Arthritis hand

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 commonly affects the hand. This article will discuss some of the more common causes of hand pain.

The most common form of arthritis that affects the hand are osteoarthritis with the formation of Heberden's nodes (bony enlargement of the end joints), Bouchard's nodes (bony enlargement of the second row of finger joints), and carpometacarpal arthritis.

Rheumatoid arthritis also affects the hand with involvement of the metacarpophalangeal joints and proximal interphalangeal joints. Swelling and pain are prominent.

Crystal induced forms of arthritis such as gout and pseudogout can also affect the hand.

Carpal tunnel syndrome is a common cause of hand pain and is associated with arthritis. Typically, there is aching, burning, numbness, or tingling in the palm, wrist, thumb, or fingers. The thumb muscle can become weak, making it difficult to grasp things. Pain may extend up to the elbow or even the shoulder.

Carpal tunnel syndrome occurs when the median nerve gets compressed at the wrist because of swelling. Such swelling can occur with:

•Repetitive motion like typing on a computer keyboard, using a computer mouse, playing racquetball or handball, sewing, painting, writing, or using a vibrating tool.
•Pregnancy or obesity.
•Diabetes, premenstrual syndrome, hypothyroidism under active thyroid, or rheumatoid arthritis.

Wrist and thumb pain can occur as a result of trauma. The signs of a possible fracture include deformity and inability to move the wrist, hand, or a finger. Other common injuries include sprain, strain, tendinitis, and bursitis.

Arthritis is another common cause of wrist pain, swelling, and stiffness. There are many types of arthritis. Osteoarthritis occurs with age and overuse. Rheumatoid arthritis generally affects both wrists. Psoriatic arthritis usually accompanies psoriasis.

The joint at the base of the thumb which allows swiveling and pivoting motions of the thumb is referred to as the basal joint or first carpo-metacarpal joint. Because of its design, the cartilage tends to wear out and the joint develops arthritis early. The basal joint of the thumb consists of a carpal or wrist bone (trapezium) and the first metacarpal bone of the thumb.

The joint is held in position by by ligaments and muscles surrounding the joint. Disruptions of the joint surface or the supporting ligaments can lead to slipping of the joint (subluxation) as well as to pain and swelling.

Symptoms of arthritis in the base of the thumb are pain and swelling involving the thumb and wrist, especially with grasp and pinch. These symptoms may appear when a patient awakens and be present for a few minutes before the thumb "loosens up." They then get better during the middle of the day, only to return with an aching pain towards the end of the day, or after use. A "bump" may appear at the joint, due to the shifting of the base of the metacarpal bone as the ligaments loosen as a result of chronic inflammation.

Treatment of the condition depends on the symptoms and stage of the disease. For mild-to-moderate symptoms of pain and swelling, treatment consists primarily of anti-inflammatory medication, rest, and splinting. A variety of splints designed to support the joint can be quite helpful. Education is also of great importance, as the patient learns how to minimize symptoms and protect the damaged joint surfaces.

For more severe symptoms, the patient and doctor may decide on surgery. Because basal joint arthritis is such a common problem, many types of surgical procedures have been developed to deal with it. One involves a fusion of the joint which eliminates the painful symptoms. A potential drawback here is loss of motion and stiffening of the thumb joint.

The other major category of surgical correction involves insertion of material between the two ends of the bones. Many materials have been developed; the most frequently used are a forearm tendon from the patient or a synthetic plastic rubber shaped "washer" to fit the space. Each type of surgery has its potential benefit and drawbacks.

After surgery, the doctor may prescribe a course of hand therapy designed to increase the mobility and strength in the thumb following the surgery.

Infectious arthritis, a serious type of arthritis, is a medical emergency. The signs of an infection include redness and warmth of the wrist, fever above 100°F, and chills.

Other common causes of wrist pain include:

Gout -- this is a metabolic condition characterized by an overabundance of uric acid.
Pseudogout -- this condition is due to calcium pyrophosphate deposits in the joints (usually the wrists or knees), causing pain, redness, and swelling.

De Quervain's disease is a painful inflammation involving the tendons controlling the thumb. The tendons are trapped inside a sheath through which they run. The result is pain at the thumb side of the wrist.

The pain may travel into the thumb or up the forearm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects.

Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people feel pain if direct pressure is applied to the area.

Overuse, trauma to the thumb, repetitive grasping and inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease. Gardening, racquet sports and various workplace activities may aggravate the condition. Often, the cause is unknown.

The test most frequently used to diagnose de Quervain's disease is the Finkelstein test. The thumb is placed across the palm. The fingers are then folded over the thumb. When the wrist is suddenly bent toward the side of the small finger, the inflamed tendons are pulled. This maneuver reproduces the pain of de Quervain's disease.

Treatment usually involves wearing a splint 24 hours a day for two to four weeks to immobilize the affected area. Ice is to reduce inflammation. Anti-inflammatory medication can be helpful. If symptoms persist, ultrasound-guided needle hydrodissection with lidocaine, glucocorticoid, and sterile saline can expand the swollen sheath and cure the problem.

Rarely, surgery is needed. Surgical release of the tight sheath eliminates the friction that causes inflammation.

For carpal tunnel syndrome, adjustments to work habits and environment may be needed. These include:

•Make sure that your keyboard is low enough that wrists aren't bending upwards while typing.
•Take plenty of breaks from activities that aggravate the pain. When typing, stop often to rest the hands, if only for a moment. Rest the hands on their sides, not the wrists.
•Over-the-counter pain medications can sometimes help.
•Various wrist rests and wrist splints (braces) are designed to relieve wrist pain. Some people find these devices help their symptoms.
•A wrist splint at night can sometimes help.

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