Hand and wrist arthritis

Arthritis of the hand and wrist is the loss of the smooth cartilage lining the small joints of the fingers and the joints of the wrist, which causes pain, stiffness, swelling, and a weaker grip. The main types are osteoarthritis, which develops gradually with age; inflammatory arthritis such as rheumatoid arthritis, in which the immune system attacks the joint lining; and post-traumatic arthritis, which can follow a fracture or ligament injury.

• Pain in the finger joints or wrist, often worse after heavy use and eased by rest
• Stiffness, especially in the morning
• Swelling, warmth, or tenderness around the joints
• Bony bumps on the finger joints nearest the nails or in the middle of the fingers
• Less motion, a weaker grip, and difficulty with tasks such as opening jars or buttoning
• Grinding, catching, or a joint that feels loose
• Fingers that gradually drift or bend out of line

Rheumatoid arthritis often affects the same joints in both hands. A small cyst can form near an arthritic joint at the end of a finger and may change the shape of the nail.

Osteoarthritis develops as joint cartilage wears down over time. Cartilage has little blood supply, so it cannot repair itself well. Older age, female sex, a family history, and earlier joint injuries make it more likely.

Rheumatoid arthritis and other inflammatory types occur when the immune system attacks the lining of the joints. The hands and wrists are often among the first joints involved.

Post-traumatic arthritis can develop years after a fracture that involved the joint surface, a dislocation, or a torn wrist ligament, even when the original injury was well treated.

Less common causes include gout and conditions that disrupt the blood supply to a wrist bone, such as Kienböck disease.

A clinician examines the joints for swelling, tenderness, deformity, motion, and stability, and may check nerve function, since carpal tunnel syndrome can cause similar complaints. X-rays show joint narrowing, bone spurs, and the pattern of damage, which helps identify the type of arthritis.

Blood tests are used when inflammatory arthritis is suspected, and a rheumatologist often helps manage those conditions.

Arthritis has no cure, but its symptoms can often be managed. Non-surgical treatment comes first:

• Changing or pacing activities, and using tools with larger handles, jar openers, and other aids
• A splint to rest a painful joint, used for limited periods
• Hand therapy and exercises to maintain motion and strength
• Heat, ice, or alternating warm and cool soaks
• Anti-inflammatory medication taken by mouth or applied to the skin, when appropriate
• A corticosteroid injection into a painful joint, which may give temporary relief and can be repeated only a limited number of times
• For rheumatoid and other inflammatory arthritis, disease-modifying medications prescribed by a rheumatologist

Surgery may be considered when pain or deformity continues to limit daily life despite these measures. The choice depends on the joint involved and how you use your hands:

• Joint fusion (arthrodesis), which joins the bones to relieve pain but ends motion at that joint; after a wrist fusion, forearm rotation and finger motion are usually kept
• Joint replacement (arthroplasty) for selected finger and wrist joints, which aims to preserve motion
• For wrist arthritis, removal of the row of small wrist bones nearest the forearm (proximal row carpectomy), which relieves pain while keeping some motion
• Removal of a cyst or bone spurs, or repair of tendons damaged by inflammatory arthritis

Recovery after surgery depends on the procedure. A cast or splint is usually worn for several weeks, followed by hand therapy. Returning to most daily activities typically takes a few months, and a fused joint will no longer bend.

Not all arthritis can be prevented. Protecting the hands from injury, getting prompt care for joint injuries, and starting treatment early for inflammatory arthritis may help limit joint damage.