A Guide To Hand And Wrist Arthritis
Part I: Introduction
Arthritis refers to the inflammation of the joints that can cause severe joint pain. There are more than 100 kinds of arthritis, and the causes, as well as treatment options, differ from one another. It is important to determine the type of arthritis you have to find the best treatment and pain management options. Hence, it is advisable to seek the professional advice of a specialist or doctor in Singapore if you suspect that you are suffering from symptoms of arthritis.
Part II: The most common hand arthritis: Degenerative Osteoarthritis
Our hands and wrist have multiple small joints that work together to enable motion, such as threading a needle and tying a shoelace. When these joints in our hands are affected by arthritis, performing daily activities can suddenly seem difficult. When it is left untreated, hand arthritis can even cause the bones in the joints to lose their normal shape. This results in more pain and limited range of motion.
Osteoarthritis (OA) refers to the breakdown of cartilage in the joint, and is the most common form of joint disorder affecting many people across the world.
The joint is the point where two bones meet, and the ends of the joints are covered with protective tissue known as cartilage. Cartilage is a firm, connective tissue found throughout the body. It serves various structural and functional purposes in joints like our spine, hip, ears, and even nose. In bones and joints, the function of the cartilage is to enable nearly frictionless joint movement. Furthermore, healthy cartilage also protects the joint against weight-bearing stresses.
When the cartilage breaks down or deteriorates, the bone surfaces become pitted and rough. As such, this can result in pain within the joint and irritate surrounding tissues. What makes this joint disease different from the rest is that cartilage does not contain any blood vessels, and thus damaged cartilage cannot repair itself. Over time, the cushioning buffer will disappear completely, causing painful bone-on-bone contact. Besides the breakdown of cartilage, osteoarthritis has an impact on the entire joint. It can cause structural changes in the bone and inflammation of the joint lining.
Even though OA commonly affects older people, it can also occur in adults of any age. Statistics have shown that OA affects up to 10 percent of the adult and 20 percent of the elderly population in Singapore. Because of the nature of this disease, some people refer to OA as degenerative osteoarthritis or “wear-and-tear” arthritis. Apart from the hips and knees, osteoarthritis is commonly found in the hands as well as wrists.
Patients suffering from hand osteoarthritis tend to notice bony nodules at the middle joint of the finger or the end of the finger. These affected areas may also swell up and ache. It may also be more difficult for you to open a jar or turn a key if you have hand osteoarthritis.
As osteoarthritis is mainly caused by joint damage, age is one of the most common risk factors for the disease. The older you are, the more wear and tear your joint experiences. Aside from age, your risk of developing osteoarthritis also increases with other lifestyle habits:
A study in 2007 has shown that smokers were twice as likely to experience significant cartilage loss as compared to non-smokers. Researchers also explained that smoking may cause cell disorders and deter cell production in the cartilage. In addition, smoking also raises the toxins level in the blood, contributing to cartilage loss in joints.
Although being overweight generally causes problems for weight-bearing joints like the hips and knees, it also affects osteoarthritis in the hand. Research has found that hand osteoarthritis is twice as common amongst obese people as it is in leaner people. As fat is a chemically active compound that constantly releases inflammation-causing proteins in our body, obesity naturally increases the risk of developing osteoarthritis.
- Repetitive movements
Repetitive motions that stress the joints can eventually lead to osteoarthritis. For instance, repeatedly lifting things may cause the cartilage in the stressed joints to break down, resulting in osteoarthritis. Professions that require repetitive movements in the hands, such as hairdressers and bakers, increases the risk of the cartilage wearing down. As such, people in these jobs often experience wrist and hand pain, or osteoarthritis.
In addition to these three risk factors, heredity can also play a role in osteoarthritis – individuals born with other bone diseases or genetic traits may be predisposed to develop hand or wrist osteoarthritis.
Part III: Understanding other types of hand arthritis
Besides degenerative osteoarthritis, there are other types of arthritis that can occur in many areas of our hands and have more than one cause.
1. MP Joint Arthritis
In MP joint arthritis, there is a loss of cartilage at the metacarpophalangeal joint, also known as the MCP joint or the knuckle joint. Metacarpophalangeal comes from the names metacarpals (hand bones) and phalanges (finger bones) – because it is the joint where the finger bones and hand bones meet.
