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What is Arthritis?
Arthritis is a degenerative disease of the joints that can affect joints all over the body and can be particularly debilitating in the hands. Arthritis can cause a great deal of pain in the hands and, over time, can cause deformity and disability. Dr. Fichadia has helped many patients regain their independence by restoring function and comfort.
Who is a Candidate for Arthritis Hand Surgery?
Patients experiencing arthritic pain and loss of function may benefit greatly from available surgical optionshand procedure. Patients that may be considered for arthritis hand surgery may have the following symptoms:
- Range of motion changes – patients with moderate to severe arthritis may experience range of motion changes such as a rough, grinding motion or even a looseness to the joint that inhibits control and function.
- Swelling – As the joints begin to accumulate stress they will swell, preventing further movement.
- Warm to the touch – Much of the time, an arthritic joint will feel warm to the touch as the body’s response to inflammation.
The Procedure
Arthritis does not have to result in a painful or sedentary life. It is important to seek help early so that treatment can begin, and you can return to doing what matters most to you.
Treatment Options
Fortunately, there are non-surgical options such as medications, injections, and supporting the joint with a splint. If these are not effective, you’ll have a few surgical options. The first is using a fusion of the bones of the knuckle joints to create a stronger joint, but this can lead to decreased range of motion. Another option is a complete replacement of the joint using an artificial substitute. You’ll discuss these options at length with Dr. Fichadia, but here are some basics to know before your consultation.
Nonsurgical Treatment
Treatment options for arthritis of the hand and wrist include medication, splinting, injections, and surgery, and are determined based on:
- How far the arthritis has progressed
- How many joints are involved
- Your age, activity level and other medical conditions
- If the dominant or non-dominant hand is affected
- Your personal goals, home support structure, and ability to understand the treatment and comply with a therapy program
Medications
Medications treat symptoms but cannot restore joint cartilage or reverse joint damage. The most common medications for arthritis are anti-inflammatories, which stop the body from producing chemicals that cause joint swelling and pain. Examples of anti-inflammatory drugs include medications such as acetaminophen and ibuprofen.
Glucosamine and chondroitin are widely advertised dietary supplements or “neutraceuticals.” Neutraceuticals are not drugs. Rather, they are compounds that are the “building blocks” of cartilage. They were originally used by veterinarians to treat arthritic hips in dogs. However, neutraceuticals have not yet been studied as a treatment of hand and wrist arthritis. (Note: The U.S. Food and Drug Administration does not test dietary supplements. These compounds may cause negative interactions with other medications. Always consult your doctor before taking dietary supplements.)
Injections
When first-line treatment with anti-inflammatory medication is not appropriate, injections may be used. These typically contain a long-lasting anesthetic and a steroid that can provide pain relief for weeks to months. The injections can be repeated, but only a limited number of times, due to possible side effects, such as lightening of the skin, weakening of the tendons and ligaments and infection.
Splinting
Injections are usually combined with splinting of the affected joint. The splint helps support the affected joint to ease the stress placed on it from frequent use and activities. Splints are typically worn during periods when the joints hurt. They should be small enough to allow functional use of the hand when they are worn. Wearing the splint for too long can lead to muscle deterioration (atrophy). Muscles can assist in stabilizing injured joints, so atrophy should be prevented.
Surgical Treatment
If nonsurgical treatment fails to give relief, surgery is usually discussed. There are many surgical options. The chosen course of surgical treatment should be one that has a reasonable chance of providing long-term pain relief and return to function. It should be tailored to your individual needs.
If there is any way the joint can be preserved or reconstructed, this option is usually chosen.
When the damage has progressed to a point that the surfaces will no longer work, a joint replacement or a fusion (arthrodesis) is performed.
Fusion
During fusion, also known as arthrodesis, the bones of the knuckle joints are fused to create a stronger and more stable knuckle. While this method can eliminate pain, it will also result in less flexibility and range of motion.
Joint Replacement
Joint replacement, or arthroplasty, includes removing the worn down joint and replacing it with an artificial replacement. This type of arthritis hand surgery also relieves pain but since the joint is being replaced, some function is possible.
Results & Recovery
After your procedure, it will be very important that you follow Dr. Fichadia’s aftercare and recovery instructions. During this recovery period, you may need to modify your everyday activities in order to put less stress on your hand while it heals. Dr. Fichadia may also recommend that you see a physical therapist or an occupational therapist to help you return to your normal everyday activities.
If you are experiencing arthritic pain in your hands and you feel that you may need a more intensive solution, contact Dr. Fichadia’s office today to schedule a consultation.
Dr. Fichadia is a double board-certified, comprehensively trained plastic and reconstructive surgeon. She completed general surgical training at St Elizabeth’s Medical Center, an affiliate of Tufts University School of Medicine in Boston, MA, and subsequently completed a highly competitive plastic surgery program at Oregon Health and Science University in Portland, OR. She has presented research from her time in Boston and Portland at national and international surgical meetings such as Clinical Congress of the American College of Surgeons and annual meeting of American Society of Plastic Surgery.
