Arthritis

Hand and Wrist Arthritis

Description

There are many small joints in the hand and wrist that work together to produce the fine motion necessary to perform detailed tasks such as threading a needle or tying a shoelace. When one or more of these joints is affected by arthritis, even simple activities can become difficult. Although there are many types of arthritis, most fall into one of two major categories: osteoarthritis and rheumatoid arthritis, or RA. Both are diseases of the joint, but symptoms, causes, methods of diagnosis, and treatments may differ for each.

Symptoms

Swelling, pain, limited motion, and weakness are all common symptoms of arthritis. Other symptoms may also occur, depending on the type and severity of the disease, location in the body, and other factors. In osteoarthritis of the wrist, symptoms are usually limited to the wrist joint itself, but with RA, knuckle joints in the hand may also be affected. Early symptoms of arthritis in the hand include dull pain or a burning sensation. Increased joint use, such as with heavy gripping or grasping may be followed by pain immediately or many hours later. Pain and stiffness in the morning is typical, and in advanced cases, joint pain may even wake you up at night. Adapting use of the hand can help to prevent pain.

Additional symptoms may include a sensation of grating or grinding (crepitation) that is felt in the affected joint as damaged surfaces of cartilage rub together. If the arthritis is caused by damaged ligaments, the joint may feel unstable or loose. In advanced cases, changes in the bone, loss of cartilage, and swelling may cause the joint to appear larger than normal (hypertrophic). When the end joints of the fingers (DIP joints) are affected by arthritis, small mucous cysts may develop. These cysts may also produce ridging or dents in the finger's nail plate.

Causes

• Osteoarthritis—This progressive condition is caused by excessive use; wear and tear that occurs as part of the aging process; or fractures, sprains, dislocations or other traumatic injuries that damage or destroy the smooth articular cartilage covering the ends of bones. Even when properly treated, an injured joint is about seven times more likely to develop arthritis. Osteoarthritis of the wrist may also be a result of Kienböck's disease, which interrupts the blood supply to one of the small bones in the hand, near the wrist (the lunate). When a bone's blood supply is stopped, the bone can die and over time, this can lead to osteoarthritis.
• Rheumatoid arthritis (RA)—This is a chronic, autoimmune disease that causes the immune system to attack and damage normal tissue, including many joints throughout the body. RA often begins in smaller joints, such as those found in the hand and wrist, and it is symmetrical, so it usually affects the same joint on each side of the body. RA often affects the joint between the two bones of the forearm (the radius and ulna). RA can soften and erode the ulna, which can cause tearing of the tendons that straighten the fingers, resulting in bent wrists, gnarled fingers and other joint deformities.

Diagnosis

To diagnose arthritis of the hand and wrist, and the category of disease, your physician may use a variety of diagnostic tools, including patient history, physical examination, blood tests, and X-rays. When X-rays appear normal but arthritis is still suspected, a bone scan can help diagnose the disease in an early stage. Arthroscopy may also be used to allow direct inspection of the joint. During this procedure, the surgeon inserts a small camera inside the joint, allowing the clearest view possible without requiring a large incision. This diagnostic tool is used only in certain situations however, because although the incision is small, it is an invasive procedure.

Nonsurgical Treatment

There are several options for nonsurgical treatment of arthritis, depending upon: how far the disease has progressed; how many joints are involved; your age, activity level and other medical conditions; whether or not the dominant hand is affected; your personal goals and home support structure; and your ability to understand your treatment and comply with a therapy program. Following a prescribed exercise program can also help improve strength and range of motion in the affected joint.

• Medications—Although they offer relief for symptoms, medications cannot restore joint cartilage or reverse damage. Anti-inflammatories are the most commonly used because they stop the body from producing chemicals that cause joint swelling and pain. These include over-the-counter options such as aspirin and ibuprofen, as well as certain prescription medications. Acetaminophen is not an anti-inflammatory, but it can be used to help relieve the pain of arthritis. When symptoms of RA are not adequately controlled by these therapies, additional disease-modifying, anti-rheumatic drugs may be prescribed. Specially designed to stop the immune system from destroying joints, these medications carry varying risks and benefits to be discussed with your physician.
• Glucosamine and chondroitin—Dietary supplements or neutraceuticals such as these are also widely advertised. These compounds are the "building blocks" of cartilage, they are not drugs. Originally used by veterinarians to treat arthritic hips in dogs, these neutraceuticals have not yet been studied as treatment for hand and wrist arthritis. (Note: The U.S. Food and Drug Administration does not test dietary supplements, and these compounds may cause negative interactions with your other medications. Always consult your doctor before taking dietary supplements.)
• Injections—These may be used when anti-inflammatory medication is not appropriate. Typically containing an anesthetic (similar to novacaine but longer lasting) and a steroid, injections can offer pain relief for weeks or even months. Injections can be repeated, but only a limited number of times because of possible side effects, such as lightening of the skin, weakening of the tendons and ligaments, or infection.
• Splinting—Injections are usually given in conjunction with splinting of the affected joint. The splint provides support that eases stress on the joint during use. A split should be small enough to allow function of the hand, and because using a splint for too long can lead to atrophy of the muscles that stabilize the joint, it is usually worn only when the joint is painful.

Surgery

When nonsurgical treatment does not provide the desired outcome, a variety of surgical options may be considered, such as fusion of the joint, joint replacement or removal of the arthritic bone. The appropriate option will depend on a variety of factors, including: the location and number of joints affected; the severity of disease; other medical conditions; and your age, goals, activity level, and home support structure. Your orthopaedic surgeon will review surgical treatments with you, and discuss which ones offer the highest potential for long-term relief of pain and allowing you to return to normal activity.

Recovery

Following surgery, a trained therapist will help you maximize your recovery. The length of time needed for recovery varies, depending on the extent of the surgery and individual factors. Most people are able to return to most, if not all, of their daily activities about three months after major joint reconstruction.