The word arthritis literally means “inflamed joint.” In normal joints, cartilage covers the ends of bones and acts as a shock absorber allowing smooth, pain-free movement. Arthritis occurs when these joint surfaces become irregular. They don’t fit together well anymore and the joint “wears out” over time.
The most common types of arthritis of the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other types of arthritis in the hand may be due to infection, gout, or psoriasis.
In osteoarthritis (OA) or “degenerative arthritis,” the cartilage layer covering the ends of the bones wears out, resulting in bone-on-bone contact, pain, and joint deformity.
Causes of Arthritis of the Hand
OA in the hand has many causes, but it is difficult to determine an exact cause. Many factors including genetics, old injuries such as fractures or dislocation, and/or generalized joint laxity may lead some people to develop this type of “wear and tear” arthritis. Women, particularly active women or female athletes, are more prone to joint laxity than men – which is often called joint hypermobility. The most common sites to develop OA in the hand are:
- The base of the Thumb – CMC or basilar joint
- End joint close to the fingertip – the distal interphalangeal or DIP joint
- Middle joint of the finger – the proximal interphalangeal or PIP joint
- Wrist joint
- Pain within the joint, often described as a "burning" or "dull" feeling
- Grinding sensation in the arthritic joint. Joint may seem warm to the touch
- As arthritis progresses, grip and pinch strength may be affected making it difficult to perform functional activities such as gripping and pinching items, opening a jar, turning a key and writing
- Pain following increased use of the joint, pain may even surface later that day or the next morning
- Stiffness or pain in the morning, some experience pain that wakes them during the night
- Swelling in the joint, or bone spurs, in advanced cases the joint looks larger than normal
Treatment options depend on progression affected, activity level and other factors.
Changing or avoiding symptom provoking activity may help reduce pain. Using different equipment - such as an ergonomic keyboard, tools with a pistol grip, or a key holder - helps reduce joint stress.
Hand therapists can custom fit splints for the arthritic joint. A splint acts a brace to support the joint and limit stress placed on the joint during activity. Intermittent use of a splint is a good long-term strategy to help improve joint stability, minimize pain, and decrease stress to the affected joints during daily activity. Soft sleeves or gloves may also provide some relief when a rigid splint is too restrictive.
Medication can address symptoms of arthritis, but cannot cure the underlying cartilage and joint damage. Most commonly anti-inflammatory medications may help manage pain and should be used as directed by your provider.
Heat and cold can be used 3-4 times/day for 10-15 minute sessions. Heat is typically helpful in reducing stiffness and achy pain, while cold packs may help reduce inflammation and pain. Consider using whichever makes your hand feel better.
Over-the-counter creams, ointments, or gels may help temporarily decrease pain.
One or two sessions with a hand therapist can provide education and strategies for activity modification, joint protection techniques, splint(s), and a specific home program for range of motion and strengthening exercises.
While injections cannot cure the underlying arthritis, an injection of this anti-inflammatory medication into the affected joint may help decrease pain. Response to the injection will vary from person to person, relief is usually temporary.
A variety of surgical procedures can provide long-term pain relief, when non-operative treatment is no longer an option. Depending on the progression of damage, the surgeon may be able to preserve or reconstruct the joint. In advanced cases, joint replacements may provide pain relief and restore joint mobility, and at other times, joint fusions are recommended to stabilize the joint and relieve pain. A consultation with your hand surgeon can help decide the best course of treatment for you.
The joints affected by rheumatoid arthritis
Courtesy of American Society for Surgery of the Hand