Arthritis of the Hand/Wrist
Arthritis of the hand is a condition that is characterised by stiffness, swelling, deformity, and loss of motion in the thumb and finger joints. The two common forms of arthritis affecting the hand are osteoarthritis (a degenerative joint disease), and rheumatoid arthritis (an inflammatory joint disease). Both conditions are progressive and can be extremely painful and debilitating.
Arthritis – Hand Surgery
There are many beneficial surgical procedures that can be used in the management of patients with arthritis of the hand. Often these can complement the medical management of arthritis suggested by rheumatologists and arthritis physicians. It is suggested that patients discuss the role of hand surgery in the treatment of their arthritis with their rheumatologist or contact a hand surgeon directly to determine if hand surgery may be of benefit. Hand surgery can restore movement in the thumb and fingers, ease painful swelling and inflammation, and also remove deformities of bone and/or tissue. There are several hand surgery procedures used to treat rheumatoid arthritis and osteoarthritis. Surgery is usually recommended after the disease process is established but can also have a role in prevention of disease progression by surgical removal of the diseased tissue (synovectomy) when medical treatments have not been effective. Surgery for joint pain can involve joint fusion (arthrodesis) or joint replacement with natural tissues or artificial joints (arthroplasty). Plastic surgery of the hand can also be beneficial in improving the deformities of the hand caused by the arthritic process resulting not only in a more natural hand appearance but also improved hand function.
Following arthritis hand surgery, there usually will need to be a period of hand rehabilitation to achieve an optimal functional result from the procedure. This therapy is usually supervised by a qualified hand therapist who works with Dr. Ross during the postoperative period, and may involve splinting to protect the surgery during healing and then mobilization to optimize hand function. It is important to understand that neither medical nor surgical treatment can cure arthritis; however hand surgery can certainly improve hand function to minimize disability and prevent much of the pain involved with this condition.
Surgical Procedures in treatment of hand/wrist arthritis
Synovectomy
This procedure is the surgical excision of inflamed, painful arthritic soft tissues around the wrist and finger joints. It is of benefit to patients who have failed to respond to medical treatment or is concerned about side effects of medication. It is effective in quickly alleviating the symptoms caused by painful swollen wrist arthritis.
Basal Joint Arthroplasty
The basal joint of the thumb is commonly affected by osteoarthritis causing collapse, deformity, pain and immobility in the joint. In more advanced arthritis the trapezium bone and surrounding carpal bones can significantly collapse causing a painful deformity. In this situation only surgery can relieve the pain symptoms and reconstruct the thumb joint to regain improved function. Although implants have been used for this joint reconstruction, most surgeons favour the tendon suspension arthroplasty procedure, which reconstructs the joint and stabilises with a wrist joint tendon. Surgery is undertaken usually as a day case and recovery takes 4-6 weeks before return to normal hand function in most cases.
If you feel that you that your hand/wrist arthritis is causing problems please contact hand surgeon, Dr David Ross at his Bayside Plastic Surgery, Melbourne practice to discuss whether reconstructive hand surgery may be of benefit to you.
Proximal Interphalangeal Joint Arthroplasty
The proximal interpahalangeal joint (PIPJ) of the finger is a complex structure that functions as a hinge joint. Deformity and pain due to arthritis involving this joint can occur as a part of diffuse arthritis process or as the result of an isolated injury or fracture. Reconstruction of this joint has been difficult in the past to achieve an improved outcome, however recent surgery with modified joint implants as improved the outcomes for this problem. Dr Ross has been using pyrocarbon joint implants for his PIP joint arthroplasties over the past 5 years with good outcomes. Due to the inherent instability of the PIP joint, reconstruction is not advised for patients who will be placing a heavy functional load on the digit, such as manual workers or sportspeople. Joint reconstruction is best reserved for cases of painful movement in the affected joint. If you have a deformed or arthritic PIP joint please contact Dr David Ross at Bayside Plastic Surgery to discuss whether joint replacement surgery might be feasible in your case.
Wrist/Carpal Bone Arthrodesis
The wrist joint is a complex structure, which consists of multiple articulations to allow the various movements that characterise wrist and hand function. It includes the radiocarpal, intercarpal and carpometacarpal articulations. On occasions some of these articulations can be affected with relatively isolated osteoarthritis causing pain symptoms aggravated by certain movements. Although there maybe various treatment options to treat this pain, if joint destruction has occurred arthrodesis (fusion) of the joint can be very beneficial in alleviating symptoms. An arthritis assessment would be required to discuss the appropriate treatment options that may be of benefit.
Distal Interphalangeal Joint Arthrodesis
In patients with painful and deformed osteoarthritis of the distal interphalangeal joints (DIPJ) of the finger, arthrodesis (fusion) is a relatively simple procedure to relieve pain and improve the appearance of the joint. This procedure limits mobility but can been very beneficial alleviating pain in an isolated DIP joint.
If you are interested in finding out about hand surgery for the treatment of arthritis, contact our Melbourne practice to undergo an assessment to determine the specific surgical procedures that may be beneficial in your situation.
