Arthritis finger

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Arthritis of the finger joints can result from many conditions.

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 that make up the palm of the hand are called metacarpal bones. One metacarpal connects to each finger and thumb. The bones of the five fingers of the hand are called phalanges.

The knuckle joints are formed by the connection of the metacarpals to the phalanges. 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.

The ends of the finger and thumb joints are covered with a layer of articular cartilage. This material has a rubbery consistency. The function of articular cartilage is to absorb shock and provide a smooth surface for the joints to interact.

The most common form of arthritis to affect the finger is osteoarthritis. Osteoarthritis, or degenerative arthritis, is a condition in which a joint wears out, slowly over a period of many years. There is also a prominent inflammatory component to this disorder in most cases where the hand is involved. Lumps can form with Heberden's nodes affecting the DIP joints and Bouchard's nodes affecting the PIP joints.

Injury to a joint, such as a sprain or fracture, can cause damage to the articular cartilage. An injury to any of the joints of the fingers can alter how the joint works. When an injury changes the way the joints line up and move, forces are abnormal and lead to joint damage.

Since articular cartilage cannot heal itself, the damage progresses. Eventually, symptoms begin. The damage in the joint starts well before the symptoms of arthritis start.

Pain is the primary symptom of arthritis. At first, the pain usually occurs with the start of an activity. Once the activity gets underway, the pain eases. But after resting, the pain and stiffness return. When the arthritis worsens, pain may be felt even at rest. The sensitive joint starts to become inflamed with swelling, heat, redness, and warmth.

In rheumatoid arthritis, the fingers often become deformed as the disease progresses. The MCP joints of the fingers may begin to turn sideways (towards the little finger). This is called ulnar drift.

Ulnar drift can cause weakness and pain, making it difficult to use the 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 leading to inflammatory destruction of the joint.

Systemic lupus erythematosus and scleroderma may cause all the fingers to swell.

The diagnosis of arthritis of the finger joints begins a careful history. Details about any injuries to the hand are important and may provide a clue as to why the condition exists.

Following the history, a physical examination will be done. The joints will be carefully evaluated.

Regular X-rays, magnetic resonance imaging, and diagnostic ultrasound are all imaging procedures that may be required to make a correct diagnosis and to assess the amount of damage that has taken place already.

Treatment usually begins immediately. This may entail simply mild anti-inflammatory medications, such as aspirin or ibuprofen. Reducing activity, or even changing occupations may be necessary to help control the symptoms.

An injection of cortisone into the finger joint can give relief. Cortisone is a powerful anti-inflammatory medication and when injected into the joint can help relieve pain. Pain relief, though, is temporary. Injections should be administered into the same joint only three times a year, maximum.

Physical and occupational therapy, play an important role in non-operative treatment of finger joint arthritis.

A brace may be prescribed to help support the hand and fingers to help reduce pain and prevent deformity. Range of motion and stretching exercises are prescribed to improve finger movement. Strengthening exercises for the arm and hand help protect the finger joints from further damage. The therapist will provide tips on how you can get tasks done with less strain on the joints.

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. Obviously, this procedure requires someone with a lot of experience with small joint arthroscopy. At the Arthritis Treatment Center, we have that experience.

For patient with more advanced arthritis, other techniques are used.

A fusion (also called an arthrodesis) of a joint is supposed too eliminate pain by allowing the bones to fuse into one solid bone. Fusions were very common before the invention of artificial joints. Even today, joint fusions are still commonly used in different joints for treating the pain of arthritis. Fusions are more commonly used in the PIP or the DIP joints in the fingers.

Artificial joints are used by hand surgeons to replace the arthritic joint. The prosthesis forms a new hinge, giving the joint more motion as well as pain relief.

Range-of-motion exercises and strengthening exercises can help finger arthritis get better. Dexterity and fine motor exercises are used to make fingers move more efficiently.

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.
•Men with arthritis in a single finger joint were 42% more likely to die from cardiovascular disease.
•Women had 25% higher risk of cardiovascular death if there were symmetrical joints with arthritis and 26% if only a single finger joint was affected by arthritis.

Though osteoarthritis in any finger joint significantly predicted cardiovascular death in men it was not completely understood why this was the case. The research analysis revealed though that 2,139 of the 3,595 participants had body mass indexes over 25, indicative of being overweight. There is a need for more research and more comparative studies so that replication of the findings can be demonstrated. It can be concluded that maintaining an ideal weight, exercising, and a healthy diet lowers the risk of both osteoarthritis and 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.

Stiff Fingers Are Windows Into Heart Disease, Kathleen Doheny, HealthScout, 1/17/03

Trigger finger (the formal medical term is "stenosing tenosynovitis") is a "snapping" of any of the digits of the hand when being opened or closed. Typically, trigger finger is most common in the ring, middle, or index fingers. The finger movement is often associated with pain at the base of the digit in the palm of the hand. Trigger finger can also affect the thumb.

Trigger finger is caused by local inflammation of the tendon sheath that the finger tendon travels in. Sometimes trigger finger is associated with an underlying condition such as rheumatoid arthritis.

Stretching, ice, and anti-inflammatory treatments can be helpful. Many patients respond to a local cortisone injection. Sometimes an ultrasound guided hydrodissection procedure will be necessary. This is a simple technique that can be performed in an office setting using local anesthetic. Surgery is rarely required.

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