The hand helps us interact with the world around us, so any pathology in the hand ‒ especially involving the thumb  ‒ generally causes disability with activities of daily living.

The hand is a complex structure consisting of several bones surrounded by a number of ligaments, tendons and muscles.

These bones articulate together to make a number of small joints which allow the wrist and hand to exhibit a wide range of movements.

There are principally two types of arthritis that affect the hand and wrist. Degenerative arthritis (or osteoarthritis) and inflammatory arthritis, most commonly rheumatoid arthritis or psoriatic arthritis.

Osteoarthritis of the hand is very common. In fact, 80 per cent of the population over 80 years of age have radiological or clinical evidence of the condition. 

Degenerative arthritis means wear-and-tear of the cartilage lining (hyaline cartilage) of the joint. It presents with varying amounts of pain, stiffness, swelling, crepitus, deformity, lumps and bumps (called Heberden and Bouchard nodes) and altered function as well as weakness.

Osteoarthritis most commonly affects the base of the thumb, called the CMC (carpometacarpal) joint of the thumb, and the most distal joints of the fingers, called the distal interphalangeal joints.

Osteoarthritis of the hand is more common in older age, females, obese patients and those with a family history of the condition.

X-rays typically show loss of these joint spaces, thickening of the bone around the joint, called sclerosis, and projections of bone, called osteophytes. There may be cysts around the joint and occasionally, the joint may slip out of place (subluxation). Severity of the condition is graded one to four, with four being the worst grade.

It is true to say that a patient may have significant changes on the radiographs but very few symptoms. The converse is also true.

There is no cure for arthritis. However, the symptoms may be controlled or reduced. Most patients with osteoarthritis of the hand and wrist may be treated non-operatively using anti-inflammatories, heat treatment, use of a brace or splintage and physiotherapy.

Home exercises using a soft ball or plasticine are usually effective in the early stages. If this fails, one of two different injections may be used ‒ a steroid injection or a prp (platelet rich plasma). Both may or may not work and the effect may be temporary.

Surgery is indicated for cases where non-operative treatment fails. This may involve fusion or arthrodesis of the most distal joints of the fingers (DIP joints) or the base of the thumb; removal of a bone from the wrist in case of thumb base arthritis with insertion of a tendon from the forearm (trapeziectomy); or sometimes replacement (arthroplasty), most commonly of the middle joints of the fingers (pip joints) or thumb base.

The success rates with these procedures is very high, with excellent patient satisfaction rates.

Alistrair Pace is a consultant orthopaedic surgeon.