• Are you feeling some stiffness in your joints?  Is it more difficult to do some things with your hands? You might have arthritis and it’s important to understand it and learn what to do.

    You’re not alone. According to the Centers for Disease Control and Prevention, about 52.5 million adults in the United States deal with the daily chronic pains of arthritis. As a hand surgeon, I see a large number of patients who struggle with various types of hand arthritis on a regular basis. Although there is no sure way to prevent this condition, being aware of symptoms and treatments will go a long way for your long-term hand health.

    There are two main manifestations of hand osteoarthritis to be aware of: Basal joint arthritis and finger joint arthritis, both of which are more common in women.

    Basal joint arthritis produces pain at the base of the thumb near the wrist. Finger joint arthritis involves pain in the two joints (or knuckles) closest to the tips of your fingers and is often less painful.  However, both can result in potentially large, bony prominences at the affected joints.

    Basal joint arthritis is ten times more common in women than men. Patients complain of irritation at the base of the thumb or in the palm that is exacerbated by many activities of daily living. Over the past three years, several clinical studies have demonstrated that strengthening the muscles around your thumb can help minimize the pain.  A doctor can refer the patient to an occupational therapist who can teach them proper strengthening exercises. These exercises require precise technique, which should be taught by a professional. It is possible that good thumb muscle strength can help prevent development of this arthritis, so consultation with an occupational therapist may be advised.

    Basal joint arthritis is treated non-operatively with great success, but surgery is sometimes also needed. Non-operative treatment starts with avoiding any pinching or twisting activities with the painful thumb, and using the noninvolved thumb as much as possible. Other treatments include splinting of the thumb with a thumb spica splint for immobilization and steroid injections into the thumb basal joint that can produce long-term relief. If the above measures fail and the pain is severe, surgery may be required.

    Finger joint arthritis is also much more common in women but does not typically produce the severity of pain that thumb basal joint arthritis does.  The finger joints do experience much stress during pinch and grip activities but our current understanding is that the development of this type of arthritis is mainly genetically determined.  In other words, the fate of your knuckles was most likely determined by what your mother or grandmother’s knuckles looked like.  At this time, there are no known recommendations to prevent it. Finger joint arthritis produces bony masses at both finger joints, called Heberdens nodes at the joint closest to the fingertip, and Bouchards nodes at the joint in the middle of the digit.  Since the pain is often not severe, patients seek medical attention more often for the bony overgrowth that they consider finger masses.  If pain is the major complaint, a steroid injection may be beneficial.  Ultimately, if the pain is intolerable, surgical fusion or replacement of the diseased joint (like a total knee replacement) is possible, depending on the age of the patient and the specific joint that is diseased.

    A relatively easy treatment option to treat hand arthritis is to take over the counter glucosamine/chondroitin sulfate.  One should strive for 1500mg of glucosamine sulfate per day, and this typically requires two pills to be taken daily. These are natural substances found in healthy joints and have proven to be helpful in alleviating pain in some patients with hand arthritis.  The other advantage to taking these pills is that they result in minimal side effects – mild stomach issues being the most common. I typically recommend that patients try taking these pills for four to six weeks and then determine if their pain has improved.  If the pain is improved, I recommend continuing the pills; if the pain has not improved, I recommend that they discontinue the pills.

    Do you have additional questions?

    Dr. Louis W. Catalano

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    Article by: Dr. Louis W. Catalano

    Dr. Catalano is an Assistant Clinical Professor of Orthopedic Surgery at Icahn Mt. Sinai School of Medicine, Residency Director and Attending Surgeon in the Department of Orthopedic Surgery at St. Luke’s-Roosevelt Hospital, and Attending Hand Surgeon here. Dr. Catalano has been Fordham University’s team physician since 2002 and is the shoulder specialist for Team New York Aquatics swim team. For more information, please visit www.cvstarrhandsurgery.org.

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    1. juliaofthebees@gmail.com' Julia says:

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