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OsteoarthritisWhat is Osteoarthritis?Osteoarthritis is a deterioration of the moving parts of the joints. In the hand, osteoarthritis most often affects the small joints of the fingers and the joint at the base of the thumb - the basal joint. This is sometimes referred to a degenerative arthritis or degenerative joint disease. What causes osteoarthritis?The exact reason for developing osteoarthritis is not known. It is thought to be due to deterioration of the smooth layer of cartilage which covers the ends of the bones. The small joints of the fingers are prone to breakdown of this layer, which seems to self-destruct in some people early in life. It tends to run in families, and is probably a genetic condition in many people. Degenerative joint disease can also occur after injury, but the typical pattern of osteoarthritis is that the small joints of the fingers are affected, but the other joints of the hand are not. Osteoarthritis is different from other forms of arthritis, such as rheumatoid arthritis, gouty arthritis, psoriatic arthritis and others. How is it treated?Many patients with mild symptoms will improve with a limited period of anti-inflammatory medication and avoiding painful activities. A cortisone shot into the sore area may also provide temporary relief (lasting about two months) of pain and swelling. If all other treatments have failed, surgery is an option. The main goal of surgery is to relieve pain and, when possible, prevent the progressive weakness and deformity which may occur. There are two types of surgery commonly performed for joints affected by arthritis, fusion and arthroplasty. Fusion (arthrodesis) is an operation to make bones on each side of the joint grow together. Fusion can be very helpful for joints which are stiff and painful, awkwardly crooked, or unstable. Arthroplasty, or joint reconstruction, in osteoarthritis is most often performed for thumb basal joint arthritis. Artificial joints have also been developed for the small joints of the fingers. Finger joint replacements made of pyrolytic carbon (the same material used in most artificial heart valves) were FDA approved for use in 2002. Implants are a reasonable alternative to fusion, and in some cases can be used to restore motion to a joint which has been fused. List of Physicians Who Treat OsteoarthritisIt is important to find a physician who has specialized training in caring for all conditions of the hand, wrist and forearm, ranging from acute, limb-threatening injuries to chronic, degenerative diseases. At the University of Michigan Hand Center, all of our physicians are board certified surgeons with specialization in plastic surgery and additional fellowship training in hand surgery. For details about education, experience, and specialty in this clinical area, please visit these physician profile pages: Scheduling an Initial ConsultationIf you are considering treatment, the first step is to schedule an initial consultation with a plastic surgeon. To schedule an appointment at the University of Michigan Hand Clinic, please call (734) 998-6022. What to Expect During the Initial ConsultationDepending on the complexity of your condition, you may visit with more than one physician, surgeon, therapist or nurse practitioner. You should plan on your consultation lasting between 1-2 hours. During this important visit, you should expect:
Hand Therapy and RehabilitationTreatment plans are tailored to fit your condition, living and work requirements. The ultimate goal is the restoration and optimization of your hand function, renewed independence and overall quality of life. Whether as a non-surgical option or to enhance your recovery from hand surgery, the plastic surgeon may recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist. Hand therapy is provided on site at the University of Michigan's Hand Center by our team of Occupational and Physical Therapists. Referrals can be arranged closer to your home when that is more convenient. Click here for a listing of hand therapy and rehabilitation providers recommended by the University of Michigan Hand Center if treatment is pursued off-site. Preparing for Your SurgeryIf your plastic surgeon recommends surgery to treat the condition, you'll work with the Hand Center scheduling nurse to set a date for the operation. You will be given a pre-operative information packet that explains everything you should do and know before your surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You should arrange for someone to drive you home after your surgery, and to help you out at home for a day or two. Where Your Surgery Will Be PerformedThe majority of these procedures are completed on an out-patient basis. Your procedure will take place at the University of Michigan Hospitals which provides state-of-the-art surgical suites and recovery areas. Types of AnesthesiaIn most cases, general anesthetic is not necessary. Your surgeon will discuss the best anesthetic options to make you feel comfortable and relaxed during the procedure, including local anesthesia in your hand and/or an anesthetic block near the shoulder. After Your SurgeryClick here for information about how to care for yourself after the surgery and what to expect during your recovery. It is very important that you follow your surgeon's instructions. Your post-operative rehabilitation may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It's crucial that you follow the therapist's instructions and complete the entire course of therapy if you want to regain the maximum use of your hand. |
