Finger Arthritis

Background

Osteoarthritis (OA) affecting the digits is quite common. This condition involves wear and tear of the joints of thumb and fingers called interphalangeal joints.

Causes

Wear and tear during aging leads to progressive degeneration of the cartilage layer at the interphalangeal joint. Trauma of the joint can predispose to arthritis, e.g. a history of fracture. Genetic predisposition can play a varying role.

Symptoms

Symptoms include pain and swelling of the affected joint, worse after prolonged use. Loss of range of motion and reduced grip and pinch strength can result. Often, the affected joint is visibly deformed: there can be unusual angulation of the joint, or a visible “bump” which represents growth of additional bone called “bone spurs” or “osteophytes”. Ganglion cysts can also arise from such arthritic joints which are commonly called “mucous” cysts. These can also cause a ridge in the nail plate.

Diagnosis

The physical examination is the first step, and is supplemented with xrays of the affected joint to show the extent of the degenerative changes. Overall range of motion of the joint is assessed, as well as pinch and grip strength. The position of the other joints of the affected digit is also examined, since this may affect the choice of treatment. Ultrasound can be used to help differentiate between bone spurs and ganglion cysts.

Treatment

Almost always begins with conservative measures, including splinting, hand therapy, activity modification, and use of antiinflammatories (topical or oral). The next step is a steroid injection. This is often done under ultrasound guidance which is more precise and less painful.

Although the injections provide relief and can be repeated, some patients may be candidates for surgery which involves cleaning out and replacing or fusing the arthritic joint. Several operations have been described.

Dr. Dowlatshahi offers the following procedures:

• joint denervation.
• PIP joint replacement.
• PIP, DIP and thumb IP joint fusion.

Dr. Dowlatshahi will discuss his specific recommendations with you during your visit.