WHAT YOU SHOULD KNOW
The term arthritis simply refers to the condition of a joint losing its smooth cartilage surface. When this happens the two bones that make up the joint begin to contact each other. This friction and grinding causes pain, swelling, stiffness and further cartilage loss. Osteoarthritis has no special cause other than use of the joint for many years throughout life. Other types of arthritis are special inflammatory conditions such as rheumatoid arthritis or post-traumatic damage to the joint causing arthritis.
MEDICAL HISTORY
The symptoms usually set in slowly over time. Eventually patients complain of lost function, pain, stiffness, swelling, weakness, and sometimes deformity. The doctor will ask questions to determine whether the arthritis is post-traumatic, osteoarthritis, or a special inflammatory arthritis.
EXAMINATION
The joints are tested for range of motion, stability, alignment, and any grinding during movement.
ADDITIONAL TESTS
Plain x-rays show the degree of arthritis and any bone loss or erosion that may have happened.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL JOINT FUSION | SURGICAL JOINT REPLACEMENT | |
| CONSISTS OF | Oral arthritis medications, cortisone joint injections | Causing the 2 bones that make up the joint to become one unit | Replacing the damaged joint surfaces with man made prostheses |
| FEATURES | Limited number of injections is allowed | Used for the joints at the tip of the fingers | Used for the joint in the middle of the finger and at the knuckles |
| ADVANTAGES | Avoids surgery | Solid and durable | Allows motion |
| DISADVANTAGES | Only treats the symptoms not the underlying bone contact | No motion, small chance of not healing or fusing correctly | Prostheses may loosen or fail over time requiring replacement that is more complicated than the first time due to additional bone loss |
RECOVERY
Sutures are removed in the office at 2 weeks. Fusions are protected by splints from stress until x-rays prove that healing has occurred. The screws placed in the bones to cause fusion remain in place. The time to healing may be anywhere from 8 to 12 weeks. The rate of failing to fuse in the published literature is around 10%. Joint replacements must begin a rehabilitation program of limited motion early after surgery to avoid stiffness. Precaution is exercised during the first month with gradually increasing usage of the hand allowed over the next month. In the third month the hand is trained to perform normal activities with a goal of graduating from therapy by 12 weeks after surgery.