The MCP joint allows our fingers to move in multiple directions, perform movements such as bending, straightening, and even spreading apart. These joints are also responsible for the pinching and gripping action of our fingers. As such, patients with MP joint arthritis often experience loss of motion, swelling of joints, as well as pain in the fingers. Another common symptom of MP joint arthritis noticed by hand doctors in Singapore is the shift in fingers toward the pinky side.
2. Psoriatic Arthritis
Psoriasis is a skin disease that results in patients suffering from dry, red, and scaly skin rash on their body. As a result of this skin disease, some patients end up developing psoriatic arthritis. In this condition, the lining of the joints becomes inflamed and swollen. The inflammation also stretches the tissues that keep the joint in the area strong, causing the joint to end up loose or crooked. Furthermore, the smooth ends of the bones wear out, resulting in the bone losing its normal shape.
Psoriatic arthritis may not affect the hands equally like rheumatoid arthritis, and it may be hard to tell the condition apart from other types, as they have similar symptoms like swelling, stiffness, and ache. However, other parts of the hand and wrist are usually not affected. Instead, the swelling typically affects the whole finger, and more so at the middle joint. The joint at the end of the finger may also become deformed.
3. Thumb Arthritis
Thumb arthritis, also referred to as basal joint arthritis, comes with age and is more common in women than men. This joint disease tends to develop in patients above the age of 40. In addition, any type of trauma to the thumb can also increase the risk of developing thumb arthritis. Other conditions such as rheumatoid arthritis and lupus may also affect the base of the thumb, resulting in the deterioration of the joint. Certain actions or movements such as opening jars, turning doorknobs, and writing can be painful when you suffer from thumb arthritis.
If you suspect or are experiencing any of the conditions mentioned above, then it is recommended to see Dr Jacqueline Tan, a hand specialist in Singapore, as soon as possible to find out about the treatment options available.
4. Rheumatoid Arthritis
Unlike degenerative osteoarthritis which results from wear and tear, rheumatoid arthritis is caused by inflammation in the joints. This inflammation causes the breakdown of cartilage, which exposes the bone and thus leads to stiff and painful joints.
This condition commonly affects the wrist, knuckles, and both hands, with symptoms including:
- A soft lump on the back of the hand
- Bent middle finger
- Firm nodules developing along the fingers or elbow
- Inability to straighten or bend finger
- Numbness and tingling sensation in the hands
Part IV: Wrist Arthritis
Besides hand arthritis, hand doctors in Singapore can also diagnose wrist arthritis and provide treatment options for them too.
As mentioned earlier, pain and stiffness are common symptoms of arthritis. When these symptoms occur in your wrist, performing simple daily activities can seem more difficult.
Our wrist is a complex joint that is made up of multiple small joints. In a healthy wrist, the bones glide easily over each other during movement as they are protected by smooth cartilage coating the joint surfaces. However, in an arthritic wrist, the smooth joint surface is absent, so the bones rub against each other, which eventually leads to irreparable joint damage.
Similar to the hands, arthritis can also develop in different parts of the wrist. Arthritis in the small wrist bones is referred to as midcarpal arthritis, whereas radiocarpal arthritis occurs in the joint where the small bones and long forearm bones meet. Distal radioulnar arthritis occurs at the area of the joint where the radius meets the ulna of the wrist.
There are many potential causes of wrist arthritis, but here are the three most common ones:
Just like arthritis in other parts of the body, wrist arthritis can also be caused by gradual wear and tear.
- Autoimmune diseases
In certain cases, the body’s immune cells may attack its own cartilage – this condition is known as autoimmune or inflammatory arthritis. One common type of inflammatory arthritis is rheumatoid arthritis. Most of the time, wrist specialists in Singapore will prescribe medication to manage this condition. Hence, if they think you are suffering from inflammatory arthritis, they may refer you to see a rheumatologist for a treatment option to prevent the inflammation from spreading to other parts of your body.
Rheumatoid arthritis often starts in smaller joints such as those found in our hand and wrist. The radius and ulna of the forearm are also two wrist joints that are commonly affected by rheumatoid arthritis. Deformities in the ulna can cause further wearing and possible rupture of the tendons that help you straighten your fingers. This in turn causes more deformity and loss of function in your hand.
Last but not least, the symptoms of rheumatoid arthritis are symmetrical, and this means that it affects the same joint on both sides of the body.
