Arthrosis of the Finger and Hand Joints
Broadly speaking, arthrosis is the wear and tear of joints. The causes of the damage can be varied and it affects various joints.
Osteoarthritis in the hands mostly affects the end joints of fingers, which develop bony bumps on them known as Heberden's nodes, so-called after the man who first described this type of condition. Also commonly affected are the middle joints of the fingers, which also develop nodes called Bouchard's-nodes.
A distinction must be made between osteoarthritis and chronic polyarthritis (rheumatoid arthritis), which is a systematic disease of the rheumatoid type where the immune system builds anti-bodies against its own tissue. Therefore, increased levels of antibodies known as rheumatoid factor indicate the presence of polyarthritis, but they are not always traceable. In contrast to osteoarthritis, anatomical changes usually occur in the joints in the middle of the fingers and in the base joints, but practically never in the finger-end joints. Because these two diseases are fundamentally different, chronic arthritis and rheumatoid arthritis are described separately. Destructive joint deformation can also occur in connection with psoriasis, but is limited to end joints of fingers.
The cause of osteoarthritis is often natural wear and tear (primary osteoarthritis) thus it affects older people. However, inadequately healed fractures near a joint can prematurely lead to what is usually an isolated occurrence of osteoarthritis (secondary osteoarthritis). Hormonal factors have also been discussed as triggers of osteoarthritis in the middle and end joints of fingers, in which case the majority of people affected are women during the menopause (10 times more likely than men).
Generally, degenerated joints can be treated using a variety of surgical methods. For example, a procedure called a syneovectomy might be performed depending on the extent of the degeneration or its cause. The inflamed membrane on the joints is removed and any adhesions are freed. In addition, any bone growths (exostosis) can be removed. Denervation of the joint capsule is usually also performed at the same time. As a result, the symptoms can be reduced, however, the success of the surgery is often not permanent, so further surgery may be necessary at a later point in time.
Another option is the replacement of the affected joint with an artificial one. However, this procedure is limited to middle and basal joints of the finger. The tendons and ligaments of the hand must still be intact. Any destroyed or damaged joint surface is also removed in this surgery and the artificial joint is implanted.
Improved finger motion can also be achieved through the implanting of so-called silicone spacers such as those designed by Swanson. These implants do not have any joint structure but ensure the necessary distance between the bones of the affected joints is maintained. Here a good level of flexibility is achievable. This surgical method requires intensive post-operative care and physiotherapy in order to achieve the above mentioned good flexibility.
Finger and hand joints that show signs of advanced osteoarthritis with distinctly limited movement are recommended to be immobilized (arthrodesis) in a functionally advantageous position because this can stop or at least considerably reduce pain. Depending on which joint is affected or the joint's existing state of mobility due to the osteoarthritis, there will be certain functional limitations after surgery. The affected joint is removed and the finger is fixed by wires, screws or plates in such a way that the bones heal together in 6-8 weeks. In general, the finger will then be pain-free. The wires should be removed after a few months while the screws and any plates can usually be left in.