In arthritis, the cartilaginous surface of the affected joint is damaged or worn. This leads to inflammation with swelling and pain, especially with strenuous activity. Arthritis of the finger joints is the most common arthritic condition of the hand. It can involve one or more joints, and develop in both hands (polyarthritis). Women are considerably more often affected than men.
In principle due to daily mechanical stress, the cartilage lining in every joint can be worn off over the years. There are familial, and probably also hormonal, factors that can provoke the development of arthritis. Other causes include inflammatory diseases of the rheumatoid group, metabolic disturbances (gout, etc.), or sequelae of trauma (fractures, ligamentous damage), which result in dysfunction of the joint.
Usually the discomfort develops slowly over time. The primary symptom is pain, which is initially related to strain, but later persists. Transient swelling can also appear. Cysts (ganglia) can evolve, especially at the distal finger joints. Over time, movement can become limited – in part because of pain, and in part for mechanical reasons, due to joint deformities. In certain arthritic conditions, a complete stiffness of the joint can occur, often followed by pain relief.
The diagnosis is established based on patient history, clinical examination, and radiographs.
Depending on the stage of the disease therapy can include several levels. The primary aim is to address the existing complaints and their causes. Minor disorders can be treated with anti-inflammatory pain medication, to reduce swelling and pain. In addition, cortisone injections into the joint can be applied. Patients with constant pain who do not respond to the above conservative treatment options need surgical therapy.
For the metacarpophalangeal and proximal interphalangeal joints we generally recommend to replace the joint, in order to achieve not only pain relief but also to preserve joint function. For this indication silicone spacers have proven to be successful. They reliably reduce pain and allow for preservation of joint function. A drawback of these prostheses is that they often break after a few years and then need to be replaced in cases of discomfort. If joint replacement is not possible, a fusion/fixation of the affected joint in a functionally beneficial position must be considered. However, especially in the MCP region, this results in significant disabilities and discomfort.
Silicone prostheses may also be implanted in the distal interphalangeal joints (distal finger joints). Although a disadvantage in this position is the reduced stability. Therefore joint fusion is used more frequently in this location, because a stable and pain free outcome can be achieved reliably and the resulting functional limitation is mild.
Follow up care
Immediately following the operation there is usually a short period of immobilization. When prostheses are implanted, mobilization should be started as soon as possible. This is introduced with guidance by hand therapy and occasionally assisted by supportive splinting. At night, the patient usually wears a postural splint, which keeps the finger in a good position.