Arthritis in the hands may be debilitating, causing pain, deformity, and functional impairment. It is important to distinguish if the arthritis is due to degenerative changes commonly seen with age and wear and tear, or if it’s due to an underlying inflammatory pathology like rheumatoid arthritis, gout, psoriasis, etc.
The first line of managing the symptoms is always nonoperative. However, the help of a rheumatologist is usually required for the initial medical management of inflammatory pathology. Activity modification, medication and gentle therapy and splinting with the help of an experienced hand therapist are the cornerstones of non-operative management.
The next step up the ladder is to consider steroid injections preferably under image control (ultrasound or x-ray) and this can help tide over an acute phase of the symptoms.
When the disease progresses, pain increases, movement may become restricted, and function may become impaired. Surgical options can then be considered to restore the damage caused by hand arthritis is uncommon. It is important to discuss the risks versus benefits of each option with your surgeon who help you navigate the many surgical options and choose the operation best suited to your needs and requirements.
Surgical options:
Denervation involves as the name suggests cutting the nerves that supply that joint and thus decreasing the perception of pain. It does not involve any bone or joint sacrifice but requires an operation, nonetheless. Has a reported success of about 60-70% and last for about 3-5 years. It does not treat the underlying pathology but temporarily helps with the pain.
Keyhole surgery can be useful in staging the degree of the disease and thus help plan further interventions, in some cases partial removal of the joint, joint debridement or even arthrodesis can be facilitated arthroscopically. If feasible this usually involves smaller scars and quicker rehabilitation but bear in mind this is not suitable for all patients.
Fusion or Arthrodesis entails removing the worn-out joint surfaces and fusing the joint’s bones together (usually with some form of metal work- plates, screws or wires) resulting in a joint that is stronger, more stable, and practically pain-free, but with the compromise of loss of movement in the joint. This is usually reserved for younger individuals who are engaged in high-demand physical or athletic work.
Arthroplasty is the process of removing a damaged joint and replacing it with a prosthetic joint. The objective is to alleviate discomfort while also restoring form and function to the hand. However prosthetic joints do not completely mimic normal joint movements nor does joint replacement surgery significantly improve on any lost motion in stiff joints contrary to expectations. They do permit early range of movement and return to activities but are associated with wear and tear and thus failure with loosening of the components and joint dislocations. In the right patient for the right indication, they do perform well.
Whether arthrodesis or arthroplasty is performed depends on the joint that must be treated, as well as the patient’s age, functional demands, and tolerance for stiffness etc.
If you have pain in the joints of your wrist or your finger joints, contact Mr. Mathew who can help tailor a treatment plan specific to your needs.