Compare normal and rheumatoid arthritis hands

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

The bones in the hand that connect the wrist to the fingers are called carpal bones.

The bones in the hand that articulate with the carpals are called the metacarpals. 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 joint (MCP). This joint works like a hinge.

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 one bends and straightens their hand.

Articular cartilage covers the ends of all hand and wrist bones that articulate with each other. This material has a rubbery consistency. The function of articular cartilage is to absorb shock and provide a smooth surface to for gliding.

Pain is the main problem with arthritis. At first, the pain is brought about by activity. When the arthritis condition worsens, pain may be felt even at rest. The joint may be inflamed.

Swelling and pain involving the wrist and the MCP joints are suggests the diagnosis of rheumatoid arthritis.

In addition, the tendon sheaths, which are the tunnels that the tendons to the fingers run through may also become inflamed and swollen.

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 the hand for daily activities.

Arthritis can affect the IP joints of the fingers.

When fingers become weakened so that the tendons begin to pull in different directions, patients may develop swan-neck deformities (the PIP hyper-extends and the DIP hyper-flexes) or boutonniere deformities (the PIP hyper-flexes and the DIP hyper- extends).

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