Surgery For Arthritis In Hands

Can Arthritis In The Hand Be Prevented

Arthritis cant be prevented. However, you can watch for symptoms of arthritis as you age and see your healthcare provider if you notice changes in your joints. You can also take steps to control factors that you can control. Eat healthy to nourish your body and maintain a healthy weight. Being overweight puts more stress on your joints. Dont smoke. Smoking increases your risk of arthritis.

What Is A Joint Fusion When Is It The Best Surgical Option

Fusion of a joint involves removing the joint and surgically fusing the bone ends so that the two bones effectively become one solid bone. This procedure terminates all motion at that joint and thus eliminates the pain. The benefit of fusion is pain relief and the downside is elimination of motion at the fused joint, which can hinder function. This surgical option is reserved for patients with advanced arthritis.

Joint fusion is usually the best surgical option in patients who are younger and very active. Younger patients may not be candidates for joint replacement because of the increased stress demand on the joints which accompany higher activity levels. This increased stress demand can quickly wear out an artificial joint.

Classification Of Thumb Deformities

Nalebuff described 5 types of deformities of the thumb associated with RA, and Ratliff described a sixth type.

Type 1 thumb disorder is a boutonniere deformity. The pathology originates at the MP joint with significant synovitis, dorsal hood disruption, and subluxation of the EPL tendon ulnarly. The distal phalanx is drawn into extension as the proximal phalanx subluxes dorsally. The type 1 deformity is the most common in persons with RA.

Type 2 thumb deformity maintains the hyperextension at the MP joint, but it is also associated with hyperextension at the IP joint. Also, the CMC joint is often subluxed.

The type 3 thumb deformity is a swan-neck deformity and is the second most common type of thumb disfigurement in persons with RA. CMC joint synovitis initiates the subluxation of the first metacarpal radially and dorsally. The first metacarpal is adducted. This adduction combined with volar plate laxity results in hyperextension of the MP joint. A relative shortening of the lateral bands and the pull of the flexor pollicis longus draw the distal phalanx into flexion.

The type 4 deformity is analogous to skier thumb or gamekeeper thumb. The MP joint synovitis initiates the pathology, with resultant laxity of the ulnar collateral ligament with or without subsequent adduction of the first metacarpal.

The type 6 deformity involves isolated IP joint and/or MP joint destruction with subluxation, as a result of bone resorption and destruction.

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What Is Arthritis Surgery

Arthritis surgery consists of a synovectomy procedure in which the joint is cleaned of inflammation, a joint arthroplasty where the joint is replaced, and an arthrodesis procedure where the joint is fused stiff.

A joint synovectomy usually provides only temporary relief. An joint replacement is a procedure that involves replacing a joint with an artificial joint made of a metal such as titanium in the wrist and elbow or the fingers using silicone or a metallic pyrocarbon implants, or removing the joint and replacing with a tendon from your own body such as with basilar thumb arthritis.

Rheumatoid Arthritis Of The Wrist

RA can affect any tendon sheath or joint in the body. Often, distal appendage deformities are the result of the proximal joint pathology. This is no truer than in the wrist. Significant wrist synovitis and destruction results in dysfunctional pain, weakened grip, and distal finger deformities. Therefore, correction of the wrist pathology is usually required before, if not at the time of, MP joint or finger reconstruction efforts.

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What Outcome Can I Expect If I Have Arthritis In My Hands

There is no cure for arthritis. However, you can usually manage mild to moderate symptoms with a combination of medication and non-medication approaches. Surgery may be an option if other treatments fail or the arthritis in your hands is severe. Your healthcare provider will explain what outcome you can expect for your type and severity of arthritis, your age, other existing medical conditions and other factors.

