WRIST AND HAND ARTHRITIS

Arthritis is an inflammatory condition of joints. There are several types of arthritis and the most common type is osteoarthritis or wear-and-tear arthritis. Arthritis affects various joints in the body and the arthritis in hand affects the joint at the base of the thumb. Arthritis may also affect the joints of other digits and the symptoms include swelling, pain, stiffness, and malformation all of which interfere with use of the hand.

Who develops arthritis?

Arthritis is often seen in people aged over 40 years however may affect people of all ages. The most common cause is wear-and-tear, as you age you are more prone to develop arthritis. Also, traumatic injuries, fractures and joint dislocation make you more susceptible to develop arthritis. Certain types of arthritis are more common in women than men as in the thumb arthritis.

What are the types of arthritis?

There are over several types of arthritis. The most common are:

Osteoarthritis: Osteoarthritis is also called degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, and this is called a bone spur.

Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose a lot of movement, causing a person to become disabled. Disability most often occurs in the thumb or finger joints.

Rheumatoid Arthritis: This is an auto-immune disease in which the body’s immune system (the body’s way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-50), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or cause the finger to bend or curve.

Rheumatoid Arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body at the same time and with the same symptoms. About two to three times as many women as men have this disease.

Post-traumatic arthritis: Arthritis developing following an injury to hand, wrist or elbow is called as post-traumatic arthritis. The condition may develop years after the trauma such as a fracture, severe sprain, or ligament tear.

Psoriatic arthritis: This form of Arthritis occurs in some persons with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved.

Neuropathic Arthritis This is a rare form of painless arthropathy where due to nerve involvement the joint loses its sensation and joint position sense and starts to wear out fast. It may be seen in conditions involving the spinal cord and in diabetes.

How is arthritis diagnosed?

Diagnosis of wrist or hand arthritis is made by examining the hand. There is usually painful restriction of movement and swelling due to thickening of the joint lining or fluid collection.

X-rays of the joint may be taken to know the severity of the disease and to determine any bone spurs or calcium deposits. MRI or MR Arthrogram (where a dye is injected into the wrist joint before an MRI) can help to identify early arthritis. A synovial biopsy can be confirmatory of the etiology along with other blood tests and a rheumatologist’s opinion.

What are the treatments available for arthritis of the wrist and hand?

Nonsurgical treatment methods for relieving pain in an arthritic joint include activity modification, pain medications, physiotherapy, and use of splints, and steroid injections.

 

https://orthopaedicsurgeon.pradeepbala.com/

Surgery is usually considered if nonsurgical treatment fails to give relief. There are different surgical procedures that can be used and may include:

Synovectomy: This surgery is usually indicated for early cases of inflammatory arthritis where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion of digits and thumb. Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure is often performed using key hole surgery (wrist arthroscopy). The procedure is often combined with a biopsy and culture of the synovium.

https://upperlimbcare.pradeepbala.com/wrist-arthroscopy-key-hole-surgery/

Arthroplasty: In this procedure, the affected joint is removed and replaced with an artificial implant such as silicone rubber or bio-compatible metal alloy joints (finger replacement).

Replacement of the wrist joint is called Wrist Arthroplasty/ Wrist joint replacement. 

Replacement of the finger joint near the base of the finger is called PIP joint replacement. The finger joint near the tip of the finger DIP joint is usually not replaced but is fused. Replacement of the basal joint of the finger is called MCP joint. Dr Bala has undergone cadaver workshop training for replacement of small joints of the hand.

In Distal Radio-Ulnar Joint (DRUJ) arthritis, an excision arthroplasty procedure called the Darrach’s procedure is performed. Dr Bala chooses to do this procedure in elderly patients with low functional demand. He also provides this option for some patients where the wrist fracture has healed in a position where the ulna is longer than the radius (ulnar positive variance) and impinges on the hand bones. For those elderly patients with higher demand but lower loading, a DRUJ replacement may be considered.

Dr Bala treats base-of-thumb arthritis with a procedure called thumb suspensionplasty. This is an interposition arthroplasty where the arthritic joint surfaces are removed and replaced with a tendon. Dr Bala uses half of a tendon from the front of the wrist and approaches this joint from the back of the thumb.

Arthrodesis: A fusion, also called an arthrodesis involves removal of the joints and fusing the bones of the joint together using titanium screws/ plates/ staples. Even though this surgery eliminates all motion at the joint, the resulting fusion is very strong and removes pain and the joint is in a functional position.

This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous arthroplasty, and when heavy manual use is expected.

Fusion of the wrist joint is called Wrist Arthrodesis/ Wrist joint fusion. The Wrist fusion may be Partial wrist fusion or Total wrist fusion depending on the extent of fusion. Fusion of the finger joint near the base of the finger is called PIP joint arthrodesis/ PIP joint fusion, while fusion of the finger joint near the tip of the finger is called DIP joint arthrodesis/ DIP joint fusion. Fusion of the basal joint of the finger is called MCP arthrodesis/ MCP joint fusion.

For younger patients with DRUJ arthritis, Dr Bala may offer a procedure where the DRUJ is fused and a cut in the ulna bone is made proximally to permit forearm rotation. This is called the Sauve-Kapandji procedure. Dr Bala will discuss the options with you and help you decide which type of surgery is the most appropriate for you.

Rehabilitation

Following surgery, a rehabilitation program, often involving a physiotherapist may help to regain hand strength and movement. You may need to use a post-operative splint for a while after surgery that helps to protect the hand while it heals. You may need to restrict activities for 12 weeks to let the joint reconstruction heal properly. Although recovery is slow, you should be able to resume your normal activities within a few months of surgery.