Osteoarthritis in the fingers


What is osteoarthritis in the fingers and hand?

Osteoarthritis in the fingers and hand is a chronic and degenerative disease.

It can affect the base, middle and end joints of the fingers, as well as the saddle joint between the first metacarpal and the large polygonal bone;

the latter case is referred to as rhizarthrosis or saddle joint arthrosis. A joint is the entirety of all structures contained in two bone ends that move against each other.

Between the two bones is a smooth and soft substance: the cartilage;
it reduces friction and ensures smooth and pain-free movement.
Inside the joint is the synovial membrane, a layer filled with lubricating fluid that reduces friction during movement.

As the cartilage wears and thins, the joint structure changes, the bone changes shape, and the synovial membrane becomes inflamed .
The metatarsophalangeal joints degenerate, especially in men who have worked hard for years (bricklayers, carpenters, etc.).

Here the arthrosis is less symptomatic and does not deform the hand.
Arthrosis of the middle and end joints of the fingers, on the other hand, is unsightly and painful, the crooked phalanxes have fibrous knots;
in this case, women are predominantly affected.
Rhizarthrosis is arthrosis of the saddle joint (therefore also called saddle joint arthrosis), which lies between the large polygonal bone and the first metacarpal bone; it mainly affects women over the age of 50 and is usually bilateral; however, one hand causes more pain than the other.
The degeneration at this point can be very painful, causing night pain and also implying major functional limitations.

What are the causes of finger and hand osteoarthritis?

Osteoarthritis is a pathology without specific causes, rather there are a number of factors that can contribute to joint degeneration.
Osteoarthritis creeps in and develops very slowly, and those affected often only realize that they have osteoarthritis at an advanced stage, when the signs and symptoms are already relatively serious.

Osteoarthritis occurs mainly in older people, it can also be defined as aging of the joints; women after the menopause are often affected .
Factors that contribute to joint degeneration are:

  • certain occupations: bricklayers who use jackhammers put significantly more strain on their joints than other people;
  • women who mainly do domestic work;
  • a high degree of heritability: children of osteoarthritis patients are more likely to also develop osteoarthritis;
  • major trauma and fractures that have become immobilized result in poor blood flow and therefore poorer nutrient supply to the cartilage, causing it to degenerate and thin out.

How is she noticeable? What are the symptoms of hand osteoarthritis?

Symptoms of osteoarthritis include: pain in the hand and fingers , stiffness, joint crunch, loss of mobility; in certain phases, the joint can also swell.

The main problem is the pain, especially in the morning, about half an hour after getting up and after a rest of at least an hour, when the joints are still “cold”; when the movement begins, there is practically no pain, but it reappears with increased or prolonged stress.

In an advanced stage, the painful stitches can also be felt during periods of rest.
Symptoms worsen with higher humidity and weather changes.
Clearly visible signs of arthrosis are swelling of the hands and fingers caused by inflammation , as well as the appearance of lumps on the joints; If these are located at the end joints of the fingers, they are called Heberden knots, while at the middle joints of the fingers they are called Bouchard knots.

As osteoarthritis progresses, the joints become stiffer and movement is restricted.
The hand deforms because the finger bones are crooked to the side. In the case of saddle joint arthrosis (rhizarthrosis), the pain can become very intense and make even the simplest thumb movements impossible.

Osteoarthritis between the large polygon and the metacarpal can lead to the formation of an exostosis (bony outgrowth, ganglion) because the first metacarpal becomes partially dislocated (subluxated) and the hand assumes a square-like shape.

How is osteoarthritis of the hand diagnosed?

The doctor assesses the patient’s condition, examines the hand for deformities, Heberden’s knot, and listens for joint sounds when moving the fingers.
If the patient is older than 50 years, there is a legitimate suspicion of arthrosis of the hand and finger joints;
the doctor can order an x-ray for confirmation or, if he is sure of his diagnosis, directly recommend a therapy.

