Hand Surgery: Arthritis

All joints in the body are lined by a smooth layer of cartilage and lubricated by a viscous joint fluid. Osteoarthritis (or degenerative arthritis) is the loss of the normal cartilage lining. Unfortunately, osteoarthritis is a normal part of the aging process. Everyone will get it to some degree. It can range from mild stiffness to debilitating pain and loss of motion. It is the most common type of arthritis.

The most commonly affected joint by osteoarthritis is at the thumb base, called the first carpometacarpal joint. Hence the term CMC arthritis. It involves pain at the base of the thumb that is worse with activity (specifically turning motions such as turning the lids on jars). Although it usually doesn't cause symptoms until the fifties or sixties, some individuals as young as their early forties can have significant symptoms.

Work-related arthritis is common in manual laborers who use their hands for heavy lifting or repetitive motion activities. It is often seen in the wrist and at the thumb base.

Post-traumatic arthritis occurs following an injury to a joint. It can develop in any age group, most commonly after a fracture or severe ligament injury.

Rheumatoid arthritis, can lead to joint destruction by the body's own immune system attacking various components of the joint.

Other diseases such as gout, psoriasis, and inflammatory bowel disease can cause arthritis. The end result is similar to classic osteoarthritis: joint destruction leading to pain and loss of motion.

The diagnosis of arthritis is relatively straightforward, and involves a thorough medical history and examination by a surgeon and obtaining x-rays of the involved joint. Some blood tests may be necessary if a condition other than osteoarthritis is suspected.

Treatment is initially non surgical, and consists of oral anti-inflammatory therapy, splinting and rest. The next step is a steroid injection directly into the joint. Surgery is reserved as a last resort. We offer a variety of surgical options for arthritis of thumb base, as well as arthritis of other joints in the wrist, hand and fingers. Our hand fellowship-trained surgeon, Gil Kryger, md, directs the hand clinic at the Kryger Institute of Plastic Surgery and will make sure that the appropriate treatment is chosen for you.