Education: Hand Wrist & Elbow Arthritis
the base of the thumb or Basal Joint Arthritis is a common condition
that is often overlooked. Patients will complain of pain at the
wrist and base of the thumb. Pain is present with writing and activities
that require a pinch type grip such as turning a key in a door or
or opening a can. Women are more often affected then men. Non operative
treatment consists of modifications of activities of daily living
and use of a splint that protects the base of the thumb. Writing
with a pen that has a wide grip relieves the pain caused by writing.
It may also be helpful to put a large head on commonly used keys
as this will decrease stresses. Supermarkets often sell rubber grips
that help opening jars.
When these measures are insufficient in relieving pain, surgery
may be considered. If x-rays show minimal joint arthritis, it may
be possible to reconstruct a ligament that stabilizes the basal
joint. When significant damage has already occurred, the surgical
procedure, Basal Joint Arthroplasty, removes the arthritic portion
of the joint. After surgery, a cast that includes the thumb and
goes above the wrist is worn for four weeks. Therapy is usually
necessary after cast removal. Most patients can expect to regain
pain free thumb function. Complications are infrequent but real
and may include the risks of: surgery, infection, problems with
therapy weakness and stiffness.
Rheumatoid arthritis occurs in 1-3% of the population.
In 90% of people, the arm and especially the hands are affected.
The disease causes inflammation in the synovium, the tissue lining
the joint spaces. This process, called synovitis leads to pain and
swelling in the affected joints. If the disease remains active,
there will be progressive damage to both the joint cartilage, and
supporting ligaments. Synovium also surrounds the tendons. Synovitis
may lead to malalignment or even tendon rupture. Synovitis in the
carpal tunnel may cause carpal tunnel syndrome.
Now, there are some new and very potent medications to treat rheumatoid
arthritis, accordingly, it is important to seek treatment early
before there has been irreversible damage. When medications are
not effective, surgery should be considered. If there is not too
much damage to the joint cartilage, the inflamed synovium may be
removed. This procedure called Synovectomy may provide long lasting
relief of pain and preservation of function for the wrist and finger
Arthritis may also develop after an injury or as part of the aging
process in some patients. When there is irretrievable damage to
the joint, Joint Replacement may be indicated. In some circumstances,
joint function cannot be salvaged. In these cases, function can
be salvaged with a Joint Fusion.
Twenty to fifty percent of patients with Rheumatoid Arthritis will
develop elbow problems. The lining of the joint, the synovium, becomes
inflamed. This inflammation, synovitis, maybe painful. To minimize
pain, patients may hold the elbow in a flexed position. Over time
a permanent contracture of the elbow joint will develop. With limited
motion, activities of daily living become progressively more difficult.
If caught in time, this inflamed synovium can be removed while preserving
the remaining bone and cartilage. This surgery is called Synovectomy.
Contractures and loss of motion can be improved as well. Therapy
to maintain motion and improve strength generally is required for
several weeks after surgery. Our research has shown long lasting
relief of symptoms.
When joint problems and arthritis have progressed such that there
is no functional cartilage, Total Elbow Replacement may be considered.
These replacements are made of metal and plastic. They work well
in eliminating pain and restoring function, but may not stand up
to the stresses of those patients who wish to perform heavy labor
After trauma and fractures, patients may develop joint damage and
contractures. Unlike Rheumatoid Arthritis, the synovium is not an
important part of this process. In appropriate circumstances, motion
can be improved and pain relieved surgically. Procedures that
release contractures and restore motion may be considered. Total
Elbow Replacement may be considered when other options are not available.