Signs and Symptoms
Symptoms usually build slowly and may include:
- Aching at the base of the thumb, especially when pinching, opening jars or turning keys
- Pain, stiffness and swelling in the finger joints, often worse in the morning
- Firm bumps on the finger joints closest to the fingertip or in the middle of the finger
- A weak grip or dropping things
- Wrist pain and stiffness with lifting, pushing up from a chair or bending the wrist back
- Fingers or the thumb that start to look crooked or bent
What Causes It?
Each joint is covered with smooth cartilage that lets the bones glide. In osteoarthritis, this cartilage thins and roughens over time, so bone rubs on bone and bone spurs form.
- Finger osteoarthritis, most often in the joints near the fingertip and in the middle of the finger, linked to age and family history
- Thumb base arthritis, also called basal joint or CMC arthritis, which affects the carpometacarpal (CMC) joint where the thumb meets the wrist
- Wrist arthritis after an old injury, such as a wrist fracture that healed out of line or a torn wrist ligament that let the bones shift
- Rheumatoid arthritis, an inflammatory disease in which the immune system attacks the joint lining. It often affects both hands and usually needs care from a rheumatologist as well.
How We Diagnose It at POPB
Your physician will ask about your pain, how you use your hands and your goals, then check each joint for swelling, tenderness, motion and stability, and test your grip and pinch strength. X-rays in our office, usually taken at the same visit, are often enough to show arthritis and how advanced it is.
MRI and diagnostic ultrasound are available in our office when more detail is needed, for example to check the wrist ligaments or tendons. Hand and wrist arthritis is treated by Dr. Tucker, a fellowship-trained hand and upper extremity surgeon, with Dr. Adelman providing non-operative care and ultrasound-guided injections.
Non-Surgical Treatment Options
Most people start with non-surgical care, which aims to ease pain and keep your hands working:
- A splint to rest and support a painful thumb, finger or wrist. Elise Burger, OTR, our occupational and hand therapist, makes custom splints in our office.
- Hand therapy with Elise Burger for gentle motion and strength, plus joint protection: easier ways to grip, open, carry and use tools that put less stress on sore joints
- Anti-inflammatory medication, if it is safe for you
- Cortisone injections into the painful joint to calm inflammation, with ultrasound guidance available to place the medicine accurately
If you have Medicare and osteoarthritis, you may qualify for our Care Management program, with monthly check-in calls and no extra office visits.
Surgical Options
When pain and stiffness limit your daily activities despite non-surgical care, surgery may help. The right procedure depends on which joint is affected and what you need your hand to do.
- Thumb base reconstruction: the worn bone at the base of the thumb is removed and the joint is reconstructed to relieve pain and keep the thumb moving.
- Joint fusion: the worn joint surfaces are removed and the bones are held together so they heal as one. This relieves pain in exchange for motion at that joint.
- Joint replacement: in selected finger joints, the worn surfaces are replaced with an implant to relieve pain while keeping motion.
- Wrist procedures: depending on the pattern of arthritis, options range from removing worn bone to partial or full fusion of the wrist.
Dr. Tucker will explain which option fits your hand and the benefits and risks of each.
Recovery
With non-surgical care, many people notice less pain over several weeks of splinting and therapy, though arthritis tends to progress over time.
After surgery, you will usually wear a splint or cast for several weeks while the joint heals, followed by hand therapy to restore motion and strength. Recovery takes a few months, and timelines vary with the procedure. Elise Burger provides hand therapy in our office and shares your chart with Dr. Tucker.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, X-rays, splints, hand therapy, cortisone injections and medically necessary surgery, subject to your co-pay, co-insurance and deductible. Surgery often requires prior authorization from your plan.
HMO and managed-care plans require a referral from your primary care physician before your visit. If arthritis followed a work injury, ask us about workers' compensation. Our staff verify your benefits when you call.
When to Be Seen
Call our office if pain, stiffness or swelling in your fingers, thumb or wrist lasts more than a few weeks, makes everyday tasks hard, or keeps you from working. After hand or wrist surgery, go to the emergency room or call 911 if you have fever, spreading redness or drainage from the incision. For other questions after hours, call our main office number to reach the answering service.
