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Alaska Hand-Elbow-Shoulder is home to Alaska's premier upper extremity surgical specialists. We provide care for orthopedic injuries and conditions of the hand, wrist, elbow, and shoulder as well as fracture care and sports medicine. Call AkHES today to schedule your appointment.

Finger or Thumb Joint Arthritis

What is Finger or Thumb Joint Arthritis?

The fingers are comprised of 3 bones with 3 joints responsible for motion. The metacarpophalangeal (MCP) joint is found at the base of each finger where the finger connects to the hand, and permits motion in multiple planes, meaning flexion and extension, as well as side to side motion, allowing for both pinching and gripping. The proximal interphalangeal (PIP) joint, found at the middle of the finger, and the distal interphalangeal (DIP) joint, found at the tip of the finger, both allow motion in only one plane—that is for flexion and extension. The 3 joints of the thumb are the carpometacarpal (CMC) joint, metacarpophalangeal (MCP) joint, and interphalangeal (IP) joint. The CMC joint is formed between the trapezium bone of the wrist and the first bone of the thumb known as the metacarpal, and allows the thumb to have a wide range of motion including flexion and extension, as well as side to side motion, allowing for pinching and gripping. The MCP joint, found where the thumb meets the hand, and the IP joint, found at the tip of the thumb, both only allow for flexion and extension.

1. Normal Thumb and Finger Joints

Figure 1

Arthritis of the fingers and/or thumb may result from previous injury to the joint, or from degeneration of the joint with time. When injury to a joint occurs, inflammation takes place and cartilage is lost—allowing the bones of the finger to rub against each other, causing arthritic pain.

Signs and Symptoms

Swelling, stiffness, and pain within the joint are the most common symptoms of joint arthritis. When the MCP joint is experiencing symptoms, pain is usually worse during gripping or pinching activities. The joint may also experience instability and/or begin to appear deformed or develop a bony nodule as symptoms progress.

Conservative Options:

Conservative treatment options may include modification of activities and rest, ice, splints, and anti-inflammatory medications. Cortisone injections may help to temporarily reduce pain. Range of motion exercises and simple strength training exercises can also be helpful.

Surgical Options:

If conservative treatment is not effective in reducing symptoms or slowing the arthritic process, surgery may be recommended. There are two main types of procedures to repair a joint damaged by arthritis.  1) Arthroplasty is the surgical repair and reconstruction of an injured joint through joint replacement with implants.  2) Arthrodesis is the removal of the joint space by fusion of the two involved bones. Depending on the severity of the arthritis in the joint and surrounding tissues, one procedure may be favored over the other.

1) Arthroplasty may be a beneficial option for patients with increasing pain or stiffness caused by joint arthritis. Arthroplasty is considered in patients with an incongruent joint with pain, deformity, or stiffness, who retain sufficient bone stock and supporting soft tissues. Arthroplasty is the repair or reconstruction of an arthritic joint with implants. Joint replacement surgery can greatly reduce pain while improving functional range of motion.

The surgeon will make a small incision at the affected joint and will either perform surface replacement arthroplasty (and remove and replace only the surfaces of the damaged bones and surrounding soft tissues) or perform total joint replacement (and remove the damaged joint in its entirety and recreate the joint with an implant, as shown in Figure 2). Typically, a PyroCarbon implant will be used to recreate the MCP joint through total joint replacement. These implants are stabile, durable over time, help to restore joint function and to relieve pain. The prosthetic joint is then joined to the adjacent joint to form the repaired joint. PyroCarbon implants are used for traumatic MCP joints, while silicone implants are more often used in rheumatoid joints.

Figure 2

Figure 2

Following Surgery:

  • Expect a bulky surgical dressing and splint to be applied to hand and wrist to be kept in place for 10-14 days.
  • Elevate and ice for at least 3 days.
  • Continue to elevate as often as possible until your next clinic visit. (Elevate above your heart.)
  • Shower with a plastic bag covering the splint and seal with tape
  • Take your pain medicine as needed and as prescribed. Call if any problems or questions arise

3-5 Days Post Op (at therapy):

  • Initiate gentle ROM (range of motion) exercises.

10-14 Days Post Op:

  • Follow up appointment in clinic with P.A. or M.D.
  • Dressing, splint, and sutures will be removed.
  • Expect a custom-fabricated dynamic extension splint for daytime and a static splint for nights.
  • Initiate “radial walking” (active finger radial deviation).
  • Begin home exercise program as instructed by therapist.

