Osteoarthritis of the hand and wrist
There are at least 20 joints in each hand and wrist which may be affected by osteoarthritis. As well as pain, patients will suffer from stiffness, deformity, weakness and loss of function. Patients with hand arthritis often suffer for years thinking that nothing can be done to help them, yet this is far from the case.
Thumb base arthritis
One of the joints most frequently affected by osteoarthritis is the joint at the base of the thumb between the trapezium and the first metacarpal. As the arthritis develops, the joint becomes increasingly painful causing difficulty with gripping and twisting movements and activities which involve applying pressure with the thumb. If a thumb splint or cortisone injection into the joint doesn’t control the symptoms then an operation such as a trapeziectomy will usually relieve the pain and restore hand function.
Osteoarthritis of the finger joints
There is often a family history of osteoarthritis of the finger joints, or it may develop following a fracture. The joints become misshapen, painful and stiff. If the joint at the tip of a finger is sufficiently painful that it requires surgical treatment, then the joint can be fused. This operation abolishes the pain and stabilises an unstable joint, but all movement is abolished.
The middle finger joints can develop painful osteoarthritis. Fusion of the joint is an option, but most of my patients prefer to have an artificial joint inserted, which should relieve the pain while maintaining a functional range of movement. There are various implants available such as an uncemented surface replacement with a metal on plastic bearing surface, which gives good results.
Osteoarthritic finger joint
Post-operative x-ray after insertion of a finger joint replacement
Osteoarthritis of the wrist
Painful osteoarthritis of the wrist usually develops as a consequence of a previous injury to the wrist rather than as a primary condition. The classic injuries are a fracture of the scaphoid bone which has failed to unite, or disruption of the ligaments between the scaphoid and lunate bones. Successful treatment of these injuries at the time should prevent the subsequent development of arthritis. However, scaphoid fractures are notoriously difficult to initially diagnose and, if left untreated, have a high risk of developing into a non-union. Most scaphoid fractures will heal in a plaster cast but in some, healing seems slow or the configuration of the fracture is thought to have a higher risk of non-union. In these cases, the tendency now is to choose early internal fixation with a metal screw which can be inserted through a short incision.
If painful arthritis of the wrist fails to respond to conservative treatments, such as a splint and analgesics, then there are surgical options available. If the joint isn’t too badly affected an arthroscopic debridement and wrist denervation can give good relief. For the more severe cases, total or partial fusion of the wrist may be required.
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