The hand and wrist are made up of many small joints that all work together to create motion, including fine motor skills needed to handle small and large objects. Joints that are affected by arthritis can make daily activities, including tying your shoes or picking up a spoon, difficult. Since arthritis can occur in many areas of the hand and wrist, it’s important to get a clear diagnosis and treatment plan.
Causes
Arthritis is defined as inflammation of one or more joints. The most common types are osteoarthritis (the wearing down of cartilage) and rheumatoid arthritis (the body’s immune system attacking its own joints), but there are many different kinds
When joints are healthy, they move easily because of the cartilage that covers the ends of bones. Inflamed joints don’t move easily and this can cause pain and irritation.
There are two main causes of arthritis:
Disease
Arthritis caused by disease occurs over a long period of time. It gradually builds up, getting worse and worse.
Two common type of disease related arthritis are the two mentioned earlier: osteoarthritis and rheumatoid arthritis.
Osteoarthritis is much more common and generally affect older people. It it characterized by the slow decay of joint cartilage.
Rheumatoid arthritis is an autoimmune disease that affects many parts of the body. It usually starts in the hands and feet and can gradually progress to other parts of the body.
Trauma
Bone fractures, especially ones that occur near a joint, can account for the development of arthritis. Even if treated properly, these injuries can still cause arthritis in the joints affected.
Symptoms
Pain
First symptoms of arthritis of the hand include pain that is usually described as “dull” or a “burning” sensation. The pain is usually more prevalent after periods of hard gripping. You may not feel pain right away, and can show up even the next morning in the form of stiffness.
You may find yourself using your hand differently to avoid pain caused by arthritis.
Swelling
When the joint takes on more stress than it can handle, it may become inflamed in order to prevent further use.
Changes in Surrounding Joints
Patients with advanced thumb base arthritis may experience increased mobility in neighboring joints.
Warmth
Arthritic joints can feel warm to the touch due to inflammation.
Crepitation and Looseness
Crepitation is defined as the sensation of grating or grinding in a joint. This is caused by damaged cartilage surfaces rubbing against each other.
Joints may begin to feel “loose” when arthritis is caused by damaged ligaments, the support structures for joints.
Cysts
Cysts can occur when arthritis affects the ends of fingers (DIP joints). This can cause ridging or dents in the nail of the affected joint.
Diagnosis
Arthritis can be diagnosed by a hand examination or by x-ray.
If x-rays look normal, a bone scan can sometimes be helpful to detect early-stage arthritis.
Treatment
Even though arthritis can be painful, it doesn’t have to limit you from enjoying life. There are many options to address the pain, swelling, and discomfort, especially when treated early.
Nonsurgical Treatment
Medications. Medication can be used to decrease pain and swelling. The most commonly prescribed medications for arthritis are anti-inflammatories which block chemicals that cause pain and swelling around the joints.
Injections. Injections may be used when anti-inflammatory medication treatment is not appropriate. These typically contain an anesthetic and steroid component. The pain relief can last weeks to months and can be repeated several times.
Splinting. When given an injection, splinting is typically used in conjunction to stabilize the joint and increase the effectiveness of the pain relief.
Since splinting can lead to muscle atrophy (deterioration), preventative exercise should be considered when using a splint for long periods of time.
Surgical Treatment
If nonsurgical treatment is not enough to relieve the patient of pain, especially long-term, surgical treatment is then considered. The type of surgery performed depends on what is appropriate for the patient to provide the most relief with the least amount of surgery.
Preservation or reconstruction of the joint is always considered first.
Joint replacement or fusion (arthrodesis) is performed when the surfaces of the joint no longer work due to chronic damage.
After Surgery
Post surgery recovery will typically take place with a hand therapist to restore maximum function to the hand. A splint or cast may be used to help protect the hand as it heals.
The time it takes to recover from hand surgery varies from patient to patient but generally you’ll be back to full working capacity within three months.
New Research
Doctors are doing more to recover the function of damaged joints. This means getting an earlier diagnosis so that preventative treatment can be taken.
The recent development of arthroscopy for the small joints in the hands and wrists has attributed to this earlier joint damage detection.
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