ARTHRITIS OF THE FINGER JOINTS

When you stop to think about how much you use your hands, it’s easy to see why the joints of the fingers are so important. Arthritis of the finger joints has many causes, and arthritic finger joints can make it hard to do daily activities due to pain and deformity. Unbearable pain or progressive deformity from arthritis may signal the need for surgical treatment.

Anatomy

How do the finger joints normally work?

The bones in the palm of the hand are called metacarpals. One metacarpal connects to each finger and thumb. Small bone shafts called phalanges line up to form each finger and thumb.

The main knuckle joint is formed by the connection of the phalanges to the metacarpals. This joint is called the MCP joint.

The MCP joint acts like a hinge when you bend and straighten your fingers and thumb.

Causes of Arthritis

What causes arthritis?

  • Degenerative arthritis is a condition in which a joint wears out, or degenerates, usually slowly over a period of many years. The term arthritis means joint inflammation (pain, redness, heat, and swelling). The term degenerative arthritis means intermittent inflammation of a joint due to wear and tear. You may also hear the term degenerative arthrosis  Degenerative arthritis is usually called osteoarthritis.
  • Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. An injury to any of the joints of the fingers, even if it does not injure the articular cartilage directly, can alter how the joint works.
    Arthritis
  • After a fracture, the bone fragments may heal in slightly different positions. This may make the joints line up differently. When an injury changes the way the joint lines up and moves, force can start to press against the surface of the articular cartilage. This is similar to how a machine that is out of balance wears out faster.

Over time, this imbalance in the joint can lead to damage to the articular surface. Since articular cartilage cannot heal itself very well, the damage adds up. Eventually, the joint can no longer compensate for the increasing damage, and symptoms begin. The damage in the joint starts well before the symptoms of arthritis appear.

Symptoms of Arthritis

What does arthritis feel like?

  • Painis the main problem with arthritis.
  • At first, the pain usually only causes problems when you begin an activity. Once the activity gets under way, the pain eases. But after resting for several minutes the pain and stiffness When the arthritis condition worsens, pain may be felt even at rest. The sensitive joint may feel enlarged and warm to the touch from inflammation.
  • In rheumatoid arthritisthe fingers often become deformed as the disease progresses. The MCP joints of the fingers may actually begin to point sideways (towards the little finger). This is called ulnar drift.Ulnar drift can cause weakness and pain, making it difficult to use your hand for daily activities.
    Swan Neck Deformity
  • Both rheumatoid arthritis and osteoarthritis can affect the IP joints of the fingers. The IP joints may begin to flex (bend) or hyperextend (over straighten), causing characteristic finger deformities. Swan neck deformity occurs when the middle finger joint (the PIP joint) becomes loose and hyperextended, while the DIP joint becomes flexed. When the PIP joint flexes and the DIP joint extends, a boutonniere deformity
    Boutonniere deformity
  • Both forms of arthritis can cause enlarged areas over the back of the PIP joints. These areas tend to be sore and swollen. They are known as Bouchard’s nodes. Osteoarthritis causes similar enlargements over the DIP joints, called Heberden’s nodes.
    bouchards-nodes-heberden-nodes

 

Arthritis Diagnosis

The diagnosis of arthritis of the finger joints begins with a history of the problem. Details about any injuries that may have occurred to the hand are important and may suggest other reasons why the condition exists. Following the history, a physical examination of the hand and possibly other joints in the body will be done. Your doctor will need to see how the motion of each joint has been affected.

X-rays will be taken to see how much the joint has changed. These tests can help determine how bad the degenerative damage from the arthritis has become. The X-rays also help the doctor estimate how much articular cartilage is still on the surface of the joints.

Arthritis Treatment

What can be done for the condition?

Treatment usually begins when the joint first becomes painful or stiff.

  • Reducing the activity, or changing from occupations that require heavy repetitive hand and finger motions, may be necessary to help control the symptoms.
  • Soft tissueand special joint mobilisation techniques of the joints helps to restore their range of motion, reduce inflammation and pain
  • Clinical pilatesand exercise rehabilitation play a critical role in treatment of finger joint arthritis. A primary goal is to help you learn how to control symptoms and maximize the health of your hand and fingers. Strengthening exercises for the arm and hand help steady the hand and protect the finger joints from shock and stress.
  • Range-of-motionand stretching exercises are prescribed to improve your finger movement.
  • An injection of cortisone into the finger joint can give temporary relief. Cortisone is a very powerful anti-inflammatory medication. When injected into the joint itself, it can help relieve the pain. Pain relief is temporary and usually only lasts several weeks to months.

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