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| HAND & WRIST PROBLEMS |
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| Arthritis of the Hand |
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| Arthritis can affect any joint in the body, but it is most
visible when it strikes the hands and fingers. Each hand
has 27 bones plus the two bones of the forearm that
help define the wrist. Joints are created whenever two
or more bones come together, so there is plenty of
potential for arthritic problems in the hand. |
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| Osteoarthritis of the hand |
| Osteoarthritis is a degenerative joint disease in which
the cushioning cartilage that covers the bone surfaces
at joints begins to wear out. It may be caused by simple
"wear and tear" on joints, or it may develop after an
injury to a joint. In the hand, osteoarthritis most often
develops in three sites: |
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at the base of the thumb, where the thumb and wrist come together (the trapezio-metacarpal joint) |
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at the middle joint of a finger (the proximal interphalangeal or PIP joint) |
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at the finger tip (the distal interphalangeal or DIP joint) |
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| Rheumatoid arthritis of the hand |
| Rheumatoid arthritis affects the cells that line and
normally lubricate the joints (synovial tissue). It is a
systemic condition, which means that it affects multiple
joints, usually on both sides of the body. The joint lining
(synovium) becomes inflamed and swollen. The swollen
tissue may stretch the surrounding ligaments, which are
connective tissues that hold bones together, resulting in
deformity and instability. The inflammation may also
spread to the tendons, which are the connective tissues
that link muscles and bones. This can result in tears
(ruptures) in the tendons. Rheumatoid arthritis of the
hand is most common in the wrist and finger knuckles
(the metacarpophalangeal or MP joints). |
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| Signs and symptoms of arthritis of the hand |
| Stiffness, swelling, loss of motion, and pain are
symptoms common to both osteoarthritis and
rheumatoid arthritis in the hand. With osteoarthritis, bony
nodules may develop at the middle joints of one or
more fingers (Bouchard’s nodes) and at the finger tip
(Heberden’s nodes). The joints become enlarged and
the fingers crooked. In rheumatoid arthritis, some joints
may be more swollen than others. There is often a
sausage-shaped (fusiform) swelling of the finger. Other
symptoms of rheumatoid arthritis of the hand include: |
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a soft, lumpy mass over the back of the hand |
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a creaking sound (crepitus) during movement |
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a shift in the position of the fingers as they drift away from the direction of the thumb |
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inflammation of the finger tendons, resulting in a permanent bending (Boutonnière) deformity |
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a "swan’s neck" deformity caused by hyperextension (sway-back) at the middle joint of the finger
associated with a bent fingertip |
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| How arthritis of the hand is diagnosed |
| Your doctor will examine you and ask whether you have
similar symptoms in other joints. X-rays will show certain
characteristics of arthritis, such as a narrowing of the
joint space, the formation of cysts or bony outgrowths
(osteophytes or "nodes") and the development of hard
(sclerotic) areas of bone. If your doctor suspects
rheumatoid arthritis, he or she may request blood or
other lab tests to confirm the diagnosis. |
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| Rheumatoid arthritis treatments |
| If you have rheumatoid arthritis in your hands,
medications can help decrease inflammation, relieve
pain and retard the progress of the disease. Rest,
controlled exercise, and wearing finger or wrist splints
may also be part of your treatment program. Several
disease-modifying treatments are now available. These
include cortisone injections, antimalarial drugs,
methotrexate, cyclosporine, gold and some other drugs
that help suppress the body’s immune system to reduce
the inflammation. Adaptive devices may help you cope
with the activities of daily living. |
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| Rheumatoid arthritis often affects the connective tissues
(tendons) as well as the joints. The tendons that become
inflamed may rupture. If this happens, you may be
unable to bend or straighten your fingers or to grip
properly. In certain cases, specific preventive surgery
may be recommended. Preventive surgery options
include removing nodules, releasing pressure on
tendons by removing the inflamed tissue, and
strengthening the tendons. If a tendon rupture occurs,
an orthopaedic hand surgeon may be able to repair it
with a tendon "transfer" or graft. Unfortunately, there is
no cure for rheumatoid arthritis. However, surgical
procedures can often help correct deformities, relieve
pain, and improve function. These options include joint
replacements, joint fusion and, in some cases, removing
damaged bone. |
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| © September 2001 |
| Co-developed with the American Academy of
Orthopaedic Surgeons. |
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