Hand pains arthritis
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.
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Many types of arthritis can affect the hands. The most common type of arthritis that affects the hands is osteoarthritis.
This causes knobby bony swelling in the distal row of finger joints. These are called Heberden’s nodes. The bony swellings that affects the more proximal row of finger joints are called Bouchard’s nodes.
Gout causes deposits of uric acid to accumulate in finger joints. These deposits, called tophi, can lead to joint swelling and pain and be mistaken for other types of arthritis. While gout is more common in men than women, there is a syndrome that occurs in postmenopausal women on diuretic therapy where tophi form on the distal interphalangeal joints.
Pseudogout can also affect the hands, ususally the second and third metacarpal phalangeal joints. It is often confused with rheumatoid arthritis.
Psoriatic arthritis causes inflammation and swelling of fingers as well. The swelling involves the joints and the tendon sheaths making the finger look like a small sausage.
In rheumatoid arthritis, hand involvement leads to contractures and deformities. The most effective prevention for this is early and aggressive treatment with disease modifying anti-rheumatic drugs (DMARDS) and biologics.
De Quervain's tenosynovitis is inflammation of the tendon on the side of the wrist at the base of the thumb. This tendon is the extensor pollicus longus tendon. De Quervain's tenosynovitis causes pain and tenderness at the side of the wrist next to the base of the thumb. Sometimes there is slight swelling and redness in the area.
De Quervain's tenosynovitis may be caused by repetitive activity which involves pinching with the thumb while moving the wrist. Treatment usually involves taking NSAIDS, an ultrasound-guided cortisone injection using hydrodissection technique. Surgery is rarely necessary.
The carpal tunnel is a narrow passage into the wrist formed by a floor of bones and a roof of tendons and ligaments which shield the nerves and tendons that extend into the hand. Symptoms of carpal tunnel syndrome (pain, numbness, and tingling in the hand and wrist) occur when tissues within the carpal tunnel become inflamed and swollen and press on the median nerve.
Degenerative arthritis often affects the basilar joint at the base of the thumb, formed by the thumb metacarpal bone and a small wrist bone called the trapezium. Osteoarthritis leads to wearing away of the cartilage causing pain and inflammation.
Basal joint arthritis results in pain and restricts movement of the thumb across the palm.
In advanced cases, there may be complete destruction of the joint, an inward collapse of the metacarpal and arthritic deterioration on all sides of the trapezium.
Along with pain and swelling at the base of the thumbe, the patient may have a positive "grind test". In this test, the first metacarpal is grasped, pushed downward and rotated. Pain and a crunching or gritty sensation during this maneuver usually indicate that at least some degree of arthritis is present.
In the early stages of arthritis at the base of the thumb, anti-inflammatory medication, ultrasound-guided cortisone injections into the joint, or splinting of the wrist and thumb may be helpful. Splints will put the thumb at rest and prevent the arthritic joint from moving. This may provide relief from the annoying symptoms of this condition.
It is important that the splints used for this condition extend well up on the thumb. Arthroscopic debridement followed by viscosupplementation can be extremely successful in the early stages. When these conservative methods of treatment are no longer beneficial to the patient, surgery may be warranted.
The most important goal of surgery is to eliminate the pain at the base joint of the thumb, by creating a new joint.The procedure is referred to as an arthroplasty.
Techniques involve removing all or part of the small wrist bone - the trapezium. The space created by removing the trapezium will be filled with tendon material, and most surgeons use all or part of an adjacent tendon to suspend and stabilize the base of the first metacarpal so that the reconstructed thumb will regain strength.
Strength recovery may take up to one year.
Trigger finger is a "snapping or catching" 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. Instead of a smooth, continual movement, the digit sticks, then snaps closed. This is frequently associated with pain at the base of the digit on the palm of the hand. Trigger finger can also affect the thumb.
Trigger finger is caused by local swelling from inflammation or scarring of the tendons that pull the affected digit in toward the palm. Sometimes trigger finger is associated with an underlying illness such as rheumatoid arthritis.
Stretching, ice, and anti-inflammatory drugs can be helpful. Most patients respond to an ultrasound guided cortisone injection. When trigger fingers persists, ultrasound-guided hydrodissection of the tendon sheath is usually curative. Surgery is rarely needed.
Joint replacement is recognized as a treatment option for large joints which have been severely damaged by arthritis. Painful, deformed, and limited small joints can also be helped by implant replacement.
Finger implant surgery is not a perfect solution for everyone. The surgery is most valuable for patients who will benefit from pain relief and restoration of some function.
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