6 Weeks Post Op (at therapy):

  • May initiate stretching exercises and gentle hand strengthening exercises with soft putty.

8 Weeks Post Op:

  • Follow up appointment in clinic with P.A. or M.D.
  • Expect x-ray to evaluate healing.
  • May discontinue dynamic extension splint, but may continue static splint at nights for up to 12 weeks depending on progress.
  • Return to normal activities as tolerated.

12 Weeks Post Op:

  • May discontinue static forearm splint at nights.

protocol

2) Arthrodesis is primarily recommended for patients with more severe cases of joint arthritis, including poor bone stock or severely damaged supporting soft tissue. Arthrodesis permanently locks a joint in a fixed position by fusing two bones together, thus eliminating the joint altogether. The primary goals of arthrodesis are to relieve pain and to stabilize the joint. Patients whose work or sport requires heavy demands on the joint may consider fusion of the joint, as fusion gives additional strength not achieved by arthroplasty. However, normal range of motion of the joint is lost. (This surgical option is more often used in arthritis of the DIP and PIP joints and not the MCP joint.)

The surgeon will make a small incision at the affected joint and will open the joint capsule surrounding the finger or thumb joint to expose the joint surfaces. The articular cartilage is then removed from both joint surfaces to leave two surfaces of the exposed bone. The bottom of teh upper phalange is hollowed to form a socked using a Chevron cut (see Figure 3) or ball and socket reamer.

Figure 3

Figure 3

The surgeon will then place metal pins (see Figure 4) or a screw (see Figure 5) across the joint and through both bones to connect the bones snugly together. This allows the surgeon to hold the two bones in the correct alignment and prevents the bones from moving too much as they fuse together. The soft tissues over the joint are then stitched back together.

The surgeon will make a small incision at the affected joint and will open the joint capsule surrounding the finger or thumb joint to expose the joint surfaces. The articular cartilage is then removed from both joint surfaces to leave two surfaces of exposed bone. The bottom of the upper phalange is hollowed to form a socket using a Chevron cut (see Figure 3) or ball and socket reamer.

The surgeon will then place metal pins (see Figure 4) or a screw (see Figure 5) across the joint and through both bones to connect the bones snugly together. This allows the surgeon to hold the two bones in the correct alignment and prevents the bones from moving too much as they fuse together. The soft tissues over the joint are then stitched back together.

Figure 4

Figure 4

Figure 5

Figure 5

Following Surgery:

  • Expect a surgical dressing and splint to be kept in place for 10-14 days.
    • If finger DIP or PIP fusion, or thumb IP fusion, expect an aluminum splint for involved digit.

      4. Arthrodesis Finger PIP Joint (screw)

      Figure 6

    • If thumb MCP fusion, expect a forearm thumb spica splint.
  • Elevate for at least 3 days, or as often as possible until your next clinic visit. (Elevate above your heart.)
  • Shower with a plastic bag covering the splint and seal with tape.
  • Take your pain medicine as needed and as prescribed. Call if any problems or questions arise.

10-14 Days Post Op (at therapy):

  • Dressing, splint, and sutures will be removed.
    • If finger fusion or thumb IP fusion, expect a new protective splint for involved digit for continual wear for 6-8 weeks (may be changed as needed).
    • If thumb MCP fusion, expect a thumb spica cast for 6-8 weeks.
  • If pins are exposed outside of the cast or splint, clean the pin/skin interface daily with hydrogen peroxide and a Q-tip.
  • Active and passive Range of Motion (ROM) exercises may be initiated to all uninvolved joints.
  • Therapist will address edema control with a fingersock or 1” Coban™, as well as scar management once wound has healed (i.e. scar massage with lotion and elastomer™, Rolyan 50/50™ or OtoformK™).

8 Weeks Post Op:

  • Follow up appointment in clinic with P.A. or M.D.
  • Expect x-ray to evaluate healing.
  • Once fusion is clinically healed (as shown on x-ray).
    • Protective splint or cast may be discontinued.
    • Progressive strengthening program will be initiated under the direction of therapist.
    • May follow up in clinic as needed.

Considerations:

  • Typically, 1-3 therapy visits will be sufficient after fusion of the bones occurs.

protocol

Note: These instructions are to serve as guidelines and are subject to Physician discretion. Actual progress may be faster or slower depending on the individual.