Osteoarthritis fingers thumb
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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There are several bones that in the hand.
The bones in the palm of the hand are called metacarpal bones. One metacarpal connects to each finger and thumb. The five fingers of the hand are made up of phalanges, shafts of bone that line up to form each finger and thumb.
The primary knuckle joint is formed by the interplay of the phalanges to the metacarpals. This joint is called the metacarpophalangeal joint (MCP). This joint acts like a hinge to allow bending and straightening of the fingers and thumb.
The three phalanges in each finger are separated by two joints, called interphalangeal (IP) joints. The one closest to the MCP 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 are hinge joints.
The finger and thumb joints are covered on the ends with articular cartilage. The function of articular cartilage is to absorb shock and provide a smooth surface to allow motion.
The term degenerative arthritis means inflammation of a joint due to wear and tear.
Injury to a joint can cause damage to the articular cartilage. An injury to any of the joints of the fingers--even if it does not injure the articular cartilage directly--can alter how the joint functions. This occurs when a fracture occurs and the bone fragments don't quite align and heal properly.
Over time, this imbalance can lead to damage to the joint surface. Since articular cartilage cannot heal itself, damage progresses. Eventually, symptoms begin.
Pain is the main symptom of arthritis.
Arthritis can affect the IP joints of the fingers. Osteoarthritis may cause soreness and swelling on the back of the PIP joints. These enlargements are known as Bouchard's nodes.
Patients with osteoarthritis of the fingers may have swelling and tenderness over the top of the DIP joints. These enlargements are called Heberden's nodes.
Osteoarthritis at the base of the thumb is also very painful. This affects the ability of the thumb to perform pincer movement; therefore, grip strength is affected. The ability to grasp is greatly affected.
The diagnosis of arthritis of the finger joints begins with a history. Details about any injuries that may have occurred to the hand are important.
Following the history, a physical examination of the hand, and other joints will be done.
X-rays may be taken to see how much the joint is affected.
Treatment usually begins when the joint first becomes painful. This may simply require mild anti-inflammatory medications. Reducing the activity, or changing from occupations that require heavy repetitive hand and finger motions, may be necessary to help control the symptoms. Topical agents may also help.
An injection of cortisone into the finger joint can give temporary relief. Cortisone is a powerful anti-inflammatory medication and when injected into the joint can help relieve the pain. Pain relief is temporary and usually only lasts several weeks to months. Ultrasound-guided injection with platelet-rich plasma (PRP), an ultraconcentrate of blood that contains a large number of platelets, cells packed with healing factors is often effective for both pain as well as healing.
Arthroscopic debridement of the base of the thumb followed by an injection of viscosupplement may help relieve pain and restore function. This technique has been published by Wei, N and colleagues.If this fails, the "anchovy procedure", a technique where a hand surgeon uses a tendon in the forearm as a spacer for the joint at the base of the thumb.
Physical and occupational therapy play a critical role in nonoperative treatment of finger joint arthritis.
Braces 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 shock.
A fusion (also called an arthrodesis) of any joint is designed to eliminate pain by allowing the bones to fuse into solid bone. Fusions are more commonly used in the PIP or the DIP joints in the fingers.
Artificial joints are available for the finger joints. These plastic or metal prostheses are used by some hand surgeons to replace the arthritic joint. The prosthesis forms a new hinge, providing the joint more rang of motion and pain relief.
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