Ad hoc, ad loc and quid pro quo. So little time, so much to know.
The Nowhere Man from the animated movie “Yellow Submarine”.
There are a number of things a patient usually doesn’t want to hear when them come to the doctor, and finding out that they have arthritis is certainly one of those things. Unfortunately, arthritis of the hands and wrist is a very common condition that patients and doctors have to deal with, and the more you know about this condition the better prepared you can be to deal with the problem and understand what a doctor can and can’t do for your arthritis.
First off, the term arthritis encompasses a wide array of conditions. Some forms, such as Rheumatoid Arthritis, can cause crippling deformities of the hands as well as other joints. Other forms of arthritis may cause painless bumps and swelling at different joints in the hand. Most types of arthritis in the hands follows a specific pattern and involves specific joints. Most primary care physicians are knowledgeable about the basic forms of arthritis and the non-operative treatment for these conditions. Patients usually wind up seeing a hand surgeon either for advice about their treatment or to consider injections or surgery after trying other less invasive measures.
I’m going to start by talking about arthritis of the thumb. This is the most common painful area of arthritis in the hands. The most common location is at the base of the thumb where your thumb joins to your hand. Although the thumb can be involved in a number of different types of arthritis, most commonly arthritis of the thumb is seen in basic osteoarthritis. Although other joints of the hand and wrist can be affected, arthritis at the base of the thumb is rarely the sign of a more aggressive, crippling if you will, arthritis of the hands. This is a beautifully designed joint that allows us a great deal of mobility of our thumbs in a wide variety of planes of motion. This is the joint that separates our hand function from that of primates and allows the thumb to be the dominant digit of our hands. Alas the price we often pay for specialization is an increased tendency to break down or wear out, and that is the case with the base of the thumb.
Although some people develop arthritis of the base of the thumb after injuries, most of the time it is an insidious process that develops over many years. The cause is a wearing out or degeneration of the ligaments that support the joint. The onset can be fairly early in life (for arthritis) and I often see the problem in patients around 50 years of age. The first symptoms are usually pain and swelling. Patients have trouble grasping large objects and pinching smaller objects. Both of these actions put a great deal of stress on the base of the thumb. At first the symptoms are aggravating, but they often progress to the point where they can interfere with use of the hand and activities that people do every day. So what do you do?
Unfortunately there are no medicines that can stop or slow down the process. The easiest thing to do is to simply avoid activities that aggravate the pain. You can try anti-inflammatory medications like Advil or Aleve as well. Braces seem to help a lot, especially in the early stages of the problem. Flexible sleeves that support the thumb usually provide enough stability and are readily available at pharmacies and other retailers.
If these measures don’t work then you have to think about other considerations such as injections or surgery. Most hand surgeons will try a combination of steroid and local anesthetic injected directly into the joint. My experience has been that these shots do a pretty good job of controlling pain but that they eventually wear out. If injections don’t work or aren’t too appealing, then surgery is really the only other option. There are a number of techniques available to treat the arthritis, but almost all of them involve removing a small bone in the wrist and stabilizing the thumb. No matter what technique is used this is a big surgery that can take up to 3-6 months to recover from and regain full use of your hand. I think the surgery generally works very well but as a patient you need to be aware of the long recovery and rehabilitation that is involved.
Next time I’ll plan to discuss basic osteoarthritis in the other joints of the hand. Thanks for reading!