Cartilage is the substance that lines our bones to allow smooth gliding surfaces for our joints. As the cartilage wears out and deteriorates, our bodies are not able to regenerate or replace the loss of joint cartilage. Eventually, this loss of cartilage leads to symptoms of arthritis including joint stiffness, swelling, and pain. As a joint becomes more arthritic, synovial tissue that lines the joint capsule thickens, synovial fluid production increases, and bones spurs develop along the joint margins which can further restrict motion and cause increased pain. With more advanced arthritis, significant secondary deformities of the nearby joints can occur which can further compromise functional motion of the joints. Symptoms of pain can often vary, but when arthritis becomes more symptomatic, even simple activities of daily living can become difficult to perform. Arthritis can greatly affect one’s quality of life.
Arthritis can be defined as either degenerative or inflammatory. Degenerative arthritis (also known as osteoarthritis) is the most common form of arthritis. Osteoarthritis occurs from “wear and tear” on the joints and generally affects older patients. However, some patterns of degenerative arthritis such as basal joint arthritis of the thumb can affect younger patients, particularly women over 40 years of age. Another form of degenerative arthritis that can affect younger patients is post-traumatic arthritis, a condition that results from injury to a joint such as fractures that extend into the joint, torn ligaments that cause chronic joint instability, and joint dislocations.
Inflammatory arthritis is often associated with systemic (total body) symptoms that may appear throughout one’s body. The most common form of inflammatory arthritis is rheumatoid arthritis. Eventually the inflammatory process can lead to erosive and destructive changes to the joints, and eventually secondary deformities of the wrist and fingers. Advanced inflammatory arthritis can greatly affect functional use of the hand and wrist. Patients with inflammatory arthritis should be evaluated by a Rheumatologist for appropriate evaluation and medical management, although surgery may be necessary for more advanced arthritis and deformities to help alleviate pain and to restore functional use of the hand and wrist.
Treatment for arthritis of the hand and wrist typically begins with conservative non-operative options. Basic treatment measures include modification of activity with splinting, medications, and corticosteroid injections. However, the success of treatment and options available depends on several factors which include the number of arthritic joints involved, the anatomic location of the arthritic joint, the degree of arthritis, and the patient’s age, activity level, and medical conditions. It should be understood that these methods of treatment, particularly use of medication, do not provide a cure for arthritis or restore cartilage, but are used to reduce arthritic flares and to alleviate symptoms. With the successful reduction of symptoms, one can expect improvement of functional use of the hand and wrist, but some limitations of activity could persist depending on the degree of arthritis.
Splinting helps to rest the joint and to reduce the stress placed on the arthritic joint during activities. Splints are generally worn when symptoms flare or with activities that increase pain. The splints are designed for specific joints of the hand and wrist and can still permit functional use of the hand. Some splints are prefabricated by manufacturers as “off the shelf” items but some of the unique and smaller splints are best made and fabricated by a Hand Therapist. Your doctor and Hand Therapist will provide you with the best splint options for your needs.
Non steroidal anti-inflammatory medications (NSAID's) are the most common type of medications used for arthritis. These medications can reduce pain and swelling by blocking the body's pathways responsible for inflammation. However, it is important to have follow-up evaluations with your primary care physician if these medications are used on a long term basis as some side effects to other organ systems such as the kidneys can occur, particularly in patients with a history of diabetes or hypertension. Use of these medications may also be difficult for patients that have a history of gastric reflux or stomach ulcers and may not be allowed for patients that require other blood thinning medication. You may need to consult with your physician on their use. Other medications such as chondroitin sulfate and glucosamine have also been used for arthritis and may have an anti-inflammatory effect. Their effectiveness for treatment of arthritis of the hand and wrist, however, has not been fully determined. Another medication that can offer effective pain relief for arthritis is acetaminophen which is not classified as an NSAID.
Injections with a corticosteroid (also known as “cortisone” injection) can also be offered, particularly if NSAID’s are not effective or a patient is unable to take anti-inflammatory medication. Although corticosteroid injections can be very effective for alleviation of joint pain and swelling, the long-term relief following an injection can be unpredictable. Pain relief following an injection may be limited to several weeks, but could possibly last over months. Based on some of the potential side effects of injectable corticosteroids, there are limitations on the number of allowable injections that can be done. Your doctor will discuss these limitations of an injection.
If the prescribed non-operative treatment options are no longer effective or fail to provide relief, then surgery is generally considered. The goal of surgery is to optimize pain relief and allow return of functional use of the hand and wrist. Depending on the specific joint involved, there are a wide variety of surgical techniques for arthritis of the hand and wrist offered to provide pain relief and restore functional activity. Dr. Katz will discuss your possible treatment options and expectations.