Courtesy of Orthopedic Center of Florida

Rheumatoid Hand ArthritisPainful aching joints and a general feeling of being unwell are often the first signs of rheumatoid arthritis (RA). It affects nearly 1.5 million Americans between the ages of 30 and 70, and it’s more common in women than men.

Rheumatoid arthritis is an autoimmune disease, and like all other autoimmune-related conditions, it causes the cells in the body to attack itself. In the case of RA, it causes the body to attack its joints. The synovial tissue that lines the joints is the first to become inflamed, and it deteriorates. As the disease progresses, especially if left untreated, it can degenerate the cartilage and then the bone of the joints. Individuals with RA have severe stiffness and mobility issues from the disorder, and their joints may begin to look deformed as RA advances.

Typically, rheumatoid arthritis is symmetrical, meaning that if the right index finger is affected, the left index finger will also be affected. They may not both be as severe as each other, but there will be marked stiffness and inflammation on both sides of the body.

Rheumatoid Hand Symptoms
RA can be challenging to diagnose at first since it mimics many other disorders. Along with pain, many people experience fatigue, loss of appetite, and a low-grade fever. The symptoms and effects of RA may come and go. A period of high disease activity (increases in inflammation and other symptoms) is called a flare. A flare can last for days or months. Ongoing high levels of inflammation can cause problems throughout the body. When the hands, fingers, or wrists are affected, the limited range of motion can be debilitating for many individuals.

Surgical Treatment Options
If nonsurgical treatment does not relieve your pain, and your quality of life has been significantly affected by arthritis, your doctor may recommend surgery. The goal of surgery is to relieve pain while preserving or improving hand function. Typically, this is done by minimizing or eliminating bone-on-bone contact. There are a number of procedures for arthritis of the wrist and hand. Your doctor will talk with you about which procedure will work best in your case.1

Proximal Row Carpectomy
In this procedure, your doctor removes three carpal bones in the row of bones that is closest to the forearm. The procedure is designed to reduce your pain while maintaining some wrist motion.1

Fusion
If motion is the source of your pain, your doctor may recommend fusion. Fusion is essentially a “welding” process. The basic idea is to fuse together the bones so that they heal into a single, solid bone. The theory behind fusion is that, if the painful bones do not move, they should not hurt.1

During the procedure, your doctor removes the damaged cartilage and then uses pins, plates, or screws to hold the joint in a permanent position. Over time, the bones fuse or grow together— similar to the way the fractured ends of a bone heal together.1

Diagnosis
High levels of ESR, (erythrocyte sedimentation rate), and elevated levels of CRP, (C-reactive protein), can be a signal that RA is causing the inflammation in the joints. Other tests can pinpoint rheumatoid factors in the blood, but they’re not always accurate. X-rays and MRIs allow physicians to see the severity of the disease and to track its progression once diagnosed.

Surgical Treatment Options
If nonsurgical treatment does not relieve your pain, and your quality of life has been significantly affected by arthritis, your doctor may recommend surgery. The goal of surgery is to relieve pain while preserving or improving hand function. Typically, this is done by minimizing or eliminating bone-on-bone contact. There are a number of procedures for arthritis of the wrist and hand. Your doctor will talk with you about which procedure will work best in your case.1

Proximal Row Carpectomy
In this procedure, your doctor removes three carpal bones in the row of bones that is closest to the forearm. The procedure is designed to reduce your pain while maintaining some wrist motion.1

Fusion
If motion is the source of your pain, your doctor may recommend fusion. Fusion is essentially a “welding” process. The basic idea is to fuse together the bones so that they heal into a single, solid bone. The theory behind fusion is that, if the painful bones do not move, they should not hurt.1

During the procedure, your doctor removes the damaged cartilage and then uses pins, plates, or screws to hold the joint in a permanent position. Over time, the bones fuse or grow together— similar to the way the fractured ends of a bone heal together.1

In some cases, your doctor can perform a partial fusion in which just some of the carpal bones are fused together. This addresses the damaged joint surfaces but leaves the healthy joints intact to preserve some wrist motion.1

If your arthritis is extensive, a complete wrist fusion may be necessary. In this procedure, all of the carpal bones are fused together, along with the radius (one of the bones in the forearm). Although all wrist motion is eliminated in a complete fusion, forearm rotation and finger/thumb motion are generally preserved.1

Total Wrist Replacement (Arthroplasty)
In total wrist replacement, your doctor removes the damaged cartilage and bone in your wrist and then positions new metal or plastic joint surfaces to restore the function of the joint. Replacing the wrist joint relieves the pain of arthritis while allowing more wrist movement than fusion.1

SANDRA B. COLLINS, M.D.
Orthopedic Surgeon of the Hand and Upper Extremities

Board Certified, Fellowship Trained Orthopedic Surgeon Specializing in Hand, Upper Extremity and Microvascular

Surgery. Dr. Collins focuses on reconstruction and rehabilitation of traumatic injuries and arthritic conditions of the hand, wrist, forearm, and elbow, nerve and tendon injuries, work related conditions, and congenital differences of the hand and upper extremity. She accepts patients of all ages, including children, and works closely with several area certified hand therapists.

Sandra Collins, M.D. continues to focus her practice on reconstruction and rehabilitation of traumatic injuries and arthritic conditions. Dr. Collins looks forward to helping you regain the function of your hands and upper extremity.

For more information, please call 239-482-2663, or visit www.ocfla.net.

Orthopedic Center of Florida
239-482-2663 | www.ocfla.net
12670 Creekside Lane, Fort Myers, FL 33919

Reference:
1. The American Academy of Orthopedic Surgeons, April 2016, https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-wrist/