Do I have arthritis in my hands?
Achy, swollen hands? Tender joints? It’s common to assume these are symptoms of arthritis. After all, 350 million people worldwide and about 40 million Americans suffer from arthritis.
Arthritis is inflammation of a joint due to degenerative changes. There are many types of arthritis, but the most common forms are osteoarthritis (OA), when the protective cartilage in the joint breaks down, and rheumatoid arthritis (RA), when the joints are attacked by the immune system.
Dr. Daniel P. Mass, hand surgeon at the University of Chicago Medicine, explains how arthritis can affect the hands:
Fingertip joint arthritis
About 10 percent of people develop hereditary arthritis in the joints of the finger tips.
“When we work and put pressure through our fingertips, we’re putting about the equivalent amount of pressure as we put through our knees when we’re walking,” said Mass. “So we see lots of patients with little nubby bumps on their fingers that can look ugly, but rarely need to be treated.”
These bumps are called Heberden’s nodes, which are actually small bone outgrowths. Other symptoms include pain, swelling, stiffness where the node is, and a loss of motion.
Basal thumb arthritis
About 25 percent of women over the age of 50 develop arthritis in the thumb. This figure jumps to more than 50 percent of women over the age of 70. However, the condition is significantly less common in men; only about 5 percent develop basal thumb arthritis.
Symptoms of basal joint arthritis include a decrease in strength and range of motion, hand pain and swelling at the base of the thumb.
Post-traumatic arthritis
Post-traumatic arthritis is a form of osteoarthritis that occurs because of an injury to a joint. Because the arthritis develops gradually, it may be hard to recall or determine when the injury occurred.
“We see a lot of arthritis in the wrist due to undiagnosed fractures,” Mass continues. “It’s hard to recognize early. Because we don’t walk on our hands, it can take eight to 10 years or more before we see it, which is why it’s common between the ages of 45 and 60.”
The wrist is prone to arthritis because there are no muscle or tendon attachments to the eight bones in the wrist, which means there isn’t much protection from everyday wear and tear. “The bones of the wrist can be thought of as tiny marbles stacked on top of each other,” Mass said. “That makes them more vulnerable to injuries.”
How doctors diagnose and treat arthritis
Arthritis can be complicated to diagnose, especially in its beginning stages. If the Xray shows narrowing or changes in the joint, arthritis may be developing.
Early treatment of arthritis involves managing symptoms through options such as anti-inflammatory medications, ice and heat treatments, cortisone injections and splints.
To treat arthritis of the thumb, for example, Mass tries to keep things simple, usually starting with a splint to immobilize the thumb. “It keeps reminding people to not aggressively use their thumb, but because the thumb is so important for hand function, many people quit using the splint,” Mass said. “We also give steroid injections, which may decrease the localized inflammation for a short period of time. But that doesn’t cure the problem, doesn’t realign the bone and doesn’t put the cartilage back in.”
If nonsurgical treatments fail to provide symptom relief, surgery is an option for treating finger joints affected by arthritis.
“As I say to my patients, when you say ‘uncle,’ I’ll fix it,” said Mass. “We remove the joint and replace it with a tendon from the forearm to give it new padding. And that seems to work with the tip of the finger joints.”
ARTHRITIS VS. TENDONITIS
While arthritis is common, it’s actually found in the hands far less frequently than people expect. Instead, what many mistake for arthritis is actually tendonitis. Tendonitis is inflammation of the tendons that move the joints. Tendonitis pain can come and go suddenly or last for a few days. Doctors can diagnose tendonitis through a physical examination to evaluate the range of motion and tenderness in the affected area. It can be treated with medications, rest, physical therapy, or, in the most severe cases, a surgical procedure.