What Is Hand Surgery

Hand surgery is a broad term that covers many different types of procedures. Plastic surgeons who perform hand surgery seek to restore hand and finger function. But hand surgeons also try to make the hand look as normal as possible, as well. Hand reconstructive surgery may be done for many reasons, including:

• Hand injuries
• Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, that change and damage the structures in the hand
• Degenerative changes to the structures in the hand
• Problems or defects of the hand that are present at birth, or congenital
• Infections of the hand

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When Is Surgery Needed

RA surgery may be pursued when joint deterioration becomes so bad that surgery becomes a necessary option. This may happen when patients do not respond positively to medications or physical therapy. Patients may also become so debilitated that they can no longer walk, stand or move around without pain, or they cant grasp or grip items with their hands to perform daily tasks.

When daily activities become too difficult or impossible to perform, then surgery may be critical. In these cases, the particular patients case of RA may be considered very severe and so surgery becomes the only option for relieving pain and restoring joint function.

Here are some of the considerations when deciding if RA surgery is necessary for you:

• How effective have medications been at preventing joint damage?
• How effective have medications been at relieving pain?
• Am I able to perform daily activities including physical, family, and social activities?
• Are my disease symptoms impacting my sleeping patterns?

If any of these scenarios is negatively impacting your quality of life then surgery may be a consideration. However, surgery wont usually restore a joint back to normal or to its full function.

Physicians will consider other factors as well before deciding to pursue surgery. These factors include :

• Overall health of the patient
• Health risk factors like obesity or diabetes
• Patients age
• Patients bone density levels

Nalebuff Type I Deformity

Swan-neck deformity can arise at the PIP or DIP joint in either case, it can lead to the classic appearance of PIP joint hyperextension with DIP joint flexion. Patients with type I deformity maintain the ability to actively flex the PIP joint. When the deformity originates at the PIP joint, it is caused by stretching of the capsule secondary to active synovitis or rupture of the flexor digitorum superficialis tendon, removing the restraint to PIP joint hyperextension.

If the synovitis involves the DIP joint, the deformity begins with stretching or rupture of the terminal tendon attachment of the extensor mechanism to the distal phalanx, resulting in a mallet deformity. This subsequently causes extensor mechanism imbalance, with relative overpull of the central slip these problems, together with laxity of the PIP joint’s volar plate, result in PIP joint hyperextension.

The treatment of type I deformity is focused on correcting PIP joint hyperextension and restoring DIP joint extension. Conservative treatment can be used, with Silver Ring splints employed to permit active PIP flexion and limit hyperextension of the PIP joint. Alternatively, an inexpensive figure-8 thermoplastic splint can be fashioned by a hand therapist. These splints can be useful in the early stages of the disease.

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Joint Fusion Surgery For Arthritis Of The Fingers

Our hands, thumbs, and fingers are what set us apart from most other animals. These differences, even from our closest primate relatives, allow us to grasp and manipulate objects with a great deal more fine motor control. In fact, you use your hands and fingers so much in your daily life that you probably dont really appreciate that fact until you develop painful arthritis in your fingers.

If you have tried conventional therapy, to no avail, it may be time to consider joint fusion surgery. Dr. Steven Bailey, at The Hand Center at Crawford Plastic Surgery, discusses the options of joint fusion and joint replacement for treating either rheumatoid arthritis or osteoarthritis of the fingers. Here, he also discusses the pros and cons of each type of treatment.

Joint Fusion Or Arthrodesis

Arthrodesis fuses or joins two bones together, and usually helps arthritis in the thumb or small finger joint. The surgeon makes an incision over the joint and removes the damaged cartilage. The bones are then held in place with metal pins, wires, or screws and allowed to heal. Once the bones have healed, you will not be able to move the joint. This surgery is usually the last resort when other treatments havent helped relieve pain or improve function.

The procedure is an outpatient surgery, which means you can go home the same day.

However, you may need to stay in the hospital overnight if your provider deems it necessary.

Arthrodesis may be an option if you have:

• Thumb or small finger arthritis that has not responded to other treatments
• Arthritis in multiple joints in the hand
• Severe pain and loss of function in the hand

Your provider will perform arthrodesis depending on the location of your arthritis and the severity of your condition. They may do a partial fusion on a few bones in a joint, allowing you to keep some movement. They may also perform a complete fusion, which fuses all bones in the joint. This procedure eliminates all movement in the affected area.

