Arthritis

The joints of the hand can be damaged by arthritis, causing pain and deformity.

Osteoarthritis is essentially the result of “wear and tear” and tends to affect the small joints of the fingers and the base of the thumb.

Rheumatoid arthritis is an autoimmune disorder which usually affects the knuckles, thumb and wrist. In the early stages of arthritis, treatment involves activity modification, splinting and medication.

As the arthritis becomes more severe, the following treatments can be offered:

Steroid Injection into Joints

Performed under local anaesthetic to reduce the discomfort of the injection. Steroid injections can be effective at relieving painful joints and delaying the need for surgery.

Joint Replacement

In more severe cases, a painful arthritic joint can be replaced by a silicone “hinge” in the fingers. A special ball and socket joint can be inserted at the base of the thumb, which has been likened to a miniature hip replacement.

Joint Fusion

This may be the best option in painful joints with severe destruction and/or instability. Fusion results in complete loss of movement at that joint, but effectively treats pain and provides stability.

Base of Thumb (1st CMC joint) Denervation

This operation involves removing the sensory nerve supply to the joint at the base of the thumb. This can be an effective means of treating pain caused by osteoarthritis, before the need for trapeziectomy or joint replacement arises. The nerves responsible for carrying sensory signals (and therefore pain) from the 1^st CMC joint are divided via 3 short incisions around the wrist.

Trapeziectomy

This procedure involves removing a bone (the trapezium) from the base of the thumb when it has become worn and painful. It is often accompanied by a procedure to loop a tendon from the wrist around the base of the thumb to provide stability. The operation takes place under general or regional anaesthesia (where the arm is made numb, but you remain awake). Following the surgery, a plaster splint is worn for 2 weeks, after which a programme of physiotherapy is started to regain strength.

Tendon Rebalancing

Rheumatoid arthritis can also affect ligaments and tendons, causing deformity. Various procedures can be performed to realign tendons to correct these deformities.

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