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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.
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