- Post-traumatic Arthritis
A broken wrist bone from playing a sport can develop into arthritis. This is known as post-traumatic arthritis. Broken bones may lead to uneven joint surfaces that wear out quicker than smooth ones, and the most common types of wrist fractures that lead to wrist arthritis are the distal radius and scaphoid fractures.
The distal radius and scaphoid may be injured when a significant load is placed on the extended wrist, like falling onto an outstretched hand. Arthritis can develop quickly after a break into the joint, or after a period of time if the bone does not heal right. That’s why, you should always seek medical treatment immediately from a hand surgeon or wrist specialist in Singapore if you suspect that you’ve sustained a wrist fracture after a fall.
Aside from fractures, ligament injuries also prevent the bones from moving the right way and can eventually lead to arthritis. The common symptoms of wrist arthritis are pain, swelling, and stiffness. These symptoms tend to be constant especially when the arthritis is severe.
Differences Between Osteoarthritis And Rheumatoid Arthritis
Both osteoarthritis and rheumatoid arthritis affect the joints, however, they are very different in terms of pathophysiology and symptoms. As mentioned earlier, osteoarthritis (OA) is a degenerative joint condition, whereas rheumatoid arthritis (RA) is an autoimmune disease. Here are some differences between OA and RA:
- Risk Factors
Both types of arthritis tend to develop in women more than men. Whilst OA is more prevalent in older adults and the elderly, RA can affect anyone of any age. You’re also more likely to suffer from OA if you are obese, have joint deformities, or chronic conditions such as diabetes and gout.
Both OA and RA share many of the same symptoms such as
- Stiff and painful joints
- Limited range of motion
- Tenderness in the affected area
However, since RA is a systemic disease affecting your entire body such as your eyes, heart, and lungs, you may observe other signs such as muscle aches, unexplained excessive fatigue, and low-grade fever in children. If you suffer from advanced stages of RA, you may also notice hard lumps under the skin near the affected joints. These lumps are known as rheumatoid nodules and can be painful or tender to the touch.
On the other hand, people with OA tend to experience symptoms that are limited solely to the joints. Whilst you may notice lumps under the skin around the joints, you need not fret as they are different from rheumatoid nodules. If you are worried about it, you can always book an appointment with our hand specialist, Dr Jacqueline, so that she can better understand your hand condition.
- Affected Joints
Both OA and RA tend to affect different joints of the body. As mentioned earlier, RA begins in the small joints, and patients may feel their finger joints hurting or notice swelling in them. Furthermore, RA is a symmetrical disease affecting both sides of the body at the same time.
Even though OA is also common in the hands, fingers, and wrists, it also affects the spine, hips, as well as knees. In addition, OA is less symmetrical – for instance, you may feel pain in both your wrists, however one side tends to be worse than the other.
Despite the differences between the two joint diseases, the primary goal of treatment is the same. Treatment options provided by hand specialists in Singapore aim to reduce pain, improve function, and minimise further damage to your joints.
Part II: Treatment For Hand And Wrist Arthritis
Unfortunately, there is still no cure for hand and wrist arthritis. However, there are many treatment options available in Singapore to help you manage symptoms such as pain and numbness associated with the joint disorder.
When left untreated, your hand and wrist arthritis can worsen and lead to:
1. Increased risk of carpal tunnel syndrome (CTS). Arthritis has an inflammatory component that can affect the lining around the tendons. This leads to increased pressure on your median nerve, resulting in CTS.
Read more about CTS here: https://www.advancedhand.com.sg/services/carpal-tunnel-syndrome/
2. Predisposal to trigger finger. The inflammation caused by arthritis may not necessarily be isolated or contained. The tissues in our fingers are interconnected and inflammation in the joint may have cascading effects. For instance, rheumatoid arthritis attacks the synovial membrane, causing inflammation that may lead to trigger finger.
3. Development of cysts. Arthritis that affects the end joints of the fingers may result in small cysts developing. These cysts can result in ridging or dents in the nail plate of the affected finger.
4. Physical changes to the finger joints. Arthritis due to damaged ligaments may lead to the support structures of the joint becoming unstable. In severe cases, the joint may appear larger than normal, and this is usually due to a combination of bone changes, joint swelling, and loss of cartilage.
