Monday Medical: Surgical options for hand and wrist arthritis
For Steamboat Pilot & Today
Editor’s Note: This story is Part 2 of a 3-part series on treating arthritis in the hands and wrists. Part 1 focuses on medical treatments, and Part 3 focuses on the role of physical therapy.
Arthritis can be debilitating, especially when it impacts your hands and wrists.
Consider the hands versus the hips. While the hip is one large joint, the hand has three joints in each finger, two in each thumb and three in each wrist.
“There are a lot more joints in the hands, which is why people often feel arthritis there,” said Dr. Patrick Johnston, a hand and elbow orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center.
Medical treatment and physical therapy can keep the pain and swelling at bay, but for some patients, surgery helps.
“If they’ve become so advanced that medical treatment isn’t doing everything they need, then surgical treatment may be necessary,” Johnston said. “Through hand surgery, we want to help people have a functional hand, a hand that physically looks good and a pain-free hand.”
For patients suffering from rheumatoid arthritis, medical treatment can help slow the progression of the disease and prevent future issues, while steroid injections may help decrease pain.
Surgery is an option for fixing physical deformities that have resulted from the disease.
Tissues around the joint can stretch and break, pulling fingers to the small-finger side of the hand. That pressure can dislocate the tendons that run over the big knuckles of the fingers, which in turn dislocates the fingers.
“When that deformity happens, the hands are not very functional,” Johnston said. “The way our body is set up is like a bunch of ropes and pulleys at different angles. But if the pulleys change location or get stretched, it can create a lot of issues.”
Through surgery, Johnston replaces the large knuckles of the hands so they’re in a straighter and more functional position, and then rebalances soft tissue to help keep fingers from getting dislocated.
Joint replacements for patients with rheumatoid arthritis have a high success rate; Johnston has found this surgery often results in a large improvement in patients’ daily lives.
Rheumatoid arthritis can affect the wrist and elbow as well, and in severe cases, a wrist fusion, wrist replacement or elbow replacement may help.
“A patient the other day said her elbow replacement for rheumatoid arthritis was one of the biggest changes that helped her life,” Johnston said. “We use our elbows so frequently to feed ourselves, clean ourselves and more, and she wasn’t able to do any of that without pain. Now, she’s pain-free.”
Johnston encourages people to get treatment early, as advancements in medications for rheumatoid arthritis mean many people can avoid surgery.
“It used to be there were training programs known for how much rheumatoid arthritis disease they treated because that was such a big part of a hand surgeon’s job,” Johnston said. “Now, there’s such great medical treatment that a lot of these people aren’t needing to have surgery.”
With osteoarthritis or post-traumatic arthritis, people often have issues within the joint instead of with the soft tissue surrounding the joint.
“Osteoarthritis can create some bigger, swollen knuckles, but doesn’t necessarily create the joint deformities and tendon dislocations that rheumatoid arthritis does,” Johnston said.
Post-traumatic arthritis impacts the joint that was injured, while osteoarthritis impacts multiple joints.
Symptoms are treated first. Using a splint, taking supplements such as tart cherry juice and turmeric, and trying steroid injections can help decrease inflammation and improve pain.
If those treatments aren’t enough, a patient may consider surgery. As with rheumatoid arthritis, surgery for osteoarthritis usually involves replacing the knuckle joints – once the arthritic joints are removed, patients find the pain they had experienced eases.
“When they say, ‘I’ve tried all the conservative things and the pain from my arthritis is interfering with my daily activities,’ then we consider surgery,” Johnston said.
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at email@example.com.
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