Corporate Office
2405 Shadelands Drive
Walnut Creek, CA 94598
925-939-8585
Fax 925-933-4932

The physicians of Muir Orthopaedic Specialists believe good medical care is a result of mutual understanding, respect and trust.  In today's fast paced world, we recognize the importance of communication and spend as much time as possible to provide information explaining condition and treatment options so that our patients can make informed decisions about their care.

OSTEOARTHROSIS OF THE HAND


Osteoarthrosis (OA) is one of the most common forms of arthritis in the human body and the hand is the most common location. OA refers to the degenerative changes which occur within joints. As OA develops, the cartilage, which is the joint surface at the end of all bones, becomes thin. Fissures or clefts erode the cartilage exposing the underlying bone. The exposed bone is initially altered by a series of changes which thickens and hardens the bone beneath the erosion. Additional changes include the growth of bone spurs called osteophytes at the margins of the joint and cysts which develop within the bone. Secondary swelling and inflammation occurs in the soft tissues. In advanced cases, the bones will develop large spurs, exhibit narrowing of the joint surfaces and develop bone cysts with dramatic alteration in the shape of the bones. OA frequently affects the small joints of the fingers and base of the thumbs, but can affect any joint in the hand or wrist.

What causes OA?
The reason OA develops is not clearly known, but there are several risk factors. There is a dramatic increase with advance age. More than one-half of man and three-quarters of women over age 65 will develop OA in the hand, making it one of the most common causes of joint pain among the elderly. Female gender is an important risk factor with woman being nearly twice as susceptible as amen, both in the incidence and severity. Estrogen is thought to be a factor, but the exact reasons are not clearly defined. Genetic factors may play a role in certain forms of OA, but the exact genetic inheritance remains unclear. Mechanical factors are thought to play a critical role. For example, life long grasping and pinching activities are prone to develop OA. The base of the thumb joint is particularly prone to develop OA due to the increased mechanical loads and stresses of pinch and grasp. Finally, OA can develop in other illnesses such as inflammatory conditions. However, these are relatively rare and the most common forms of OA develop for no known reason.

Clinical Features
OA typically occurs gradually over several weeks or months. Occasionally OA can present within a few weeks. The predominant complaint is pain and swelling with gradual bony disfigurement of the small joints to the hands. Patients typically report morning stiffness, as well as transient episodes of discomfort with daily activities. These symptoms are generally relieved with short periods of warmth or exercise.

Examination of the joints will reveal several common deformities. Small bone spurs called nodes develop on the tops of joints. When these nodes occur at the joint next to the fingernail, they are called Heberden's nodes. When they occur at the middle joints, they are called Bouchard's nodes. The base of the thumb typically has a squared off appearance, associated with swelling and tenderness. Instability at the base of the thumb can results from soft tissue laxity. Patient can develop cysts along the tops of the joints at the base of the nails. These are called mucous cysts. They occur because fluid leaks out of the arthritic joints into the soft tissues. The mucous cyst can press on the nail, resulting in deformities and ridges in the growing nail tissue.

The natural history and extent of OA is extremely variable. Some patients develop mild aches and small nodes with not further symptoms. Other patients can have progressive symptoms which affect multiple joints.

Treatment
Treatment of OA of the hand depends on the severity and presentation of the symptoms. Mild cases of pain and swelling do not require any specific treatment, nor are activity restrictions required. Many patients benefit from simple remedies such as heat, over-the-counter pain medication and temporary restrictions in activities.

Patients with more severe pain may benefit from temporary splinting and hand therapy. For example, a therapist can fabricate a custom splint which stabilized the joint. Over-the-counter topical creams can be applied. Prescription nonsteroidal medication such as ibuprofen can be given on a trail basis. Patients may also benefit from cortisone injections into the joint. Although the cortisone does not change or alter the presence of the arthritis, it can result in significant pain relief which can last several months.

Surgery is occasionally required and is reserved for those patients that have painful unstable joints which are unresponsive to conservative measures. Your physician can provide further details on the merits of surgery for individual circumstances.
 

Copyright 2003 Muir Orthopaedic Specialists