Osteoarthritis is a degenerative condition where the smooth articular cartilage that covers the ends of the bones is gradually destroyed. The end result is that bare bone ends rub against each other, which causes pain and stiffness. Osteoarthrits can affect any joint in the hand. It most commonly affects the base of the thumb (termed "basal joint arthritis" or "1st CMCJ arthritis", as in the picture on the right and x-ray below) and the fingers (interphalangeal joints).
Osteoarthritis in the fingers
Hebeden's nodes are bony nodules (termed "osteophytes") that form at the end joints of the fingers (the "distal interphalangeal joints"). They are not treated with surgery, and nor are Bouchard's nodes, which is the term given to the bony nodules that form around the proximal interphalangeal joints.
Digital mucous cysts are also found around the distal interphalangeal joints in people with osteoarthritis. They are ganglion cysts that arise from the distal interphalangeal joint and form a lump between the joint and the nail fold. They are more common in women than men and they commonly create a ridge in the nail. Mucous cysts can be conservatively treated through observation and aspiration (where the contents of the cyst are drained with a needle and syringe) but this method of treatment carries significant risks of recurrence and of infection - and these infections can result in a need for admission to hospital and multiple surgeries to treat the infection. Surgical excision of mucous cysts involves the excision of the cyst and any osteophyte related to the cyst; it is a very effective method of treatment. This procedure can be performed under local anaesthetic as day surgery (wide awake hand surgery).
Non surgical options
Non surgical options include
- use of heat and ice
- analgesics (such as paracetamol)
- corticosteroid injections
- changed activities
Indications for surgery
Surgery is indicated for osteoarthritis when pain severely limits daily activities despite adherence to non-surgical therapies.
Surgical options involve joint preservation or reconstruction wherever possible. The two main surgical treatments are: