Osteoarthritis
What is osteoarthritis?
Osteoarthritis in the hand is a result of wear and tear of the joint surfaces and can sometimes be the result of an injury to the cartilage within the joint.
Osteoarthritis tends to involve the basal joint of the thumb and the more distal joints of the fingers although the wrist joint and the main knuckles (metacarpophalangeal joints) can also be affected by osteoarthritis.
How is osteoarthritis treated?
In early stages of osteoarthritis it may be possible to treat the joint with rest in a splint, anti-inflammatory tablets and possibly an injection of steroid into the joint.
However, as the arthritis becomes more extensive and cartilage destruction occurs the joint space becomes narrowed and there are secondary changes in the joint which result in deformity and loss of movement.
At this stage the options that can be considered are:
1. Replacement of the joint with an artificial joint
2. Fusion of the joint
The decision with regard to either replacement or fusion depends upon the functional needs of the individual patient. If it is important to preserve movement and if the joint destruction is not excessive with a severe deformity and an imbalance of the tendon forces around the joint then a replacement of the joint with an artificial joint relieves pain and retains movement.
If however there is severe joint destruction or a very significant deformity with imbalance of tendon forces around the joint or laxity of the joint capsule then a fusion of the joint gives rise to a stable painless joint which is strong. Fusion of the joint does result in complete loss of movement at that particular joint. However the functional gain in terms of absence of pain and restoration of the ability to use the affected digit far outweighs the loss of movement.
