What is arthritis?
There are many types of arthritis and all of them can affect the hand and wrist including osteoarthritis, rheumatoid arthritis and psoriatic arthritis. Different types of arthritis are caused by different processes but all can result in problems with the joints.
Symptoms can include pain, swelling, stiffness, decreased strength and function, deformities and instability. Both conservative and surgical treatments are available for many of these.
What can I do about my arthritis?
Most types of arthritis affecting the hand and wrist can be helped by assessment and treatment from either a specialist consultant or hand therapist at The BMI hand & Wrist Service. Very often the most effective treatment will involve a combination of the two.
Conservative treatments from a hand therapist may include splinting to support painful or lax joints, to aid function or counteract the effects of deformities. These splints could be “off the shelf” ones but are more likely to be custom made from thermoplastics or neoprene (wetsuit material). Teaching exercises to improve or maintain movement is also important. These need to be specific and carried out regularly to be most effective.
Joint protection techniques are also taught to help understand how use of the hands will impact the pain and deformity in them. Changing the way a grip is carried out, using two hands or using specific equipment (such as a pen grip or adapted plugs) can make a daily impact on the hands and minimise the stress on the joints. The hand therapist will assess for hand function, teach joint protection techniques and provide advice and recommendation where appropriate for assistive devices.
Conservative treatments from a surgeon include injecting a swollen joint with corticosteroid. This can be done under ultrasound guidance. This treatment is an anti-inflammatory one and hopes to minimise the symptoms by reducing the swelling. This can be important, not only to relieve pain, but also to prevent damage.
Should I have surgery?
Surgery is available for arthritic joints. Surgery for arthritis in the hand and wrist aims to remove pain and improve function. Timing is very important and the surgeon will assess the symptoms and use imaging to help plan appropriate intervention.
Some common operations include:
- Joint replacements
- Joint fusions
- Synovectomies (removal of synovial fluid / swelling)
- Tendon repairs and transfers for ruptures
What happens after surgery?
Most surgery is followed by a period of rehabilitation under the guidance of your hand therapist. The surgeons and hand therapists work closely together to ensure the best outcome is achieved. The procedures mentioned above are varied in their post operative protocols. Most will include splinting, exercise, wound and scar management and a return to function. Some procedures require several months of rehabilitation. Please discuss this with your therapist and/or surgeon beforehand.