Hand & Wrist Osteoarthritis

Osteoarthritis is a common disease characterised by progressive degeneration of the gliding surfaces of a joint. It has many causes, however is most commonly idiopathic. Trauma, infection and metabolic disease may contribute or accelerate the normal ‘wear and tear’ of joints and thus disease.     

Thumb

The thumb is the key to function in the hand. It should be long, strong, stable and pain-free. There are four joints including the scaphoid-trapezium-trapezoid (STT), trapezium-metacarpal or carpometacarpal (CMC), metacarpophalangeal (MCP) and interphalangeal (IP). The thumb CMC joint is most commonly affected by arthritis, however painful degeneration of any of these joints will significantly compromise hand function.

X-ray +/- computerised tomography (CT) imaging is required to confirm the diagnosis. Treatment, and thus restoration of function, varies depending on the joint(s) involved.

Non-surgical treatment should always be trialled first. Splinting can help relieve pain and allow patients to continue certain activities and occupations. Medications and steroid injections may also help improve symptoms, although does not alter the underlying degenerative causes of the pain.

The most common surgical procedure for thumb CMC joint pain is trapeziectomy. This involves removal of the trapezium bone at the base of thumb and may be combined with various techniques to stabilise the thumb in a better position. While this procedure provides excellent pain relief, it can cause loss of strength. Other surgical options include fusion or replacement of the joint.

Fingers

Interphalangeal joints of the fingers can become swollen and stiff from arthritis. They may become unstable, deviate, and develop irregularities. Function of the hand may be inhibited by stiffness or pain in any/all fingers.

Investigation in the form of an x-ray is usually the only investigation required.

Non-surgical treatment should always be trialled first. This includes a combination of activity modification, medication and possibly splinting to improve symptoms.

Surgical options may be considered if simple measures fail. The options for surgery are to fuse or replace the affected joint. Joint fusion (arthrodesis) is an excellent solution for pain, however comes at the sacrifice of motion. This is the best solution for the distal interphalangeal joint (DIPJ), where the loss of joint motion has minimal impact on finger or hand function. Joint replacement (arthroplasty) is usually preferred for the proximal interphalangeal joint (PIPJ) and metacarpophalangeal joint (MCPJ). Many techniques and implants are available, however normal joint motion is difficult to restore and the need for revision surgery is well recognised.

Wrist

Osteoarthritis of the wrist is also predominantly spontaneous and idiopathic. Infection and trauma can accelerate the disease process as described in the hand. Trauma to specific structures in the wrist leads to certain patterns of wrist osteoarthritis and collapse. Scaphoid non-union and scapholunate ligament injury in particular can lead to scaphoid non-union advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrist respectively. Other rare but notable conditions causing wrist osteoarthritis include avascular necrosis of the lunate (Keinbock’s disease) and scaphoid (Preiser’s disease).