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Achy, swollen hands? Tender joints? It’s common to assume these are symptoms of arthritis.
After all, 350 million people worldwide and about 40 million Americans suffer from arthritis. While arthritis is common, it’s actually found in the hands far less frequently than people expect. Instead, what many mistake for arthritis is actually tendonitis.
We spoke with hand surgeon Daniel P. Mass, MD, professor of orthopedic surgery and rehabilitation medicine at the University of Chicago Medicine, to learn more about the two conditions.
Tendonitis by definition is inflammation of the tendons that move the joints. Tendonitis pain can come and go suddenly or last for a few days.
Arthritis, however, is inflammation of the joint due to degenerative changes. There are many types of arthritis, but the most common forms are osteoarthritis (OA), when the protective cartilage in the joint breaks down, and rheumatoid arthritis (RA), when the joints are attacked by the immune system.
There are actually only a few possible arthritic diagnoses in the hands and wrist:
Fingertip joint arthritis
About 10 percent of people develop hereditary arthritis in the joints of the finger tips, also called the distal interphalangeal joints.
“When we work and put pressure through our fingertips we’re putting about the equivalent amount of pressure as we put through our knees when we’re walking,” said Mass. “So we see lots of patients with little nubby bumps on their fingers that can look ugly, but rarely do they need to be treated.”
Those bumps are called Heberden’s nodes, which are actually small bone outgrowths. Other symptoms include pain, swelling, stiffness where the node is, as well as a loss of motion.
Basal thumb arthritis
About 25 percent of women over the age of 50 develop arthritis in the thumb. That figure jumps to more than 50 percent of women over the age of 70. However, the condition is significantly less common in men; only about 5 percent develop basal thumb arthritis. No one is exactly sure why this occurs.
“There are some theories that the ligaments that hold the joint together have estrogen receptors in women,” said Mass. “And after 50, when you lose your estrogen because of menopause, the ligaments stretch out and the joint degenerates. But nobody has proven that.”
Symptoms of basal joint arthritis include a decrease in strength and range of motion, hand pain and swelling at the base of the thumb.
Post-traumatic arthritis is a form of osteoarthritis that occurs because of an injury to a joint. Since the arthritis develops gradually it is typically hard to recall or determine when the injury occurred.
“We see a lot of arthritis in the wrist due to undiagnosed fractures, particularly a scaphoid or undiagnosed ligament injury,” Mass continues. “It’s hard to recognize early because we don’t walk on our hands; it can take eight to 10 years or more before we see it, which is why it’s common at ages 45 to 60.”
The wrist is prone to arthritis because there are no muscle or tendon attachments to the eight bones in the wrist, which means there isn’t much protection from everyday wear and tear.
“The bones of the wrist can be thought of as tiny marbles stacked on top of each other,” Mass said. “That makes them more vulnerable to injuries.”
Doctors can diagnose tendonitis through a physical examination to evaluate the range of motion and tenderness in the affected area. It can be treated with medications, rest, physical therapy, or, in the most severe cases, a surgical procedure.
Arthritis is more complicated to diagnose, possibly requiring an X-ray to pinpoint its beginning stages. If the X-ray shows narrowing or changes in the joint, arthritis may be imminent.
The hand and wrist specialists at UChicago Medicine are at the forefront of complex surgical and non-surgical approaches for various conditions. Mass and his colleagues have developed techniques for ligament reconstructions and flexor tendon repairs that are now standard protocol across the country.
To treat arthritis of the thumb, Mass tries to keep things simple, usually starting with a splint to immobilize the thumb.
“It keeps reminding people to not aggressively use their thumb, but since the thumb is so important for hand function, many people quit the splint,” Mass said. “We can also give steroid injections, which may decrease the localized inflammation for a short period of time. But that doesn’t cure the problem, doesn’t realign the bone and doesn’t put the cartilage back in.”
As far as treating the finger joints are concerned, there are other strategies.
“As I say to my patients, when you say ‘uncle’ I’ll fix it,” said Mass. “What we do, is we remove the joint, and take a tendon from the forearm and basically replace the joint with the tendon so that it has new padding. And that seems to work with the tip of the finger joints.”
Daniel Mass, MD, is a highly regarded expert in orthopaedic surgery of the hand and upper extremities. He has a special interest in the research and treatment of flexor tendon injuries, and he also studies the mechanics of the hand, wrist, and elbow.Learn more about Dr. Mass