The hand and wrist have a number of small joints that work together to produce motion, including the delicate movements needed to thread a needle or tie a shoelace. When the joints become affected with arthritis, even the simplest activities of daily living can be difficult. Problems can occur in various areas of the hand and wrist and can have multiple causes. To view the information on the arthritis of the ankle please view the following: risk factors, non-surgical treatment, surgical treatment, and research on the horizon.
All arthritic joints lose cartilage, which provides a smooth gliding surface for the joint. When the cartilage becomes worn or damaged, or is lost due to disease or trauma, it no longer works as nature's "shock absorber."
The body attempts to make up for the lost cartilage by producing fluid in the joint lining, which tries to act like a substitute cushion. The swelling, however, may cause the joint to swell, and the swelling restricts motion and causes pain.
Over time, if the arthritis is not treated, the bones that make up the joint can lose their normal shape. This causes more pain and more limitation of motion.
Arthritis is the leading cause of disability in the United States . Indeed, about one in five people in this country has at least one joint with signs or symptoms of arthritis, and about half of these sufferers are under age 50. How many people have it in the hand and wrist is not known.
When arthritis occurs due to disease, the onset of symptoms is gradual and the cartilage decreases slowly. The two most common forms of arthritis from disease are osteoarthritis and rheumatoid arthritis. Osteoarthritis is much more common and generally affects older people. It appears in a predictable pattern in certain joints. Rheumatoid arthritis has other system-wide symptoms and may be passed from parent to child (genetically).
People of any age may be affected by arthritics as a result of injuries, fractures and dislocations that damage cartilage. In fact, an injured joint is about seven times more likely to become arthritic, even if the injury is properly treated. With early treatment, however, arthritis does not have to result in a painful or sedentary life.
Diagnosis
A doctor can diagnose arthritis of the hand by examining you and taking X-rays. Specialized studies are usually not needed. A bone scan, though, may help the doctor diagnose arthritis when it is in an early stage, even if X-rays look normal. Arthroscopy is another way to look at the joint by direct inspection. During an arthroscopic procedure, the surgeon inserts a small camera into the joint to look inside. It provides the clearest picture of the joint without having to make a large incision. However, this is an invasive procedure and should not be used as a routine diagnostic tool.
Symptoms
Early symptoms of arthritis of the hand include joint pain that may feel "dull," or a "burning" sensation. The pain often occurs after periods of increased joint use, such as heavy gripping or grasping, although it may not show up until hours later or even the following day.. As the cartilage wears away and there is less material to provide shock absorption, the symptoms - including morning pain and stiffness -- occur even with less use. In advanced disease, though, the joint pain may wake you up at night. When the affected joint is subject to greater stress than it can bear, it may swell in a protective reaction. Many people with arthritis complain of increased joint pain with rainy weather. Activities that once were easy, such as opening a jar or starting the car, become difficult due to pain. The pain might be relieved by rest.
To prevent pain at the arthritic joint, you might find yourself using your hand in a different way. In fact, as the arthritis becomes more advanced, the neighboring joints may actually become more mobile than normal.
The arthritic joint may feel warm to touch. This is due to the body's inflammatory response. There may be a sensation of grating or grinding in the affected joint. This is caused by damaged cartilage surfaces rubbing against one another. If arthritis is due to damaged ligaments, the support structures of the joint may become unstable or "loose." In advanced cases, the joint may appear larger than normal because of bone changes, loss of cartilage and joint swelling. When arthritis affects the end joints of the fingers, small cysts may develop. The cysts may then cause ridging or dents in the nail plate of the affected finger.
Treatment options for arthritis of the hand and wrist include medication, splinting, injections and surgery. The choice depends on many factors:
Medications: Medications treat symptoms but cannot restore joint cartilage or reverse joint damage. The most common medications for arthritis are anti-inflammatories, which stop the body from producing chemicals that cause joint swelling and pain. Examples of anti-inflammatory drugs include over-the-counter medications such as Tylenol® and Advil® and prescription drugs such as Celebrex®. Glucosamine and chondroitin are widely advertised "neutraceuticals." Neutraceuticals are not drugs. Rather, they are compounds that are the "building blocks" of cartilage. They were originally used by veterinarians to treat arthritic hips in dogs. However, neutraceuticals have not yet been studied as a treatment of hand and wrist arthritis.
Injections: When first-line treatment with anti-inflammatory medication is not appropriate, injections may be used. These typically contain a long-acting anesthetic, similar to novacaine but longer lasting, and a steroid that can provide pain relief for weeks to months. The injections can be repeated, but only a limited number of times, due to possible side effects, such as lightening of the skin, weakening of the tendons and ligaments and infection.
Splinting: Injections are usually combined with splinting of the affected joint, especially during periods when the joints hurt. A splint helps support the joint to ease the stress placed on it by activities but it should be small enough to allow functional use of the hand. Wearing the splint for too long can lead to muscle wasting (atrophy). Muscles can assist in stabilizing injured joints, so atrophy should be prevented
If non-operative treatment fails to provide relief, surgery may be considered. The option chosen should be tailored to your needs and have a reasonable chance of providing long-term pain relief and return to function. It is important that the treating physician is well versed in current surgical techniques. If there is any way the joint can be preserved or reconstructed, this option is usually chosen. When the damage has progressed to a point that the surfaces will no longer work, a joint replacement or fusion is performed. Joint replacements attempt to provide pain relief and functional joint motion. Joint fusions provide pain relief but stop joint motion. The; the damaged joint surfaces are gone, so they cannot cause symptoms, but the fused joint no longer moves.
As with hip and knee replacements, there have been significant improvements in joint replacements in the hand and wrist. The replacement joints are made of materials similar to those used in weight-bearing joints, such as ceramics or long wearing metal and plastic parts. The goal is to improve the function and longevity of the replaced joint. Most of the major joints of the hand and wrist can be replaced by a surgeon with special training in this procedure. As with any evolving technology, the long-term results of the hand or wrist joint replacements are not yet known, but early results have been promising. Talk with your doctor to find out if these implants are right for you.
After any type of joint reconstruction surgery, there is a period of recovery. Often, you will be referred to a trained hand therapist, who can help you maximize your recovery. You may need to use a postoperative splint or cast for awhile after surgery. This helps protect the hand while it heals. During this postoperative period, you may need to modify activities to let the joint reconstruction heal properly. Typically, oral medications are used to reduce discomfort, but it is important to discuss your pain with your doctor so it can be adequately treated. Length of recovery time varies widely and depends on the extent of the surgery performed and multiple individual factors. People usually can return to most if not all of their desired activities, however, in about three months after most major joint reconstructions.
Increasingly, doctors are focusing on how to preserve the damaged joint. This includes getting an earlier diagnosis and repairing joint components before the entire surface becomes damaged. Arthroscopy of the small joints of the hand and wrist is now possible because the equipment has been downsized. Because of encouraging results in cartilage repair and replacement in the larger joints such as the knee, some of these techniques have been applied to the smaller joints of the hand and arm. In addition, stem cell research may lead to ways to regenerate damaged joint surfaces.
The source for this information is the American Academy of Orthopaedic Surgeons.