Hand Wrist and Elbow Arthritis
Basal Joint Arthritis
Arthritis at the base of the thumb or Basal Joint Arthritis is a common condition that is often overlooked. Patients will complain of pain at the wrist and base of the thumb. Pain is present with writing and activities that require a pinch type grip such as turning a key in a door or or opening a can. Women are more often affected then men. Non operative treatment consists of modifications of activities of daily living and use of a splint that protects the base of the thumb. Writing with a pen that has a wide grip relieves the pain caused by writing. It may also be helpful to put a large head on commonly used keys as this will decrease stresses. Supermarkets often sell rubber grips that help opening jars.
When these measures are insufficient in relieving pain, surgery may be considered. If x-rays show minimal joint arthritis, it may be possible to reconstruct a ligament that stabilizes the basal joint. When significant damage has already occurred, the surgical procedure, Basal Joint Arthroplasty, removes the arthritic portion of the joint. After surgery, a cast that includes the thumb and goes above the wrist is worn for four weeks. Therapy is usually necessary after cast removal. Most patients can expect to regain pain free thumb function. Complications are infrequent but real and may include the risks of: surgery, infection, problems with therapy weakness and stiffness.
Rheumatoid arthritis occurs in 1-3% of the population. In 90% of people, the arm and especially the hands are affected. The disease causes inflammation in the synovium, the tissue lining the joint spaces. This process, called synovitis leads to pain and swelling in the affected joints. If the disease remains active, there will be progressive damage to both the joint cartilage, and supporting ligaments. Synovium also surrounds the tendons. Synovitis may lead to malalignment or even tendon rupture. Synovitis in the carpal tunnel may cause carpal tunnel syndrome.
Now, there are some new and very potent medications to treat rheumatoid arthritis, accordingly, it is important to seek treatment early before there has been irreversible damage. When medications are not effective, surgery should be considered. If there is not too much damage to the joint cartilage, the inflamed synovium may be removed. This procedure called Synovectomy may provide long lasting relief of pain and preservation of function for the wrist and finger joints.
Arthritis may also develop after an injury or as part of the aging process in some patients. When there is irretrievable damage to the joint, Joint Replacement may be indicated. In some circumstances, joint function cannot be salvaged. In these cases, function can be salvaged with a Joint Fusion.
Twenty to fifty percent of patients with Rheumatoid Arthritis will develop elbow problems. The lining of the joint, the synovium, becomes inflamed. This inflammation, synovitis, maybe painful. To minimize pain, patients may hold the elbow in a flexed position. Over time a permanent contracture of the elbow joint will develop. With limited motion, activities of daily living become progressively more difficult. If caught in time, this inflamed synovium can be removed while preserving the remaining bone and cartilage. This surgery is called Synovectomy. Contractures and loss of motion can be improved as well. Therapy to maintain motion and improve strength generally is required for several weeks after surgery. Our research has shown long lasting relief of symptoms.
When joint problems and arthritis have progressed such that there is no functional cartilage, Total Elbow Replacement may be considered. These replacements are made of metal and plastic. They work well in eliminating pain and restoring function, but may not stand up to the stresses of those patients who wish to perform heavy labor or sports.
After trauma and fractures, patients may develop joint damage and contractures. Unlike Rheumatoid Arthritis, the synovium is not an important part of this process. In appropriate circumstances, motion can be improved and pain relieved surgically. Procedures that release contractures and restore motion may be considered. Total Elbow Replacement may be considered when other options are not available.