Arthritis finger
Among the diseases that may cause finger involvement are osteoarthritis, rheumatoid arthritis, gout, pseudogout, psoriatic arthritis, systemic lupus erythematosus, and progressive systemic sclerosis. The common denominating factor is that arthritic finger joints can make it hard to do daily activities due to pain and deformity. A quick explanation of the anatomy is in order
The bones in the palm of the hand are called metacarpal bones. One metacarpal connects to each finger and thumb. The five fingers of the hand are made up of phalanges, small bone shafts that line up to form each finger and thumb. The main knuckle joint is formed by the connection of the phalanges to the metacarpals. This joint is called the metacarpophalangeal join(MCP).. This joint acts like a hinge when you bend and straighten your fingers and thumb. The three phalanges in each finger are separated by two joints, called interphalangeal (IP) joints. The one closest to the MCP (knuckle) is called the PIP, or proximal IP joint. The joint near the end of the finger is called the DIP, or distal IP joint. The thumb only has one IP joint between the two thumb bones. The IP joints of the digits also work like hinge joints when you bend and straighten your hand. The finger and thumb joints are covered on the ends with articular cartilage. This white, shiny material has a rubbery consistency. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to facilitate motion. There is articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate. The Most common form of arthritis to affect the finger is osteoarthritis which is also known as degenerative arthritis. Degenerative arthritis is a condition in which a joint wears out, or degenerates, usually slowly over a period of many years. There is also a prominent inflammatory component to this disorder in many cases. Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. An injury to any of the joints of the fingers--even if it does not injure the articular cartilage directly--can alter how the joint works. This is true for a fracture that involves the joint when the bone fragments don't quite "line up" correctly and heal differently from the way they were before the break occurred. When an injury changes the way the joint lines up and moves, force can start to press against the surface of the articular cartilage. This is similar to how a machine that is out of balance wears out faster. Over time, this imbalance in the joint can lead to damage to the articular surface. Since articular cartilage cannot heal itself very well, the damage progresses. Eventually, the joint can no longer compensate for the increasing damage, and symptoms begin. The damage in the joint starts well before the symptoms of arthritis appear. Pain is the main problem with arthritis. At first, the pain usually only causes problems when you begin an activity. Once the activity gets underway, the pain eases. But after resting for several minutes the pain and stiffness increase. When the arthritis condition worsens, pain may be felt even at rest. The sensitive joint may feel enlarged and warm to the touch from inflammation. In rheumatoid arthritis, the fingers often become deformed as the disease progresses. The MCP joints of the fingers may actually begin to point sideways (towards the little finger). This is called ulnar drift. Ulnar drift can cause weakness and pain, making it difficult to use your hand for daily activities. Psoriatic arthritis causes one or more joints to swell up and look like a sausage. In fact, this condition is referred to as a sausage digit. Gout can cause deposits of uric acid to build up in joints and cause swelling. Systemic lupus erythematosus and scleroderma may cause all the fingers to swell. Arthritis can affect the IP joints of the fingers. Osteoarthritis may cause soreness and swelling on the back of the PIP joints. These enlargements are known as Bouchard's nodes. Patients with osteoarthritis of the fingers may have swelling and tenderness over the top of the DIP joints. These enlargements are called Heberden's nodes. The diagnosis of arthritis of the finger joints begins with a history of the problem. Details about any injuries that may have occurred to the hand are important and may suggest other reasons why the condition exists. Following the history, a physical examination of the hand, and possibly other joints in the body, will be done. Your doctor will need to see how the motion of each joint has been affected. Treatment usually begins when the joint first becomes painful. This may only occur with heavy use and may simply require mild anti-inflammatory medications, such as aspirin or ibuprofen. Reducing the activity, or changing from occupations that require heavy repetitive hand and finger motion, may be necessary to help control the symptoms. An injection of cortisone into the finger joint can give temporary relief. Cortisone is a very powerful anti-inflammatory medication and when injected into the joint itself can help relieve the pain. Pain relief is temporary and usually only lasts several weeks to months. There is a small risk of infection with any injection into the joint, and cortisone injections are no exception. Rehabilitation services, such as physical and occupational therapy, play a critical role in non-operative treatment of finger joint arthritis. A primary goal is to help you learn how to control symptoms and maximize the health of your hand and fingers. You'll learn ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs. A special brace may be prescribed to help support the hand and fingers to help reduce your pain and prevent deformity. Range of motion and stretching exercises are prescribed to improve your finger movement. Strengthening exercises for the arm and hand help steady the hand and protect the finger joints from shock and stress. Your therapist will go over tips on how you can get your tasks done with less strain on the joint. Arthroscopy (looking inside the joint with a small telescope) is a specialized technique where a specially trained physician can view the inside of the joint and remove damaged and diseased tissue with minimally invasive techniques. For patient with more advanced arthritis, other techniques are used. A fusion (also called an 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 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. If you don't need surgery, range-of-motion exercises for the finger should be started as pain eases, followed by a program of strengthening. The program advances to include strength exercises for the fingers and hand. Dexterity and fine motor exercises are used to get your hand and fingers moving smoothly. You'll be given tips on keeping your symptoms controlled. You will probably progress to a home program within four to six weeks. If you have surgery, your hand will be bandaged with a well-padded dressing and a finger splint for support. 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. Obviously, if the finger arthritis is representative of a more systemic process such as rheumatoid arthritis, then aggressive disease-modifying medications including biologic drugs are needed.
Research findings reported in the February 2003 issue of Annals of the Rheumatic Diseases point to an association between osteoarthritis in a single finger joint in men and the likelihood they will die from cardiovascular disease. The news for women was not as drastic but there was still a modest increase in the risk of dying from cardiovascular disease for women with arthritis in either one finger or in symmetrical joints. Between 1978 to 1980, a representative population sample of 8,000 Finns, age 30 or older, were asked to participate in a comprehensive health exam by Dr. Mikko Haara and his research team at the University of Kuopio, Finland. The team took hand x-rays of 3,595 study participants. By the end of 1994, 897 of the 3,595 participants had died. The researchers analyzed the causes of death and sought to determine if there was any involvement with arthritis. Through their analysis the researchers found: Men with symmetrical arthritis of the fingers were not at increased risk of dying from cardiovascular disease. Prior studies have linked the importance of weight control to managing arthritis of the knee. The new results draw a connection to arthritic, stiff fingers as well. REFERENCE: Trigger finger (medically termed stenosing tenosynovitis) is a "snapping" of any of the digits of the hand when opened or closed. Typically, trigger finger is noted when either the ring, middle, or index finger attempts to flex closed while gripping. Instead of a smooth, continual closure, the digit stutters, then snaps closed. The closure is frequently associated with pain at the base of the digit on the palm of the hand. Trigger finger can affect the thumb. Trigger finger is caused by local swelling from inflammation or scarring around the tendons that normally pull the affected digit inward toward the palm (flexion). Usually trigger finger occurs as a condition alone. Sometimes trigger finger is an associated condition resulting from an underlying illness that causes inflammation of tissues of the hand, such as rheumatoid arthritis. Stretching, ice, and anti-inflammatory treatments can be helpful. Most patients respond to a local cortisone injection around the affected tendon. When trigger fingers persist after two injections and are not responsive to the above treatments, surgical procedures to remove the inflamed or scarred tissue can be beneficial.
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