Providers commonly recommend arthrodesis for patients with arthritis affecting the:

• Base of the thumb
• Proximal interphalangeal joint the joint in the middle of the finger
• Distal interphalangeal joint the joint at the end of the finger

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Possible Benefits Of Surgery

Arthritis is usually a chronic condition and sometimes can lead to disability. However, there are many ways you and your doctor can lessen these problems. One of the ways may be surgery. Joint surgery can offer several benefits: Relief of pain is the most important benefit of joint surgery. Many people with arthritis have constant pain. Some of this pain can be relieved by rest, heat and cold treatments, exercise, splints, and medication. When these therapies don’t lessen the pain, surgery may be considered. Improved movement and use of a joint are also important benefits of joint surgery. Continuous inflammation and the wearing away of bone and cartilage can cause joints, tendons, and ligaments to become damaged or pulled out of place. Losing the use of a joint, such as a hip, knee, hand, elbow or shoulder, can seriously hamper a person’s activities. When this happens, surgery to replace or stabilize the joint may be suggested. An improvement in the appearance of deformed joints, especially in the hand, can be expected with some types of surgery.

Nalebuff Type Iv Deformity

Patients with a type IV deformity have stiff PIP joints and associated radiographic changes consistent with advanced intra-articular disease. These deformities require a salvage-type procedurenamely, arthrodesis or arthroplasty. In deciding which of these procedures to perform, it is important to consider the status of adjacent joints, flexor tendons, and ligaments. It is also important to assess the function of the adjacent fingers. Fusion is particularly useful for the index and middle fingers, because these digits need lateral stability when opposed to the thumb during pinch. Arthroplasty is recommended for the ring and small fingers, where mobility aids grasp. If the MP joints require arthroplasty, PIP joint fusion is recommended, although it has been suggested that arthroplasty can be performed.

Proximal joint fusion involves a curved dorsal skin incision. A longitudinal incision is made through the tendon over the joint, resecting the collateral ligaments. Two Kirschner wires are then passed obliquely across the joint to provide stable fixation, usually at 25° of flexion for the index finger and slightly more for the third digit. Postoperative care consists of cast immobilization for 6-8 weeks.

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What Is Basilar Arthritis And Who Is Affected

Symptoms include localized pain or swelling, difficulty opening large jars or heavy doors and loss of grip strength. Over time, the motion of the basilar joint may become so limited that the next joint up may become hyperextended to allow for gripping of large objects. Unfortunately, basilar arthritis may not be recognized and the management may not be understood by primary care doctors.

Risk factors for basilar arthritis include having a family history of osteoarthritis, increasing age and being female. Occupation, activity, diet and obesity are less clearly related to the development of basilar arthritis. Almost 30% of women develop osteoarthritis of the bases of their thumbs in the time around menopause.

How Can Plastic Surgeons Help Treat Thumb Arthritis

• Loree Kalliainen, MD, FACS | Providence, RI
• Tuesday, October 29, 2019

Hand surgery is one of many components in plastic surgery training, and many plastic surgeons incorporate hand surgery into their practices, some focusing solely on hand surgery. This type of very specialized surgery can treat diseases that cause pain and impair the strength, function and flexibility of your wrist and fingers.

One common hand condition treated by plastic surgeons is basilar arthritis, which is osteoarthritis of the base of the thumb causing pain, stiffness and deformity.

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Top Notch Hand Arthritis Surgery In Plantation Fl

Hand arthritis can prevent you from doing the activities you love. Fortunately, some treatments can help you regain function and relieve pain, like surgery. Joint replacement surgery and joint fusion are options for some people with hand arthritis. You may also consider tendon transfer surgery if other treatments have failed to relieve your symptoms.

The Orthopaedic Hand and Arm Center is here for you if youre looking for hand arthritis surgery in Plantation, FL. We have a team of specialists headed by Dr. Tosca Kinchelow who can give you compassionate care. You may call us at 908-9036 to learn more about our services. You may also use our appointment request form to book a consultation.

