Arthritis in the hand

Arthritis means painful joints. It’s common in the hands. The most common kind is osteoarthritis which is caused by wear and tear or injury. Inflammatory arthritis, such as rheumatoid arthritis, is much less common and is caused by a dysfunctional immune system. The description here is referring to osteoarthritis. It affects all the joints in the hand but particularly the base of the thumb and the fingertips. It also affects the wrist.

Treatment begins with supplementation with turmeric and glucosamine; modifying your activities to avoid provoking movements; modification of grip and splinting according to advice from a hand therapist; painkilling tablets such as ibuprofen and paracetamol or creams/gels such as Voltarol gel, Flexiseq or capsaicin; steroid injections which reduce pain but do not cure the arthritis, and surgery.

I can administer steroid injections into your painful joints in the clinic. I recommend you take painkillers an hour before hand. I inject local anaesthetic first to numb the area using a very small needle and injecting slowly. I add bicarbonate to the anaesthetic to take away the acidic sting and I also use a vibrating device that dulls the pain. Steroids often work after a few days but sometimes take two weeks to take effect. You may get up to six months pain relief. The injections can be repeated as often as necessary but if you’re needing them every two months or less, I would recommend considering surgery.  The risks of steroid injection are infection, skin changes with repeat injections, steroid flare (increased pain for several days after injection) and theoretical increased susceptibility to coronavirus infection.

The surgical options for an arthritic joint in the hand or wrist are:

1. Denervation (this lifts the nerves off the joint to reduce the pain coming from the joint whilst preserving motion but not curing the arthritis).

2. Fusion of the joint (this is good at relieving pain but means the joint does not move) and finally,

3. Joint replacement which relieves most of the pain and preserves some, but not all, movement.

Most of these operations can be performed under local anaesthetic (whilst awake) although you can go to sleep if you prefer. All of these operations are day case (you go home the same day). Time off work is essential, particularly if you have a manual job. The minimum time is 1 week but it may be several weeks for the more complicated operations.

The risks of denervation surgery are: bleeding, infection, delayed healing, poor scarring, poor or no relief of pain,  nerve injury or poor sensation, and a 5% risk of complex regional pain syndrome which is a condition of pain and swelling of the whole hand that can be difficult to treat.

The risks of fusion surgery are: bleeding, infection, delayed healing, poor scarring, failure of the bones to fuse, permanent metal work which may sometimes cause symptoms and have to be removed.  Nerve injury or ongoing poor sensation, arterial injury leading to amputation, and a 5% risk of complex regional pain syndrome which is a condition of pain and swelling of the whole hand that can be difficult to treat. The swelling and stiffness may reduce movement of the joint temporarily, rarely permanently, and you need some physiotherapy to get your motion back.

Risks of joint replacement surgery are bleeding, infection, exposure/failure/revision of the implants; swelling and stiffness of the hand; poor movement in the joints, recurrence of the deformity and unavoidable reduction in usefulness of the hand for several weeks after surgery. Physiotherapy is essential after surgery.

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