An X-ray In these cases, it is one of the most expedient examination methods for determining degeneration, because bones, joint space, any deformations and osteophytes that may be present are clearly visible here. Many older people with arthrosis in the finger joints and slanting finger joints are largely symptom-free, only complaining about the somewhat unsightly appearance of their hands.
Rheumatoid arthritis is considered in the differential diagnosis because it also produces pain and nodules;
also tendonitis and tendonitis can cause the same symptoms, especially Quervain’s disease can resemble rhizarthrosis.

What can you do? Which therapy helps with hand and finger arthrosis?

The treatment of arthrosis of the hand and finger joints is primarily intended to relieve pain and restore joint function. Short periods of rest can help if osteoarthritis becomes acute again. In some cases, wearing a wrist wrap at night or while engaging in daily activities could be useful.

With the help of physiotherapists and ergotherapists, patients learn which hand movements in everyday life put particular strain on the joints and which tricks can be used to protect the fingers and alleviate the inflammation. There are also numerous simple aids available.

Natural remedies and forms of treatment for finger and hand arthrosis

A soft bandage can be useful when rigid rods or splints are found to be tight or uncomfortable, particularly if the thumb saddle joint has osteoarthritis (rhizarthrosis).
Heat applications in the form of wax, clay or paraffin baths are said to reduce inflammation and swelling, especially on the fingers.
Physical therapy has an anti-inflammatory effect, most notably magnetic therapy , but there are also new studies on shock wave therapy , but these are yet to be confirmed.
Some patients experience temporary relief from cold applications (ice packs), but application of heat is preferable to improve blood circulation.
Of the thermal forms of treatment, fango is particularly suitable for arthrosis because it has a naturally anti-inflammatory effect.
It is important to keep your fingers moving and perform gentle gymnastic exercises.
Acupuncture is inappropriate for this type of condition.

Diet plays an important role in controlling inflammation; healthy eating without sweets, dairy products and animal proteins are fundamental for the correct functioning of the body; this is the only way to prevent hand osteoarthritis.

Pharmacological therapy

The doctor can prescribe anti-inflammatory drugs (NSAIDs) or cortisone . In order to contain the inflammation, cortisone infiltrations
can   be injected, especially in the case of arthrosis of the thumb saddle joint. The injection provides relief because the symptoms are alleviated, but it cannot cure the arthrosis. Surgical intervention is only recommended when conservative treatment methods have been exhausted and activities of daily living cannot be carried out.

What treatment results can be expected?

If the symptoms are weak, taking anti-inflammatories for a short time and avoiding activities that cause pain can improve the situation.

cortisone injection into the painful area helps most patients, at least temporarily, and the relief usually lasts about two months.
Natural treatments do not have the side effects of cortisone and can relieve pain in less severe cases.

What happens if there is no treatment at all?

That depends on the intensity of the symptoms, it’s about quality of life, not survival.
Arthrosis of the hand and finger joints cannot spread throughout the body. It is common for the pain to subside after a few years, when the arthritis   and inflammation in that joint have subsided.

The primary motivation for undergoing surgery is the prospect of relieving the pain and preventing the hand from becoming weaker and deforming over time.
Some patients experience mild discomfort, the joint becomes inflamed from time to time and they choose to treat it with home remedies or simply wait for the symptoms to subside.
Others suffer from severe ailments that make it impossible to perform many daily activities manually, and they feel that surgery is the only solution.

Surgical intervention for hand arthrosis

Surgery is appropriate when the hand has lost its ability to function or the pain is too great. The aim of a surgical intervention is to largely restore the joint functions and eliminate the pain or at least reduce it to a tolerable level. One surgical procedure is joint fusion, in which the arthrotic surface is removed and the bones are joined. The bones can then no longer move because the joint is blocked. Joint fusion is done to relieve pain and correct deformities that limit movement.

Another surgical procedure is to reconstruct the joint; this involves removing the degenerated joint surface so the bones are no longer in direct contact with each other, which causes pain and limits movement.

Once the degenerated portion of the joint has been removed, it can be replaced with soft tissue, such as a tendon, or a prosthetic joint.
Which procedure is used depends on which joint is affected by the osteoarthritis and on the needs and demands of the patient.
The patient should seek advice from the hand surgeon when choosing the right operation.

If an operation is performed, rehabilitation after the operation is of the utmost importance. The operated hand must be protected by an individual splint.

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