It is usually only when our hands become painful and stiff on a daily basis that we realize time is marching on and they may be wearing out like the rest of us! In some families “wear and tear” arthritis (or osteo-arthritis) can appear at a relatively young age and this is especially common around the base of the thumb and the top joint of the fingers (distal inter-phalangeal joint – DIPJ). In others this type of arthritis may follow an injury to a joint. When these joints become painful and stiff such that daily activities become difficult then that is the time to see your GP and then hand surgeon. Rheumatoid Arthritis is an altogether different disease and, with modern disease-modifying drugs, not nearly as common a problem in my hand clinic as it used to be.

Osteo-arthiritis

Wear and tear arthritis of the small joints of the hand (and indeed wrist) presents as early morning stiffness, pain and swelling around the affected joint(s). With time the body will try and shut down these joints by forming new bone which manifests as permanent swelling and deformity and loss of movement, but often less pain. The DIP joints of the fingers become knobbly and often bend off at strange angles; the thumb becomes weak, painful and the first web-space collapses causing an inability to grasp bigger objects and twist objects like door handles.

Treatment – in the initial phases rest and simple pain-killers (NSAIDs), supplemented by the careful supervised use of hand splints, may be all that is needed. Steroid injections into the joint may also provide relatively short-term relief but cannot be used repeatedly. Surgery is not invariable but various possibilities may be discussed with you – sometimes joint fusion (hastening what the body is trying to do naturally) of the DIPJ is used; with the thumb the usual operation is trapeziectomy where the small bone at the base of the thumb is excised. Joint replacement may also be used depending on which joint is involved.

Rheumatoid arthritis

In my early career we performed a great deal of Rheumatoid hand surgery but this has been dramatically reduced by these amazing new drugs. I am still called upon to perform various hand operations in this group of patients, usually for pain (joint replacements), but also for tendon ruptures and nerve entrapments. I work very closely with the Rheumatologists and hand physiotherapists to decide when surgery may be indicated.