Aches and pains are just part of getting older – or at least that’s the conventional wisdom. So if you feel some stiffness in your hand or pain in your wrist, you might just assume it’s natural, and definitely not worth seeing a doctor about.
Left untreated, though, arthritis can make simple tasks such as getting dressed, answering the phone, or picking up your grandkids excruciating. The inflammation in your joints can cause stiffness, pain, and limited movement.
You don’t have to live with those persistent symptoms.
UT Southwestern hand specialists provide a range of treatment options to control arthritis pain and restore mobility – from medication, physical therapy, and injections to joint resurfacing and replacement. With more than 60 years of combined expertise, our hand surgeons are skilled in the most advanced techniques to repair and replace the delicate joints of the hand and wrist, as well as procedures to decrease pain.
There are effective options to manage pain and improve function regardless of how long you have had arthritis – even years after the onset of symptoms. The treatments your care team recommends will depend on the type of arthritis you have and how advanced it is.
3 common types of hand and wrist arthritis
Osteoarthritis (OA), the most common form of arthritis, results from natural wear and tear over a lifetime of using your joints. Cartilage (tough but flexible tissue that lines your joints) cushions against grinding between your bones. Over time, the cartilage wears away, leading to bone-on-bone contact that triggers painful inflammation.
For early-stage OA, when some healthy cartilage remains intact, we focus on supporting the joint with a splint or brace and easing discomfort. Over-the-counter medicines such as ibuprofen or Tylenol help reduce inflammation and pain. Some patients are good candidates for steroid injections, which reduce inflammation and decrease pain.
Inflammatory arthritis is usually caused by autoimmune diseases such as rheumatoid arthritis or psoriatic arthritis. Severe inflammation in these conditions eats away the cartilage, resulting in bone-on-bone contact.
With inflammatory arthritis, prevention is the best cure. Medical treatment (rather than surgery) can treat the inflammation and prevent damage to the cartilage, thereby keeping arthritis from developing. A rheumatologist can create a personalized care plan to manage the disease or keep the condition at bay.
Post-traumatic arthritis is the result of an injury that didn’t heal properly, such as a fracture or torn ligament. Misaligned bones and tissues greatly increase stress on the joint, causing the cartilage to wear out much faster than usual, just like unbalanced automobile tires wear out unevenly.
First-line treatments like splints, medications such as ibuprofen and Tylenol, and steroid injections can reduce pain and improve range of motion. However, sometimes surgery is the best option in post-traumatic arthritis.
Surgical options for pain management
If nonsurgical treatments no longer control the pain, or if symptoms continue to get worse, we might recommend surgery. Most hand surgeries last about 30-60 minutes and are performed as outpatient procedures. Typically, they require general anesthesia, so you should plan for someone to take you home after surgery.
After most of these procedures, you will wear a brace, splint, or cast for two to 12 weeks. Hand physical therapy is essential to restore normal range of motion. Depending on the extent of your surgery, you can expect to return to most daily activities between two weeks and three months.
Here are some examples of the type of surgery your doctor might recommend:
For patients with painful finger motion whose range of movement is reduced to 20-30% of normal in the affected joint, finger joint replacement can be an option. Joint replacement typically restores up to 50% of the normal range of movement, but more importantly, greatly reduces pain.
Procedures vary depending on which of the many joints in the hand and wrist are affected by arthritis. For example:
- Knuckles: The surgeon removes the old joint and replaces it with a silicone device that allows you to move with less pain. The replacement joint has long silicone stems that go into the bones above and below, with flexible silicone sitting in the middle and acting as a plastic joint.
- Where the thumb meets the wrist: The surgeon will remove one of the bones that is grinding – typically the 15mm-wide trapezium bone. The surgeon then creates a hammock from surrounding tendons on which the thumb bone can rest, leaving it free to move without grinding.
Stopping the grinding of bones in a painful joint is the key to easing pain. Sometimes we can stop the grinding by replacing the worn out cartilage. But in some cases, it is better to fuse the bones to restrict movement. By using plates, screws, or wires, the bones of the joint are held still so they heal together and essentially become one.
Fusion surgery is a good option in joints that bear too much force or pressure to replace the joint, such as the first joint of your index finger (the proximal interphalangeal joint), which shares with the thumb the force of pinching or gripping.
Because fusion permanently restricts range of movement, we reserve it for patients with excruciating pain from simple movements. If you choose fusion surgery, our team will work with you to ensure you can still perform everyday tasks such as typing or holding a phone.
Nerve surgery doesn’t treat arthritis, but it allows the patient to use their hand or wrist with less pain.
For example, there are two nerves in the wrist, the anterior and posterior interosseous nerves, that have only one function— to tell your brain that your wrist hurts. By removing these nerves, wrist pain can be greatly decreased without the loss of any feeling or motion in the hand or wrist.
Prior to nerve surgery, we can test whether the procedure will work by injecting the nerve with numbing medication. If the patient notices good pain relief for the rest of the day, it’s a good indication that nerve surgery will help reduce pain symptoms.
Patients with osteoarthritis and post-traumatic arthritis can be good candidates for nerve surgery.
For some patients with moderate arthritis in their wrists, joint resurfacing (interposition arthroplasty) can reduce pain from grinding bones. Rather than removing the damaged joint, this procedure involves placing soft tissues, such as ligaments, between the bones to create a new soft surface, alleviating grinding and pain.
While arthritis is common with age, it’s not a “normal part of aging” – it’s a condition that can and should be treated to improve your daily quality of life.
If hand or wrist arthritis symptoms are making simple tasks difficult, talk with a specialist. Seeking support early gives you a chance to explore more treatment options and make educated care decisions.