• Ravi Mallina

Arthritis of The Fingers

The index, middle, ring and little fingers have three bones each and two joints between them. The term phalanx (plural: phalanges) refers to a single bone of the finger. The joint between the first and second phalanx of the finger is known as the proximal interphalangeal joint (PIPJ), and the joint at the tip of the fingers, between the second and third phalanges is referred to as distal interphalangeal joint (DIPJ).


Both PIPJ and DIPJ can be affected by arthritis, which is a condition where the cartilage covering the joint surfaces over each phalanx gets destroyed, and the two bones start rubbing against each other causing pain.


Types of PIPJ and DIPJ arthritis


There are broadly three types of finger joint arthritis.

  1. Osteoarthritis, by far the commonest form

  2. Inflammatory arthritis, rheumatoid arthritis being the commonest cause.

  3. Septic arthritis, caused by infection of the joint(s)

  4. Post Traumatic Arthritis - Sequalae of previous joint injury


Diagnosis


Patients usually complain of pain. A thorough history and physical examination by a Hand Surgeon is the first step in establishing a diagnosis of finger joint arthritis. This step is usually complemented by X-rays which would show the changes suggestive of arthritis. Each type of arthritis has unique characteristics, and the Hand Surgeon should be able to give you a diagnosis of the type of arthritis. Often, plain X-rays are adequate, and special investigations such as CT and MRI scans are not required.




Treatment


There are two broad treatment modalities: Non-surgical and Surgical. Non-surgical treatment options would include splints and anti-inflammatory medications. Steroid injection into the affected joint often can take away the pain for about 4 to 6 months.


Surgery for PIPJ and DIPJ arthritis


Once non-surgical options have been exhausted, the Hand surgeon would discuss various surgical options depending on the functional demand of the patient and the extent of arthritis. The three main types of surgical options are:

  1. Joint denervation

  2. Joint fusion

  3. Joint replacement

Joint denervation:

PIPJ and DIPJ are richly innervated by small nerve branches coming off the two main nerves running along the finger. These small nerves carry pain signals to the brain. Primary aim of denervation surgery is to selectively cut these small nerve using a special instrument called diathermy, thereby abolishing the pain signals being transferred to the brain. Patient has a small dressing at the end of surgery and could start moving the joint as early as the same day. The advantage of this procedure is that it would preserve joint motion and restore function early.



Joint fusion:

During this procedure the remnants of the damaged cartilage are shaved off and the joint is fused with either a screw or any implant that could keep the joint surfaces opposed. The joint is fused in the position where maximum function is maintained without significant reduction in grip strength. The joint is held with a splint until the opposing joint surfaces are fully fused, which normally takes about 6 to 8 weeks. This procedure has reliable success rates and is suitable for someone who accepts loss of joint motion as result of the surgery to achieve pain relief.



Joint replacement:

During this procedure the arthritic joint is replaced by artificial joint made of titanium and polyethylene or medical grade silicone. This procedure is of great benefit to someone who would like to preserve the joint motion, and willing to undergo 6 to 8 week of rehabilitation with a hand therapist to maintain motion at the joint. It is worth noting that with time there is a small risk of the prosthesis becoming loose, and patient may need further surgery such as a joint fusion.


If you are experiencing painful finger joints, get in touch to arrange an appointment and discuss treatment options that are suitable for you




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