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Finger Arthritis

What is arthritis? What is finger arthritis or DIP/PIP joint arthritis?

Our joints are the intersection where two bones meet and articulate, which then allows this joint to move. All joints throughout the body are lined with a slick substance known as cartilage, which allow for the smooth movement of one bone relative to another. Arthritis is a generic term that indicates the degeneration of this cartilage which leads to “bone on bone” motion, which causes significant pain and deformity. Osteoarthritis, also known as “wear and tear” arthritis, is a process that occurs with aging and involves the deterioration of cartilage with increasing usage. Inflammatory arthritis is an autoimmune phenomenon in numerous inflammatory conditions where the body’s immune system attacks the cartilage and causes joint destruction.

Finger arthritis, also known as interphalangeal joint arthritis, is the most common form of arthritis in the hand. It involves the wear and tear of the cartilage between either the distal phalanx and the middle phalanx (DIP or distal interphalangeal joint arthritis) or the middle phalanx and the proximal phalanx (PIP or proximal interphalangeal joint arthritis). These joints are critical for normal hand function as they move every time the fingers move. Therefore, they are very susceptible to deterioration (since we use them so often) and may cause significant pain and loss of function when they do not work properly.

What may indicate finger arthritis?

Pain is the most common presenting symptom for patients who are developing or have developed arthritis of the fingers. There is pain located at the joints themselves that initially occurs sporadically, and as the joints degenerate further, the pain becomes more consistent and more difficult to live with. Eventually, the joint mechanics will deteriorate and then other joints in the finger can become affected.

How is finger arthritis diagnosed?

The diagnosis of finger arthritis is made by reviewing your medical history, a physical examination, and X-rays. Additional tests, such as a CT scan, may be required to get high level detail of the arthritis to determine the type of treatment that is necessary.

How is DIP or PIP joint arthritis treated?

Generally speaking, the treatment will be guided by a few main factors:

  1. How “bad” the arthritis is – how painful it is, how deformed the joint is, how many other joints are affected.
  2. The “you” factors – your age, hobbies, functional demands, activities, your health, and what you do for work

 

The goal in treating your arthritis is to improve your pain while preserving and obtaining as much motion as possible. At The Center for Hand & Upper Extremity Surgery, we use an algorithmic approach to treat this common problem, allowing our patients to determine which course of action is best for them.

First, we will discuss conservative options. This includes activity modification, non-steroidal anti-inflammatory treatment, and splinting with hand therapy. Often, patients who present to us have already attempted many of these conservative treatments without sustained improvement. Then, we will discuss a steroid injection. This is a simple procedure that can be done in the office, and is effective in treating the condition. For patients who have a return of pain, a second injection can be offered.

If pain returns after steroid injections, or if the joint damage is more advanced, we will then discuss surgical options with you. There are numerous treatments that our specialists are familiar with, often approached as rungs on a ladder. Some interventions are more invasive than others, and our specialists will determine which surgical procedure is the best for you and your lifestyle. Each patient is approached as an individual, rather than with a one size fits all approach. Some minimally invasive interventions involve removing the nerve supply to the joint, which is a low down time procedure that can improve pain. Some more invasive interventions involve replacing the joint (joint arthroplasty) or even fusing the joint in more advanced conditions (joint fusion).

Tell me more about the minimally invasive treatment known as “joint denervation”

Historically, finger arthritis including DIP and PIP joint arthritis have been treated with surgeries that cause a loss of motion. Patients who undergo joint replacement are faced with less motion than they desire as well as possibility that the joint replacement may wear out. Patients who undergo joint fusion do get reliable pain relief, but they lose ALL motion at the joint, which can be severely debilitating. Therefore, patients have desired a less invasive option that could allow reliable improvement of their pain without the significant morbidity of loss of motion.

Joint denervation is a procedure that addresses the “supply” of pain to the brain rather than the joint itself. Through small minimally invasive incisions, your surgeon can meticulously and microscopically dissect the nerve branches to the joint and remove them systematically. By removing the nerve branches to the joint, your surgeon has eliminated the signals of pain to your brain without disturbing the joint biomechanics itself. Therefore, there is no need for a prolonged recovery – there is no casting, there is no therapy, and there is no restriction on motion post operatively. Many patients prefer this operation due to the reliable pain relief with limited down time as the first “rung” on their treatment ladder. Furthermore, the procedure does not affect the joint mechanics – whatever motion you had prior to surgery is what you can expect after surgery without significant loss.

Our hand surgery specialist will let you know upon review of your situation and x-rays whether or not you are a candidate for this newer minimally invasive method of treatment.

Will I need therapy following arthritis treatment?

Your need for therapy will be specifically determined by your surgeon as well as your specific situation and treatment plan. Therapy is often a component of non-surgical as well as surgical treatment plans, but there are times when it is not necessary.