Osteoarthritis (Arthritis of Hand)

What is osteoarthritis?

Osteoarthritis (OA) also known as degenerative joint disease, involves wear and tear of joints, resulting in cartilage degeneration. This results in pain, progressive deformity and stiffness in the joint.

This can happen as a result of the aging process (majority of cases) or as a result of previous injury. Treatment is mostly conservative, with activity modification to suit the functional status of the joint, occupational therapy, anti-inflammatory medication, splints and injections into the joint. Surgical options aim to reduce pain and restore function to the joint.

Who does it affect?

Studies have shown that more than 80% of adults above the age of 70 years will show xray evidence of osteoarthritis of the hand, while less than 30% of those below 55 years show this. Age is the most significant risk factor. Other risk factors like the female sex and a family history are also significant.

Where does it affect?

In the hand, the more frequently affected joints are the distal finger joints (end joints of the fingers) and the basal joint of the thumb.

Previous injuries involving fractures of the joint surfaces, malunited fractures and ligament injuries resulting in instability of joints accelerates the development of secondary osteoarthritis.

How does it present?

Patients present with pain and stiffness in the hand and wrist. The pain is worse with increased use of the hand and improves with rest. It should not keep the patient awake at night. Early morning sensation of “swelling and fullness” in the joints is typical of osteoarthritis and improves as the day goes on, only to worsen again by the end of the day due to excessive usage.

As the disease progresses, there will be a low level of constant discomfort in the joints and certain specific activities, e.g turning a door knob, , pinching car keys or openning a tight jar will worsen the pain.

Late stages of the disease will see patients develop permanent deformity and constant pain in the hand joints. It will affect their activities of daily living. This is when surgical treatment is requires to improve quality of life.

What are the Differential diagnoses?

These include tendinitis, nerve compressions and trigger fingers affecting the hand. These conditions can co-exist. A detailed history and clinical examination is required for diagnosis.

OA Hands Clinical PhotoOA Hands Clinical Photo

X rays of OA HandsX rays of OA Hands

How is it treated?

The aim of treatment for osteoarthritis of the hands is joint preservation.

Conservative treatment is based on activity modification (avoiding activities that bring about pain in the joints). Painful episodes can be treated by anti-inflammatory non-steroidal anti-inflammatory drugs (NSAIDS). Hand therapists can help by fabricating resting hand splints and educating patients on joint protection techniques for long term care.
Intra-articular injections (steroids, hyaluronic acids) can also be used for symptomatic relief, though they have not been shown to preserve the joint.

Softsplint for Thumb Basal Joint Arthritis
Softsplint for Thumb Basal Joint Arthritis

Agents like glucosamine sulphate and chondroitin are now being used widely. While they have a good safety profile and have shown some benefits for large joint osteoarthritis, their role in the treatment of hand osteoarthritis has not yet been defined.

Surgery for arthritis of the hand has specific indications. It is important to consult a hand surgeon and understand the specific aims of surgery before proceeding.

  1. Joint arthroplasty and arthrodesis
  2. Mucous cyst excision with joint debridement in distal interphalangeal joint

When conservative management fails to provide a satisfactory level of pain relief and functionality for the hand, surgical options of joint arthroplasty (reconstructive joint preservation) or arthrodesis (joint sacrificing fusion) should be considered.

Joint arthroplasty is indicated in patients who prefer to retain mobility of the joint. There are biological (using adjacent soft tissue) and non-biological (implants) reconstruction techniques that can be utilised.

Implant Arthroplasty - X Rays

Implant Arthroplasty – X Rays

Implant arthroplasty in the hand has a 20 year history and is a rapidly advancing and exciting field. It provides pain relief and retains motion in the joint, but there remains issues of durability of the implants and possible complications of the non biological material in the hand. Implant designs and material technology are constantly evolving and it is likely that in the near future, results for implant arthroplasty for the hand will be as favourable as that in the large joints of the lower limbs, which have a longer history.

Joint arthrodesis is biological and a permanent solution. It is done for younger patients with high functional demands of their hands. It provides good stability and pain relief, but at the expense of joint mobility. It is done most frequently for the terminal finger joints.

Mucous cyst of theDIPJ causing nail deformityMucous cyst of the DIPJ causing nail deformity Post excision. Nail deformity will resolve with time after joint debridement and cyst excisionPost excision. Nail deformity will resolve with time after joint debridement and cyst excision

The disease load for treatment for osteoarthritis of the hand will increase in the near future as a result of our aging population and higher functional demands of our patients. The disease is never life or limb threatening and treatment focuses on pain relief and retaining functional use of the hands

VIEW ALL CONDITIONS