Hand Surgery -3

Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis, also known as degenerative arthritis, is the most common form of arthritis and it commonly affects the hands because of their frequent use. Patients can also suffer from an autoimmune condition known as rheumatoid arthritis which causes many of the same symptoms as osteoarthritis in the hand, but has other causes and other systemic effects.

Osteoarthritis of the hand develops as the cartilage protecting the bones of the finger joints wears down. Over time, as stress is put on the joints, cartilage wears thin and sometimes even erodes completely, resulting in stiffness and pain.

Arthritis of the hand may cause the joints to lose their normal shape and limit their movement. Osteoarthritis occurs more frequently in older individuals; rheumatoid arthritis can have its onset at any age, but is more prevalent as patients reach middle age and beyond.

Symptoms of Hand Arthritis

There are a number of symptoms shared by patients with either osteoarthritis or rheumatoid arthritis of the hand. These symptoms, manifested at the joints of the hand, wrist, and fingers, may include:

• Deep, aching pain
• Stiffness and swelling
• Limited range of motion
• Crepitus, a grinding or grating sensation or sound
• Formation of mucus cysts at the fingertips
• Difficulty using the fingers to grip or turn objects
• Weakness in the hand

Common places for arthritic inflammation to affect the hand are: the joint at the base of the thumb, the joint in the middle of a finger, and the joint of a finger closest to its nail. It is fairly common for bumps to become evident on the arthritic hand.

When these appear at the joint close to the nail, they are called Heberden's nodes; when they occur in the middle of the finger, they are called Bouchard's nodes.

Diagnosis of Hand Arthritis

In order to diagnose osteoarthritis, the doctor performs a physical exam and takes a medical history. While certain symptoms of arthritis are easily observable, such as swelling, warmth, deformity, and limited range of motion, diagnostic tests are also used, including X-rays and bone scans.

In addition to showing diminished cartilage between bones, these tests may show bone spurs, often a result of arthritis. Sometimes these imaging tests show that arthritis is present even before the patient becomes symptomatic.

Treatment of Hand Arthritis

Treatment of hand arthritis varies according the cause and severity of the symptoms. Some treatments commonly used to alleviate pain and increase mobility include:

• Rest
• Heat or cold therapies
• Analgesics (pain relievers)
• Anti-inflammatory medications
• Corticosteroid injections
• A splint to support the affected joint
• Physical therapy exercises to increase mobility

Pain relievers and anti-inflammatories used to treat hand arthritis may be topical or oral, over-the-counter or prescribed, depending on the severity of the patient's condition.

In the most severe cases, Arthroscopic surgery may be necessary to treat osteoarthritis of the hand. Such surgery may involve joint reconstruction, in which damaged tissue is replaced, or joint fusion, during which two or more bones are surgically joined. In severe cases, surgery may be required to smooth irregular tissue surfaces, or to reposition or replace joints through arthroscopy.

Where rheumatoid arthritis is the cause of the disorder, medications called biologics may be prescribed, but these can have serious side effects. Alternative treatments for either type of arthritis may also be employed, including, but not limited to, acupuncture.

(Fractures and Dislocations Metacarpals)

The hand is a complex structure made up of 27 different bones. A hand fracture can occur as a result of a direct blow to the hand or a fall onto outstretched hands. The most common hand fractures include injury to the pinkie side of the palm or the thumb.

Patients with a hand fracture often experience pain, swelling, tenderness, physical deformity, inability to move the fingers, shortened fingers and or depressed knuckle.

These symptoms can vary depending on which bone in the hand is broken.

It is important for patients to seek medical attention for a hand injury, even if it appears to be minor. Function of the hand relies on the proper alignment of the bones within it, so it is important to determine whether or not those bones have been moved as a result of your injury. We will diagnose a hand fracture physically examining the motion of the hand and position of the fingers, and also by performing an x-ray exam to confirm this diagnosis.

Treatment for a hand fracture can usually be performed through nonsurgical methods that include immobilizing the broken bones in a brace or cast. Patients will be required to wear this for three to six weeks as the bones heal, and may perform hand exercises once it is removed to restore function to the hand.

Surgery may be required for severe fractures in order to realign the bones, which may require the use of wires, screws or plates.