Hand Joint Arthritis

By Houston Hand Surgery Specialist & Orthopaedic Surgeon, Dr. Dean Smith

The knuckle joints in the fingers act as hinges between the long bones in the hand and the smaller bones in the fingers. These joints are called metacarpophalangeal joints or MP joints of the hand. The MP joints are important to the hand for gripping and holding things. Pain and deformity in the knuckle joints of the fingers are common in rheumatoid arthritis but can also occur with trauma, gout, psoriasis, or other diseases. Diseases such as those mentioned can injure the MP joints by ruining the structures and muscles that move the joint, or by destroying the surface of the joint causing pain and deformity in the knuckle.
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Signs and Symptoms of Hand Joint Arthritis

Difficulty in using the hand for daily activities (holding or gripping a cup, tool, or eating utensils, turning a key, for example) is the most common complaint of patients with hand joint arthritis. These problems in using the hand may be due to deformity, pain, or both. Many patients notice their fingers slowly drifting (leaning) to the little finger side of their hand. Daily activities may become more difficult with time.

Figure 1:Loss of position of tendons on top of MP joint result in loss of ability to straighten fingers and the drift of fingers toward little finger-side of the hand.

Causes of Hand Joint Arthritis

There can be many reasons for these symptoms to occur. The ligaments that hold the joint in place can be loosened by the disease, causing the joint to slip out of place and eventually dislocate. The tendons at the top of the joint may slip out of place and lose their ability to straighten the fingers.
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Treatment for Hand Joint Arthritis

Treating the symptoms can sometimes be done without surgery. Medication, splinting, changes in daily activity, and injections of anti-inflammatory medicine may be recommended by Dr. Smith in the early stages of hand joint arthritis. If these forms of non-surgical treatment do not work, surgery may be needed.

Some advanced cases of hand joint arthritis may need surgery. Two types of surgery are commonly performed.

Synovectomy (Soft-Tissue Replacement) – Generally performed in less severe cases.  If the tendons have slipped out of place, they are put back into place over the knuckle joint. If the small muscles of the fingers are causing the fingers to lean toward the small fingers, the muscles are operated on to stop the fingers from being pulled toward the little finger.

Joint Replacement – Generally performed on more severe cases. The diseased metacarpophalangeal joint is replaced with an artificial joint. Complications with this type of surgery may happen. Infection is possible or the artificial joint may eventually break or wear down. There is a possibility that a second replacement of the joint or fusion of the joint may be recommended in later years.

The goals of treatment are pain relief and restored motion to the fingers. Dr. Smith can advise you on the best treatment for your situation.

Figure 2: With joint replacement an artificial joint is placed between the bone ends and tendons are repositioned. This procedure allows the fingers to straighten and the drift is corrected.

Rehabilitation

Following joint replacement surgery, close supervision by Dr. Smith is as important as the surgery. The hand is usually initially immobilized following surgery. A therapy program, consisting of exercises and special splints, usually starts the first week after surgery. In some cases the splinting portion of the program is continued for a longer period of time.

Dr. Smith provides a comprehensive multidisciplinary approach for the evaluation, treatment and care of hand joint arthritis.

Call Dr. Smith at 713-524-0580 to schedule an appointment concerning Hand Joint Arthritis.
The information on this webpage is based on material from the American Society for Surgery of the Hand and is for educational purposes only.