Hand/Wrist Arthritis

Hand and wrist pain caused by arthritis is an all too common problem, and usually begins to affect people in their 40s and 50s. In a lot of ways it is like your hair turning gray – if you live long enough, you’re going to get it. But, unlike gray hair, arthritis can cause serious pain and discomfort. You can develop difficulty with activities you used to take for granted, like playing a game of tennis, or even turning a doorknob. If you have arthritis symptoms of pain, stiffness, or swelling in your hands or wrists, there are treatment options to provide relief.

What exactly is arthritis?

Arthritis is inflammation of a joint, usually caused by destruction of the joint cartilage. Bones have rough surfaces, so at every joint in your body from the neck down to your toe, the bones are covered by a cartilage cap and surrounded by some lubricating fluid. This allows the joint to glide smoothly. If the cartilage wears away, the surface becomes rough. The rough surfaces of the joint rubbing on each other cause inflammation and pain. Also, the joint can begin to feel like the rusty water tap in your garden – stiff and creaky – and you start losing motion. You may also notice the neighboring joints becoming more mobile as they try to compensate for the problems in the arthritic joint.

What causes arthritis?

    Arthritis is basically caused by one of two reasons.

  1. The cartilage may have worn away simply by mechanical wear and tear. Think of the joint cartilage as the tires on your car – arthritis is like the tire tread wearing out. If you drive enough miles, even the best tires will wear out – this is primary osteoarthritis. On the other hand, if you drove your car over some really rough ground and your wheel alignment is off, this will cause the tires to wear out faster – this is post-traumatic arthritis.
  2. The other possibility is that the joint is attacked by your own immune system, causing the cartilage as well as the surrounding tissues to be slowly destroyed. This is how rheumatoid arthritis and psoriatic arthritis work.
Dr. Purushottam Nagarkar, University of Texas Southwestern Medical Center, Dallas, Plano and Frisco
Dr. Nagarkar on arthritis:

Patients often wonder if their X-rays show any arthritis. The truth is that the treatment for arthritis is not about X-rays (or CT scans, or MRIs). It’s all about the severity of your symptoms and what I find on my examination of your hand. A patient with terrible-looking X-rays might need nothing other than an occasional Advil.
And someone with an X-ray that doesn’t look too bad might nevertheless benefit from a surgery.

What are the treatment options?

The best treatment option for arthritis depends on the joint involved and the underlying cause of the arthritis.

Primary osteoarthritis

    This is the most common type of arthritis by far, and can affect any of the joints, from the tip of the finger to the wrist. The basic treatment options are similar, but the surgery options quickly become numerous and complex depending on which joint is involved.

  • Anti-inflammatory medications: Most patients are already using one of the NSAIDs (non-steroidal anti-inflammatory drugs) like Advil or Alleve by the time they seek treatment for arthritis. Nevertheless, these medications can be quite effective at treating some arthritis symptoms.
  • Splints: A lot of the symptoms of arthritis are caused by the rough joint surfaces grinding on each other every time you move the joint. Splints are a quick-and-dirty way of treating the symptom – by preventing you from moving the joint, the pain can be improved.
  • Steroid injections: Inflammation caused by joint grinding is the cause of much of the pain of arthritis. Steroids are very good at reducing inflammation, and an injection into the joint can provide a great deal of relief for months at a time. It is critical to place the injection directly into the joint – steroids are far less effective if they are off-target.
  • Surgery: Surgery options vary greatly depending on the specific joint involved. But the basic types of surgeries are the same for any joint.
    • Neurectomy removes only the specific nerve that is responsible for sensing pain in the joint, without affecting the nerves that allow the hand or wrist to move or have touch sensation.
    • Resurfacing places some smooth surface into the joint to act as the missing cartilage.
    • Joint replacement completely removes the joint, and replaces it with an artificial joint, usually made of silicone.
    • Fusion removes the joint, and joins the two bones together so that they cannot move or grind against each other – like a permanent internal splint.

    Not all of these options are available for each joint in the hand or wrist, but usually there are several possible options for any given joint.

Post-traumatic arthritis

The best cure is prevention. Post-traumatic arthritis is caused when your joints are not well aligned due to a sprain, ligament tear, dislocation, or fracture. It is best to seek care for injuries like this quickly so that they can be appropriately treated, and your joint alignment improved. This can prevent the development of early arthritis.

Rheumatoid or psoriatic arthritis

The main treatment for these auto-immune types of arthritis is with medication. Once you have been diagnosed, your rheumatologist will usually start various medications designed to prevent your immune system from attacking the joints. These medications have improved by leaps and bounds over the last 20 years, and these days the arthritis can be well controlled with medications alone. However, surgery is sometimes needed to relieve pain or deformity – the exact type of surgery depends greatly on your specific symptoms and physical examination. Your consultation with Dr. Nagarkar will involve a full exam and detailed discussion of your goals to determine what procedure is right for you.

To meet Dr. Nagarkar in person, schedule your consultation or call us.