Arthritis of the Upper Limb

Arthritis

Osteoarthritis (OA) of the hand is a slowly progressive articular disorder. It happens late in life and principally affects load-transmitting joints. Further forms of inflammatory arthritis include rheumatoid arthritis, gouty arthritis, psoriatic arthritis, among other rarer forms of arthritis.

Arthritis symptoms include pain, stiffness, difficulty in moving as well as swelling of the joints. In late cases, symptoms also include deformities.

Most arthritic conditions can be managed non-operatively with non-steroidal anti-inflammatory drugs, patient education and reassurance, hand therapy, splintage, activity modification and occasionally steroid injections.

In more serious cases where patients experience persistent pain and are unresponsive to non-operative treatment, or suffer deformity, instability or stiffness that impairs function, a joint reconstructive surgery would be required.

Joint Reconstruction Surgery

Joints can be reconstructed by various means. These include fusions and various forms of arthroplasties such as:

  • Excision arthroplasties
  • Soft-tissue interposition arthroplasties
  • Vascularised joint transfers

Artificial Joint Transfers



Rheumatologists are the best specialists to manage these conditions. However, in cases where medication cannot control the pain or when the joint is completely destroyed, reconstructive surgery may be required; and this is when hand surgeons play an important role.

The joints that are commonly affected by osteoarthritis of the hands include:

  • a) Basal joint arthritis (i.e. arthritis of the first carpometacarpal joint)
  • b) Osteoarthritis of the interphalangeal joints
  • c) Rheumatoid arthritis of the metacarpal phalangeal joints
  • d) Wrist joints
  • e) Distal radial ulnar joint
  • f) Elbow joint

Treatment of arthritis of these joints include rest, splinting and medications. As mentioned, in severe cases when conservative measures fail, surgery may be required.

This comes in the form of:

  • a) Corrective osteotomies
  • b) Ligament stabilisation
  • c) Soft tissue arthroplasty (ie. Cushioning the joint surface with tendons)
  • d) Fusion
  • e) Replacement of artificial joints

The following are examples of joint replacement for severe arthritis of the hand and wrist:

If you would like to learn more about the treatment and the possible outcomes, feel free to inquire here.