Osteoarthritis in the Hands: Types, Causes, Symptoms, Diagnosis and Treatment

It is produced by a wear of the cartilage of these joints.

Osteoarthritis of the hand includes osteoarthritis of the wrist and fingers , as well as osteoarthritis of the basal joints of the thumb. Osteoarthritis of the wrist is post-traumatic, degenerative, or metabolic.

The joints of the hands most commonly involved by the degenerative process are, in decreasing order of frequency:

  • The distal interphalangeal joints.
  • The trapezius-metacarpal joint.
  • The metacarpal-phalangeal joint of the thumb.
  • The metacarpal joint of the second and third fingers.
  • The metacarpophalangeal joints.
  • The proximal interphalangeal joints.

Types of osteoarthritis

According to the location of the lesions, several forms of osteoarthritis can be distinguished, such as:

Distal radioelectric osteoarthritis

It is frequently associated with dorsal subluxation of the ulnar head relative to the distal radius. It can endanger the tendons of the finger extensor.

Surgical treatment may be necessary to prevent this complication by resection of the ulnar head.

Osteoarthritis of the lateral compartment of the wrist

This can be degenerative or post-traumatic after scaphoid nonunion or dislocation of the scapho lunate.

This shape refers to the radial parts of the radio-carpal and mid-carpal joints.

When necessary, surgical treatment is scaphoidectomy associated with midcarpal arthrodesis.

Osteoarthritis of the ulnocarpal compartment

It is related to a positive variant ulna that produces ulno-carpal obstruction.

Surgical treatment consists of shortening the ulna.

Osteoarthritis of the central part of the carpus

It can be the last stage of osteonecrosis of the lunatum (Kienböck’s disease).

Osteoarthritis of the basal joints of the thumb can affect the trapeziometacarpal, escapotrapezial, or metacarpophalangeal joints.

Metacarpophalangeal hyperextension is associated with decreased abduction of the first metacarpal and with first network contracture.

Surgical methods of treatment include metacarpophalangeal arthrodesis, metacarpophalangeal prosthesis, or trapezioectomy.

Digital osteoarthritis mainly affects the proximal and distal interphalangeal joints:

  • Distal interphalangeal osteoarthritis.
  • May be associated with pain, instability, dorsal mucoid cyst. Treatment includes orthotics, osteophyte resection, or arthrodesis.
  • Proximal interphalangeal osteoarthritis.

It is associated with pain, decreased mobility, lateral deviation.

Causes of osteoarthritis in the hands

Generally speaking, osteoarthritis is wear and tear on the joints.

The causes of damage can be varied and affect various joints.

Osteoarthritis is born subtly and evolves very slowly. The patient may realize that he is actually suffering from osteoarthritis when he is already in an advanced state, when the signs and symptoms are already relatively severe.

Osteoarthritis occurs mainly in the elderly, and can be defined as the aging of the joint and mainly affects women after menopause.

The cause of osteoarthritis is usually wear and tear (primary osteoarthritis), which is why it affects older people.

However, improperly healed fractures near a joint can lead prematurely to what is often an isolated case of osteoarthritis (secondary osteoarthritis).

Hormonal factors have also been discussed as triggers for osteoarthritis in the middle and end joints of the fingers, in which case the majority of those affected are women during menopause (10 times more likely than men).

They can also be the result of an autoimmune disease such as rheumatoid arthritis.

The type of work that is done can be a trigger for osteoarthritis, such as the masons who use the jackhammer, the ladies who are mainly engaged in work.

There is a strong hereditary component, the children of parents with osteoarthritis easily develop the same disease.

Symptoms

The symptoms of osteoarthritis are;

  • Pain in the fingers, on the side of the palm where the thumb is located, and in the wrist.
  • Stiffness especially in the morning, becomes more painful, when the movement of the hands begins after a period of inactivity.
  • Loss of strength
  • As this disease affects several joints, both hands can be affected.
  • Reduced mobility, and in certain stages the joint can become inflamed.
  • Elderly patients with interphalangeal osteoarthritis and lateral deviation of the distal phalanx are deformed, but without pain.

Diagnosis of osteoarthritis in the hands

Radiography is the most appropriate instrumental examination to see if the joint is degenerated because it shows well the condition of the bone, the narrowing of the joint space, the osteophytes, and a possible deformity.

A differential diagnosis should be made with rheumatoid arthritis, tendonitis and tenosynovitis and Quervain’s syndrome.

Treatment

Therapy

The therapy is used for pain relief and to identify activities that aggravate symptoms and thus suggest alternative methods or postures.

Short rest periods can help if osteoarthritis flares up.

The patient may also be advised to apply a wrist brace or finger splint at night and to prevent overuse of the joint when performing some daily activities.

Physical therapy can eliminate inflammation, especially magnetic therapy (shock waves).

Medicines

The doctor may prescribe anti-inflammatory drugs (NSAIDs) or cortisone.

Cortisone injections, particularly for osteoarthritis between the metacarpal and the trapezius (at the base of the thumb), can be used to resolve inflammation.

A cortisone injection may relieve symptoms, but it will not cure osteoarthritis.

Surgery

Surgery is recommended when conservative treatments do not allow the patient to perform activities of daily living.

The goal of surgery is to restore functionality and eliminate pain or reduce it to a bearable level.

In general, degenerated joints can be treated by a variety of surgical methods, with procedures such as:

Synovectomy

Syneovectomy may be performed depending on the extent of the degeneration or its cause.

The inflamed membrane is removed from the joints and any adhesion is released. Also, any bone growth (exostoses) can be removed.

Joint capsule denervation is usually also done at the same time.

As a result, symptoms can be reduced, however, the success of the surgery is often not permanent, so additional surgery may be necessary at a later time.

Artificial joint

Another option is to replace the affected joint with an artificial one.

However, this procedure is limited to the middle and basal joints of the finger.

The tendons and ligaments of the hand should still be intact.

Any damaged or destroyed joint surfaces are also removed in this surgery and the artificial joint is implanted.

Silicone spacer

Improved finger movement can also be achieved by implanting so-called silicone spacers.

These implants do not have any joint structure, but they ensure that the necessary distance is maintained between the bones of the affected joints.

A good level of flexibility is possible here, but this surgical method requires intensive post-operative care and physical therapy to achieve that flexibility.

Immobilization, Fusion

Finger and hand joints showing signs of advanced osteoarthritis and clearly limited in movement are recommended to be immobilized (arthrodesis) in a functionally advantageous position because this can stop or at least significantly reduce pain.

Depending on which joint is affected or the existing state of mobility of the joint due to osteoarthritis, there will be certain functional limitations after surgery.

The affected joint is removed and the finger is fixed using wires, screws, or plates so that the bones heal together in 6 to 8 weeks.

In general, the finger will be pain free. The cables need to be removed after a few months, while the screws and plates can usually be left inside.

Degenerative process

Osteoarthritis is characterized by pain and stiffness in the joints that are the result of the wear and tear of cartilage.

This wear and tear is a natural process that occurs over the years. Most people over 55 years of age have osteoarthritis of the hand and wrist and only 20% of them have symptoms.

Inside the joint is a capsule called the synovium, which produces a fluid that nourishes the cartilage and serves as a type of lubricant that reduces friction during bone movement.

The degenerative process begins when the cartilage layer wears, refines, and dries out, exposing the underlying subchondral bone.

The bone then becomes deformed and the synovium becomes inflamed which is called synovitis.

The fingers usually turn outward and deform into fibrous nodules.

This degeneration can become painful even at night, leading to severe functional limitation.