The Hand Center can help.
Arthritis is joint inflammation. The area where two bones join together is called a joint. The ends of bones are lined with smooth cartilage. In normal joints, the two bones form a matched set and the joint moves smoothly by the cartilage surfaces gliding over one another. Arthritis occurs when the smooth cartilage wears unevenly and the joint surfaces no longer fit well against each other. There are many conditions that can cause one or more arthritic joints. The most common causes are osteoarthritis and rheumatoid arthritis, but diseases such as gout and psoriasis can also cause arthritis. The main symptoms of arthritis are pain, stiffness and swelling. Sometimes the symptoms can be treated effectively with non-operative measures (such as rest, activity modification, splints/orthoses, anti-inflammatory medications and therapy). If non-operative measures fail, surgery may be recommended.
Osteoarthritis results from wear and tear on cartilage surfaces. This is your typical arthritis of older age, usually occurring in middle age and beyond. The normal process of daily wear on joints can lead to osteoarthritis, but the problem can be accelerated by traumatic injury to the joint cartilage surface (post-traumatic arthritis.) Rheumatoid arthritis, on the other hand, is an autoimmune disease. In this type of arthritis, your body attacks the cells in the tissue that lines the joint (synovium). The joints become red, swollen and painful. They may deform due to stretching of the surrounding soft tissues and destruction of the bone and cartilage. Osteoarthritis and rheumatoid arthritis typically have different presentations in the hand and wrist, as well as different treatments. Medical and conservative therapeutic management is initially recommended. Surgery may be suggested to treat specific problem areas causing significant pain and functional loss or to prevent further damage.
In rheumatoid arthritis, treatment with medications has been instrumental in decreasing the need for surgical intervention. Typically, the “big knuckles” (metacarpophalangeal joints) and the middle joints (proximal interphalangeal joints) may be involved. In osteoarthritis, it is the two joints closest to the ends of the fingers that are most commonly involved (the proximal and distal interphalangeal joints). Conservative management includes activity modification and splints/orthoses to improve function and minimize pain. Surgical options, if needed, include selective joint replacement and joint arthrodesis (fusion).
Thumb carpometacarpal (CMC) arthritis is a painful, chronic condition that can affect your everyday life and prevent you from performing simple tasks. The CMC joint is the joint that connects the base of your thumb to your wrist. This joint plays an important role in many functions of the hand. Thumb CMC arthritis can cause pain, swelling, stiffness and tenderness.
Since arthritis is a chronic condition, treatment focuses on reducing pain and other symptoms to keep the disease from interfering with everyday life. A combination of treatments is often most effective and may include splints/orthoses, medication or injection. Surgery may be required for patients who do not respond to conservative treatment.
The wrist is a complex joint made up of 8 wrist (carpal) bones that attach to the forearm bones (radius and ulna) and hand (metacarpal bones). Depending on the type and severity of the arthritis, damage to the wrist may be localized to one area, or may be more widespread, affecting multiple joints. If severe, it may eventually lead to a collapse of the wrist from its normal position, causing significant pain and loss of function. Conservative management may include splints/orthoses, activity modification and medication. Surgery may be required for patients who do not respond to conservative treatment. (See Wrist Surgery/Reconstruction.)
From the youngest to the oldest of patients, upper extremity fractures are a common part of our everyday practice at the Hand Center. A fracture is a broken bone. Fractures can be very simple or very complex in appearance as well as treatment. Each fracture is individually evaluated and treated by the doctor, taking into consideration the specific needs of each patient.
Many fractures in the fingers, hands, wrists and elbows can be treated without surgery. Most require some amount of immobilization to allow the fracture to heal. Depending on specific patient and fracture characteristics, this can be achieved with custom orthoses (splints) made on site by our therapy staff or by casts that are applied by our physicians/physician assistants.
When a fracture results in bone ends that are not appropriately aligned, you may need more than a cast or splint. You may require a procedure, either in the office under local anesthesia (numbing medicine) or in the operating room under general anesthesia, to reset your broken bones. Often, this type of procedure has been done in an Emergency Room prior to your arrival at The Hand Center. When done in the operating room, metal pins may be added to hold unstable fractures in place.
If a fracture has substantially shifted out of position or is unstable in a cast or splint, it may not be possible to treat it appropriately without an open surgery. This type of surgery is called an open reduction internal fixation (ORIF). It allows your surgeon to piece together your broken bone through one or more skin incisions, and fix the pieces together with metal implants such as pins, wires, plates or screws. Your doctor will discuss the specifics of surgery with you at your pre-operative visit.