Hand Arthritis Diagnosis
To diagnose hand arthritis, your doctor will have to perform evaluation and tests. They will also check the joints in your hand for signs of arthritis. In certain cases, your hand doctor may also order an X-ray to check for cartilage loss and other signs of damage in your joints such as bone spurs and erosions. Very rarely will a hand specialist order an MRI to look more closely into your bones and soft tissues.
As the symptoms of hand osteoarthritis are similar to other joint conditions like rheumatoid arthritis, your doctor may also order blood tests to check for the levels of antibodies.
Wrist Arthritis Diagnosis
When seeing a wrist specialist for your condition, they will first ask about your symptoms and medical history before performing a physical examination of your wrists. During the physical exam, your doctor will check your wrist for swelling, pain, and tenderness. Through evaluation, they will also determine the location of swelling to find out which wrist joints are most affected.
The range of motion of your wrist will also be examined to check if you have carpal tunnel syndrome, as well as identify the severity of your wrist arthritis. Your wrist specialist may also order further tests such as X-rays and blood tests to check for rheumatoid arthritis.
Suffering from hand and wrist arthritis does not necessarily mean that you have to lead a painful or sedentary lifestyle. What is most important is for you to seek help from a hand and wrist specialist in Singapore as early as possible, so that your treatment can begin.
Nonsurgical treatment for hand and wrist arthritis include medication, splinting, injections, and surgery. These treatment options depend on the severity of your condition.
Medications treat the symptoms of arthritis and provide relief, however, they are unable to restore joint cartilage or reverse joint damage. The most common medication would be non-steroidal anti-inflammatory drugs (NSAIDS). These are painkillers and are the treatment of choice for hand and wrist pain.
Injections containing a steroid and long-lasting anaesthetic may be used to provide pain relief for a prolonged period. These injections can be administered repeatedly but at a limited number of times due to the potential side effects like skin thinning, and weakening of tendons.
Splinting is often used concurrently with medication and injections. Wearing a hand or wrist splint supports the affected joint, easing the stress placed on it from frequent use.
- Other remedies
There are other remedies and supplements that you can take if you are suffering from arthritis. For instance, curcumin in turmeric is known to reduce inflammation, and glucosamine when taken with chondroitin can help slow down the progression of joint degeneration.
If nonsurgical treatment fails to provide relief, your hand and wrist specialist in Singapore will then advise you to consider surgery. There are many surgical options available in Singapore, and the recommended course of surgical treatment by your hand surgeon should give you the highest chance of long-term pain relief. The treatment option also has to be tailored to your individual needs.
Surgeries recommended by your hand surgeon also depend on the diagnosis, joints, and soft tissue involved. Dr Jacqueline, a female hand surgeon in Singapore and director of Advanced Hand Centre often recommends hand or wrist arthroscopy in early cases. Arthroscopy is a minimally invasive surgical procedure where the surgeon inserts a tiny camera and surgical tools to examine or repair tissues inside your hand/wrist. This procedure allows your surgeon to detect problems and make repairs to the affected joint without making large incisions. The advantage of this procedure is that you may experience less pain and have a quicker recovery than open surgery.
Read more: Wrist Arthroscopy & Wrist Pain https://www.advancedhand.com.sg/wrist-arthroscopy-wrist-pain/
Joint fusion and joint replacement will only be recommended if the condition of your joint has progressed to a point where the surfaces are severely damaged. This is because, whilst joint fusions provide pain relief, they also stop joint motion. The damaged joint surfaces are removed to provide pain relief, but the fused joint makes it impossible for you to bend and straighten.
On the other hand, joint replacement requires the insertion of materials such as ceramics, or long-wearing metal and plastic parts. This procedure aims to offer pain relief as well as restore function.
Aside from the aforementioned joint surgeries, tendon transfers may also be performed on patients who suffer from rheumatoid arthritis. This helps to remove the inflamed tendon or soft tissue and as such, reduce symptoms like pain and swelling.
Most of the major joints in your hand and wrist can be replaced via surgery. However, it is important to seek the help of an advanced or senior surgeon, such as Dr Jacqueline to perform the surgery.
Part IV: Conclusion
There is a period of recovery after any type of joint surgery, and you may also be referred to see a physiotherapist to help you maximise your recovery. During the postoperative period, you may also need to modify your daily activities to allow joint reconstruction to heal properly.
It’s important to track your symptoms and see a hand specialist as soon as possible to learn about the treatment options available for you. Don’t let hand or wrist arthritis prevent you from doing the activities you love.