Arthritis
The literal definition of the term "arthritis" is the inflammation of joints. Such joint inflammation is painful and compromising to the function of the involved joint. With over 25 joints from the shoulder to the hand, the involvement of the hand surgeon in treating arthritic conditions is not surprising.
Osteoarthritis
Osteoarthritis is the "wear and tear" arthritis of aging. It commonly affects the hand, but only occasionally affects the elbow and shoulder. The common complaints are achiness, stiffness (particularly in the morning) and restricted motion of the various joints involved. Simple tasks such as opening jars, writing a letter, or knitting a sweater can become quite difficult. The tenderness of the involved joints, coupled with X-ray findings of wearing of the joints, makes diagnosis relatively easy. Early symptoms can be effectively treated by the family physician, internist or hand surgeon with the use of non-steroidal anti-inflammatory drugs. The application of protective splints by a hand therapist, along with instruction in methods to protect painful joints can help slow the progress of disability. Surgical methods may be preventative or restorative of function by reconstructing the diseased joint or joints.
By "tightening" or reconstructing the stretched out ligaments, further wearing of the joint can be prevented. If advanced arthritic changes already have occurred and do not respond to medication, reconstruction can take one of two forms - joint replacement (arthroplasty) or fusion (arthrodesis).
With joint replacement, the diseased joint surfaces are cut away and replaced with a "spacer" of tendon or some form of artificial joint. These joint replacement methods are best for patients who do not perform repetitive heavy manual activity.
On the other hand, in the carpenter, construction laborer or mechanic, fusion of the joint provides the strongest most durable thumb. This is accomplished by cutting away the opposing diseased surfaces of the joint and pinning the two bones that form the joint. This will heal together like a fracture.
Rheumatoid Arthritis
While not as common as osteoarthritis, rheumatoid arthritis can be more disabling. Unlike osteoarthritis, it can affect young people, particularly young women in the most productive years of their life.
Rheumatoid arthritis is not a "wear and tear" condition. Instead, the body's own immune system aggressively attacks and destroys the joints. Tendons that move joints can also be attacked and can rupture. Left unchecked, severe disability and deformity occur.
Non-operative care with medication and therapy is crucial in caring for these patients. The medications used are quite diverse and powerful. Therefore, a rheumatologist may be helpful to supervise their administration.
When non-operative methods fail to hold the disease in check, various surgical methods are available top relieve pain, prevent deformity, and improve function.
Preventative surgery probably plays a more integral role in rheumatoid arthritis than in osteoarthritis. The offending tissue that causes joint destruction and tendon rupture is called synovium or tenosynovium. The surgical excision of this aggressive tissue (synovectomy or tenosynovectomy) can slow down the destruction of joints and prevent the rupture of tendons. Early preventative surgery can often avoid the need for the more complex reconstructive procedure for ruptured tendon and destroyed joints.
Tendon transfer or the substitution of a normal tendon and muscle for one that is ruptured is often quite beneficial.
As in osteoarthritis, the reconstruction of destroyed joints takes the form of either joint replacement or joint fusion.
The existence of a deformity does not, of itself, automatically dictate the need for surgery. Consideration of residual overall function is important. The need for and timing of any surgery in the rheumatoid patient represents perhaps the supreme challenge of the hand surgeon's judgment.