We look forward to serving you!

What To Expect Success Rate

Early success rates with arthroplasty and Arthrodesis is often rather high. As time goes on the lifespan of replacement joints in the hands can be influenced by overall use, as well as the age of the individual. On average you should expect the lifespan of an arthroplasty-replaced joint to be a decade or less.

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What The Lrti Procedure Does

In LRTI, all or part of the trapezium bone is removed from the wrist and the remaining surfaces of the CMC and STT joints are smoothed out.

An incision is made in your forearm, and the FCR tendon that allows you to bend your wrist is cut.

A hole is drilled in the metacarpal bone of the thumb and the free end of the FCR tendon is passed through it and sewn back onto itself.

The remaining portion of the FCR is cut off and preserved in gauze. Part of the tendon tissue is used to reconstruct the ligament of the CMC joint. The other, longer portion is rolled up into a coil called an anchovy.

The anchovy is placed in the CMC joint to give the cushioning that the arthritic cartilage used to provide. An artificial anchovy can also be used to remove the need for harvesting a tendon.

To maintain the proper positioning of the thumb and wrist, specialized wires or pins, known as Kirschner , are placed in the hand. These protrude from the skin, and are usually removed about four weeks after surgery.

This procedure may be done under a type of anesthesia known as regional axillary block, so you wont feel pain. It may also be done under a general anesthesia.

Many people experience pain relief after LRTI surgery. David S. Ruch, professor of orthopedic surgery at Duke University in North Carolina, says LRTI has a 96 percent success rate.

But of LRTI procedures found that 22 percent of people with LRTI surgery had adverse effects. These included:

• scar tenderness

Medication And Therapeutic Modalities

• Cortisone injection into the joint
• Physical therapy including range-of-motion and strengthening exercises
• Occupational therapy: A therapist can recommend modifications. You may find it helpful to try splinting or supportive gloves, as well as easy-to-hold tools, which are specially made for individuals with hand osteoarthritis and other gripping issues.
• Topical rubs, such as Capsaicin, Icy Hot, and Bengay
• Heat application or cold packs

Diet is a controversial topic when it comes to osteoarthritis. Processed foods that are high in trans fats cause inflammation, and avoiding them has been proposed as a possible strategy for managing osteoarthritis. The benefits of avoiding these foods reach far beyond alleviating osteoarthritis.

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What Is Arthritis Of The Hand

Arthritis is a disease that attacks the tissues of your joints. A joint is where two bones meet. Arthritis can attack the lining of your joint or the cartilage, the smooth covering at the ends of bones. Eventually the cartilage breaks down, the ends of your bones become exposed, rub against each other and wear away. You have many joints in your hand, therefore its a common site for arthritis to happen.

Arthritis of the hand causes pain and swelling, stiffness and deformity. As arthritis progresses, you cant use your hands to manage everyday tasks as you once could.

Treatment Of Thumb Deformities

The treatment of these specific deformities depends on the severity of disease in each involved joint. Fixed joint deformities with bony destruction are usually more amenable to fusion than arthroplasty. However, in general, in an attempt to preserve motion, fusion of 2 joints in tandem is considered the last-stage effort. IP joint fusion is tolerated extremely well and maintains function. The IP joint should be fused at 0-20° of flexion. MP joint arthroplasty is recommended at the CMC joint or IP joint about to be fused. This preserves the motion of the thumb for prehensile tasks. Pathology isolated to one joint, such as in a type 4 deformity, can be surgically treated with an arthroplasty or volar plate advancement. A type 6 deformity requires fusion to regain stability. Bone grafts may be required to restore adequate bone stock.

CMC joint arthroplasties are a good option for significant deformities of the thumb if the disease initiated at the CMC joint . Ligament reconstruction with tendon interposition offers a stable joint with preservation of motion. Occasionally, fusion of the CMC joint may be required if significant bone destruction is present with poor residual bone stock.

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