Arthritis hand
Carpal tunnel syndrome is a common cause of hand pain and is associated with arthritis. You may feel aching, burning, numbness, or tingling in your palm, wrist, thumb, or fingers. The thumb muscle can become weak, making it difficult to grasp things. Pain may extend up to your elbow.
Carpal tunnel syndrome occurs when an important nerve (called the median nerve) gets compressed at the wrist because of swelling. Such swelling can occur if you: • Do a repetitive motion with your wrist like typing on a computer keyboard, using a computer mouse, playing racquetball or handball, sewing, painting, writing, or using a vibrating tool. 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 accompanies psoriasis. The joint at the base of the thumb which allows for the swivel and pivoting motions of the thumb is referred to as the basal joint or thumb CMC (carpometacarpal) joint. Because of its design, it tends to wear out and develop arthritis early in life. Basal joint arthritis is also common in people who have osteoarthritis. The basal joint of the thumb, or carpometacarpal joint, is made up of a carpal or wrist bone (trapezium) and the first or metacarpal bone of the thumb. This joint is very near the wrist and under the fleshy part of the thumb. It is subjected to an unusual amount of stress, as the thumb must be strong enough to counteract the force of four fingers put together. It has been calculated that one pound of pinch between the thumb and index finger will produce six-to-nine pounds of pressure at the basal joint of the thumb. The joint is held in position by the contours of its surface and by the 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 pain and swelling.
Symptoms of arthritis in the base of the thumb are pain and swelling about the thumb and wrist, particularly with grasp and pinch. These symptoms may appear the first thing in the morning and be present for a half hour or so before the thumb "loosens up." They might then subside throughout the middle of the day, only to return with a "dull aching" type of pain towards the end of the day or after vigorous use. A "bump" may appear at the joint, due to the shifting of the base of the metacarpal bone as the ligaments loosen through swelling. When the doctor examines the joint, an attempt is made to determine accurately whether the patient's pain symptoms are due to an arthritis in the thumb basal joint. Tests to determine loosening of the joint as well as the smoothness of the cartilage surfaces are performed. X-rays taken of the joint in various positions help the physician determine the severity of the disease. Treatment of the condition depends upon the symptoms and stage of the disease. For mild-to-moderate symptoms of pain and swelling, treatment consists primarily of anti-inflammatory medication, rest, splinting, and education. Aspirin has been a standard anti-inflammatory medication for many years, but a wide selection of non-steroidal anti-inflammatory medications may be used as well. Various splints fabricated to support the joint can prove to be quite helpful. Education is also of great importance, as the patient learns about the arthritic process and 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. Surgery generally falls into two main categories; one involves a fusion of the two bones making up the joint, thereby eliminating the joint and the painful symptoms. A potential drawback here is some loss of motion and some stiffening of the thumb joint. The other major category of surgical correction involves removal of the arthritic surfaces and insertion of material between the two ends of the bones. Many types of materials have been developed; the most frequently used are natural tendon from the patient or a synthetic plastic rubber shaped to fit the space. Each type of surgery has its potential benefit and drawbacks, and each person's requirements are different. After surgery, the doctor may prescribe a course of therapy designed to increase the mobility and strength in the thumb following the surgery. A hand therapist provides vital supporting instruction and assists the patient in regaining thumb function. Pain and stiffness at the base of the thumb are extremely common symptoms of an arthritic condition and should prompt consideration of an evaluation by your physician.
Infectious arthritis, aserious type of arthritis, is a medical emergency. The signs of an infection include redness and warmth of the wrist, fever above 100°F, and recent illness. Other common causes of wrist pain include: • Gout -- this occurs when you produce too much uric acid, a waste product. It forms crystals in joints, rather than being excreted in the urine. De Quervain's disease is a painful inflammation of tendons controlling the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel, or sheath, through which they pass. The result is pain at the thumb side of your wrist joint. De Quervain's disease is one of the most common types of tendon-lining inflammation.
Pain along thumb-side of your wrist, directly over two thumb tendons, is common in cases of de Quervain's. The condition can occur gradually or suddenly; in either case, 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, a direct blow to the thumb, repetitive grasping and certain inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease. Gardening, racquet sports and various workplace tasks are examples of activities that may aggravate the condition. Often, the cause is unknown. De Quervain's affects women eight to 10 times more often than men. The test most frequently used to diagnose de Quervain's disease is the Finkelstein test. Your doctor will ask you to make a fist with your thumb placed in your palm. When the wrist is suddenly bent toward the side of the small finger as in shaking hands, the swollen tendons are pulled throughout the tight space. If this movement is painful, you may have de Quervain's disease.
Treatment usually involves wearing a splint that includes your wrist and thumb 24 hours a day for four to six weeks to immobilize the affected area, and refraining from any activities that aggravate the condition. Ice may be applied to reduce inflammation and your doctor may give you anti-inflammatory medication such as naproxen or ibuprofen. If symptoms continue, cortisone (a steroid) may be applied topically via an electrical patch (iontophoresis) by your therapist or your physician may inject the area with cortisone to decrease pain and swelling. If de Quervain's disease does not respond to conservative medical treatment, surgery may be recommended. Surgery for de Quervain's disease is an outpatient procedure done under local anesthesia. Surgical release of the tight sheath eliminates the friction that causes inflammation, restoring the tendons' smooth gliding capability. Upon recovery, your physician will recommend an exercise program to strengthen your thumb and wrist. Recovery times vary, depending on your age, general health and how long the symptoms have been present. In cases that have developed gradually, the disease is usually more resistant to management and improvement in function, and it may take longer to relieve symptoms
For carpal tunnel syndrome, you may need to make adjustments to your work habits and environment: • Make sure that your keyboard is low enough that your wrists aren't bending upwards while you type. • Do flexibility and strengthening exercises every day. Work with a physical therapist to learn the best and safest exercises for your wrist.
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