Arthritis: Elbow, Hand, Wrist

 What is Hand and Wrist Arthritis?

Arthritis is damage to the cartilage in joints. Arthritis is common in the upper extremities and causes pain and inflammation in the wrist joints and hands.

Causes of Hand and Wrist Arthritis

Approximately 1 in 7 Americans has arthritis in the wrist.

Risk factors for Hand Arthritis include: 

• Age: Osteoarthritis is commonly seen after age 50. Rheumatoid arthritis typically first appears between the age of 35 and 50.
• Gender: Woman are more likely to develop hand arthritis
• Prior Injuries: If you’ve dislocated or broken any joints in your hands or fingers, you are more likely to develop arthritis.
• Race: whites are more often affected than African Americans.
• Weight: obese people are more likely to have hand OA than thinner people.
• Genetics: You’ve inherited genes that cause the development of arthritis.
• Joint issues: Joint infections, overuse, loose ligaments, and poorly aligned joints can also lead to hand or wrist arthritis.

There are multiple types of arthritis that affect your hand and wrist. They include the following:

• Osteoarthritis: known as “wear and tear” or degenerative arthritis, is the most common type of arthritis. 
• Rheumatoid Arthritis: RA is a chronic autoimmune disease that destroys the cartilage at the end of bones
• Psoriatic Arthritis: Specific type of arthritis that affects skin and joints.

Symptoms of Hand and Wrist Arthritis

Hand Arthritis most commonly develops in: 

• The base of the thumb, where the thumb and wrist join (the trapeziometacarpal or carpometacarpal joint)
• The joint closest to the fingertip (the distal interphalangeal joint)
• The middle joint of a finger (the proximal interphalangeal joint)

Symptoms usually start as dull or burning joint pain, appearing hours or a day after increased use of your hands, morning pain and stiffness in your hand(s) and swollen joints in your hand(s). Symptoms of hand arthritis could progress to: 

• Pain may change from dull ache to sharp pain.
• Pain may wake you up at night.
• Pain may cause you to change the way you use your hand(s).
• Tissue surrounding your affected joint may become red and tender to the touch.
• You’ll feel grating, grinding, cracking or clicking (crepitus) when bending your fingers.
• Your fingers can’t fully open and close.
• Small bony nodules form on the middle joint of your fingers (called Bouchard’s nodes) or at the top joints of your fingers (called Heberden’s nodes).
• Your finger joints become large and deformed and abnormally bent, leaving your hands weak and less able to accomplish everyday tasks.

Wrist Arthritis Symptoms include: 

• Reduced range of motion.
• Red, warm or swollen joints.
• Stiffness that’s worse in the morning and improves throughout the day.
• Wrist and hand weakness.

Prognosis of Hand and Wrist Arthritis 

There is no cure for arthritis. However, you can usually manage mild to moderate symptoms with a combination of medication and non-medication approaches. Surgery may be an option if other treatments fail or the arthritis in your hands is severe. If wrist pain becomes severe and affects your ability to enjoy life, your healthcare provider can discuss surgery options.

Diagnosis of Hand and Wrist Arthritis

Your orthopaedic surgeon will evaluate your medical history and may conduct a variety of tests to determine if you have Hand and/or Wrist arthritis:

• Physical examination: Your doctor will examine how your hands look and work and may check other joints for signs of arthritis.
• X-ray: X-rays may show loss of space in your joints – indicating cartilage loss – and formation of bone spurs.
• Blood Test: A blood test for rheumatoid factor and other markers can help determine if the cause is rheumatoid arthritis.
• CT or MRI: Your orthopedist may want to examine the bones and joints themselves using a CT scan, or MRI.

Lab Tests

Your doctor will use several blood tests to help diagnose you with rheumatoid arthritis (RA) and other inflammatory conditions. These include:

• Rheumatoid Factor
• Anti-cyclic Citrullinated Peptide
• Erythrocyte sedimentation rate
• C-Reactive Protein
• Antinuclear Antibody
• HLA-B27
• Complete Blood Count
• Creatine Kinase
• Complement
• Cryoglobulins

Pain Medicine Intervention

Pain medicine interventions include conservative treatment options:

• Activity modification or immobilization of the hand
• Bracing / Splinting
• Corticosteroid injection into the wrist
• Pain medication or anti-inflammatories
• Physical therapy
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Heat or Ice Application

Treatment of Hand and Wrist 

Treatment options depend on the type of arthritis, stage of arthritis, how many joints are affected, your age, activity level, the hand affected (if it’s your dominant hand) and other existing medical conditions. If non conservative treatment and pain medicine intervention do not work, surgery options include:

Wrist Surgeries Include: 

• Proximal row carpectomy: to remove a few carpal bones in the wrist, giving bones more room to move without friction.
• Denervation surgery: To disconnect nerves in the wrist joint, relieving pain.
• Total wrist arthroplasty (total wrist replacement): This surgery involves replacing a severe arthritic wrist joint with an artificial joint made of metal, plastic, silicone or other material. 
• Total wrist fusion: For some younger individuals with advanced arthritis who require the use of their hands for work, our surgeons will perform a total wrist fusion. During this procedure, we fuse all of the bones of the wrist together, so the wrist is not able to move anymore. This procedure relieves pain and corrects deformities, but because the bones are fused together, the joint loses its natural mobility.

Hand Surgeries Include: 

• Joint fusion (arthrodesis): This surgery uses a plate and screws to keep the bones of your joint together. You’ll have a more stable, pain-free joint, but will have limited flexibility and movement.
• Joint replacement (arthroplasty): Similar to other joint replacements, surgeons use an artificial implant made of plastic, ceramics, silicone or metals to replace your damaged joint. Keep in mind that hinged finger implants don’t mimic normal finger movement.
• Tendon transfer: Tendons connect muscles to bones. The tendons that control your fingers attach to muscles in your palm and forearm. Ongoing inflammation from arthritis can cause tendons to rupture. If this happens, a portion of a healthy tendon can be used to restore your hand function.