The hand and the wrist have multiple small joints working together to produce various motions, such as those needed to thread a needle or tie a shoelace. When a joint gets affected by arthritis, basic activities of daily living can be difficult. Arthritis can affect many areas of the hand and wrist and can have more than one cause.
Over time, if the arthritis is left untreated, the bones that make up the joint can lose their normal shape. This can cause more pain and further limit the motions.
Simply defined, arthritis is an inflammation of a joint. The most common types of arthritis are osteoarthritis and rheumatoid arthritis out of more than 100 different forms.
Healthy joints move easily because of a smooth, slippery tissue called articular cartilage. The cartilage covers the ends of bones and provides a smooth gliding surface for the joint. This smooth surface is lubricated by a fluid that looks and feels like oil. It is produced by the joint lining and is called synovium.
If arthritis occurs due to a disease, the onset of symptoms is gradual and the cartilage decreases/gets damaged slowly. The two common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis.
Osteoarthritis is more common and generally affects elderly people. Also known as “wear and tear” arthritis, osteoarthritis causes cartilages to wear away. It appears in a somewhat predictable pattern in certain joints.
Rheumatoid arthritis is a chronic disease that can affect many parts of your body. It causes the joint lining (synovium) to get swollen, which causes pain and stiffness in the joint. Rheumatoid arthritis most often starts from the small joints of the hands and feet. It is bilateral in nature and usually affects the same joints on both sides of the body.
Fractures, particularly those that damage the joint surface and cause dislocations are amongst the most common injuries that lead to arthritis. Even when treated properly, an injured joint is more likely to become arthritic over time.
Early symptoms of arthritis of the hand include joint pain that may feel of “dullness,” or “burning”. The pain often occurs after increased joint use, such as heavy gripping or grasping. The pain may not present immediately, instead may arise hours later or even the following day. Morning pain and stiffness are typical.
As the cartilage wears away leaving less material to provide shock absorption, the symptoms start to occur more frequently. In advanced disease, the joint pain may wake you up at night.
Pain might worsen with use and get relieved by rest. Many people with arthritis complain of increased joint pain with weather changes. Activities those once were easy to perform, such as opening a jar or starting the car, may become difficult due to pain. To prevent pain at the arthritic joint, you might change the way you use your hand.
When the affected joint is subjected to greater stress than it can bear, it may swell in an attempt to prevent further joint use.
Changes in Surrounding Joints
In patients with advanced thumb arthritis, the neighboring joints may become more mobile than normal.
The arthritic joint may feel comparatively warm to touch. This is due to the body’s inflammatory response.
Crepitation and Looseness
There may be a sensation of grating or grinding in the affected joint, called crepitation. It is caused by damaged cartilage surfaces rubbing against one another. If arthritis has been caused due to damaged ligaments, the support structures of the joint may be unstable or “loose.” In advanced cases, the joint may appear larger than normal (hypertrophic). This is usually due to a combination of bone changes, loss of cartilage, and joint swelling.
When arthritis affects the end joints of the fingers, small cysts (mucous cysts) may develop. The cysts may then cause ridging or dents in the nail plate of the affected finger.
A doctor can diagnose arthritis of the hand by examining the hand and by x-rays. Specialized tests MRI, are usually not needed except in cases where the doctors suspects Keinbock’s disease (a condition where the blood supply to one of the small bones in the wrist, is interrupted).
Sometimes a bone scan is helpful. A bone scan may help the doctor diagnose arthritis when it is in an early stage, even when the x-rays look normal.
Arthritis does not have to result in a painful or restricted life. It is important to seek help early so that treatment can begin and you can return to normal lifestyle.
Treatment options for arthritis of the hand and wrist include medication, splinting, injections, and surgery, and are determined based on:
How severe is the arthritis
How many joints are affected
Your age, activity level and any other medical conditions
Whether the dominant or non-dominant hand is affected
Your personal goals, home support structure, and ability to understand the treatment and comply with a therapy
Medications- Medications may treat symptoms but can’t restore joint cartilage or reverse the joint damage. The most common medications for arthritis are anti-inflammatory, which stop the body from producing chemicals that cause joint swelling and pain.
Injections: When first-line treatment with anti-inflammatory medication is not appropriate, injections may be used. These typically contain a long-lasting anesthetic and a steroid that can provide relief from pain for weeks to months. The injections can be repeated, but only a limited number of times, due to their possible side effects, such as lightening of the skin, weakening of the tendons & ligaments and infection.
Splinting: Injections may be combined with splinting of the affected joint. The splints keep the affected joint supported to ease the stress placed on it from frequent use and activities. Splints are typically worn during the periods when the joints hurt more. Wearing the splint for too long also is not good, as it can lead to muscle weakness (atrophy).
If nonsurgical treatment fails to give relief, surgery the next line of treatment. There are many surgical options. The chosen course of surgical treatment should be one that has a reasonable chance of providing long-term pain relief and return to function. It should be tailored to your individual needs.
If there is any way the joint can be preserved or reconstructed, your doctor will choose the option.
When the damage has progressed to a stage that the surfaces will no longer work, a joint replacement or a joint fusion (arthrodesis) is performed.
After any type of joint reconstruction surgery, there is a period for recovery. You will be referred to a trained hand therapist, who can help you maximize your recovery. You may need to use a postoperative splint or cast for a while after surgery. This helps protect the hand while it heals.
During this postoperative period, you may need to modify your activities to allow the joint reconstruction to heal properly. Pain medications are also used to reduce discomfort. It is important to discuss your problems with your doctor so it can be adequately treated.
Length of recovery time depends on the extent of the surgery performed and multiple individual factors. However, people usually can return to most if not all of their desired activities in about three months after most major joint reconstructions.
Doctors are now more focused on how to preserve the damaged joint. This includes getting an earlier diagnosis and repairing joint components before the entire surface becomes damaged.
Arthroscopy of small joints of the hand and wrist is now possible because the equipment has been made more compact.
There have been encouraging results in cartilage repair and replacement in the larger joints such as the knee, and some of these techniques have been applied to the smaller joints of the hand and arm.
In addition, stem cell research may be an option to regenerate damaged joint surfaces.