optimal long-term, symptomatic therapy for chronic hand and finger pain has not been established. Symptomatic hand pain and stiffness due to osteoarthritis) affect approximately 6-8% of the adult population. The prevalence of hand OA tends to be higher in women and elderly persons. It may be diagnosed via radiological tests (eg. X-ray), reported joint symptoms, or a combination, with the most commonly affected sites being the distal interphalangeal (DIP) and first carpometacarpal (CMC) joints, followed by the proximal interphalangeal (PIP) and other CMC joints.
While hand osteoarthritis is a common cause of hand and finger pain and stiffness in older populations, athletic injuries, overuse, and excessive forces are the causes typically associated with younger populations. Hand and finger pain may affect activities of daily living and quality of life enough that they seek medical attention.
SYMPTOMS IN THE HAND
Osteoarthritis is found frequently in overweight people and those who lack exercise, but rheumatoid arthritis attacks all body types and occurs even in fit persons. Early symptoms of rheumatoid arthritis in the hands include redness and slight stiffness, usually appearing in the morning and disappearing later in the day. Pain and excessive warmth in the hands usually accompanies the swelling. The hands also usually appear puffy or slightly swollen. These symptoms may go into remission or return in “flash” episodes over a lifetime. As the disease progresses in some sufferers, the pain, stiffness and swelling in the hands becomes constant and more severe.
The fingers of long-term rheumatoid arthritis sufferers show the most damaging ravages of the disease. Early symptoms of rheumatoid arthritis located in the fingers include stiff, swollen and red-colored knuckles. This may be felt in one or both knuckles in one or numerous fingers. Flashes of pain or constant pain are also present in most cases. Tingling pain may also occur. Longtime sufferers frequently experience finger disfigurement that requires surgery either to fuse fingers or replace joints.
The CMC joint (an abbreviation for carpometacarpal joint) of the thumb is where the metacarpal bone of the thumb attaches to the trapezium bone of the wrist. This joint is sometimes referred to as the basal joint of the thumb. The CMC is the joint that allows you to move your thumb into your palm, a motion called opposition.
Several ligaments hold the CMC joint together. These ligaments can be injured, such as when you sprain your thumb. The joint surfaces are covered with a material called articular cartilage. This material is the slick, spongy covering that allows one side of a joint to slide against the other joint surface easily.
Finger joint replacement surgery is an important decision to consider when arthritis of the finger makes simple actions, such as typing, driving or holding a pen, painful and almost impossible.
Patients with advanced arthritis or who do not respond to non-surgical treatment may be candidates for surgical reconstruction.”If the pain keeps you up at night, that is a good indication you need to see a hand surgeon. Far and away, pain relief is why we perform surgical procedures. In most cases, the patient knows best and actually tells the doctor when it is time for surgery.”A variety of surgical techniques are available. The goal is to restore as much function as possible and to eliminate pain or reduce it to a tolerable level.
Joint reconstruction (“arthroplasty”) is commonly performed because it maintains the motion at the base of the thumb, although it typically does not restore strength to the level of a young adult. The surgeon removes the trapezium-the small saddle bone-to eliminate the rough, irregular bone-to-bone contact that causes pain and restricts motion. The space is replaced with rolled-up tissue, such as a tendon, or natural scar, to cushion the area.
Joint fusion, in which the arthritic surface is removed and the bones on each side of the joint are fused together, eliminates motion from the problem joint. This means the motion for pinch and grasp are more restricted, but strength is typically good.
Fusion A fusion (or arthrodesis) of any joint is designed to eliminate pain by allowing the bones that make up the joint to grow together, or fuse, into one solid bone. Fusions are used in many joints and were very common before the invention of artificial joints for the replacement of arthritic joints. Even today, joint fusions are still very commonly used in many different joints for treating the pain and potential deformity of arthritis. Fusions are more commonly used in the PIP or the DIP joints in the fingers. A fusion of these joints is far easier and more reliable than trying to save the motion by replacing the joint.
ARTIFICIAL JOINT REPLACEMENT
Artificial joints are available for the finger joints. These plastic or metal prostheses are used by some hand surgeons to replace the arthritic joint. The prosthesis forms a new hinge, giving the joint freedom of motion and pain relief. The procedure for putting in a new joint is called arthroplasty.
Your hand will be bandaged with a well-padded dressing and a finger splint for support after surgery. Physical or occupational therapy sessions may be needed after surgery for up to eight weeks. The first few treatments are used to help control the pain and swelling after surgery. Some of the exercises you’ll begin to do help strengthen and stabilize the muscles around the finger joint. Other exercises are used to improve fine motor control and dexterity of your hand. You’ll be given tips on ways to do your activities while avoiding extra strain on the finger joint.