Arthritis in the hand and wrist

Rheumatoid arthritis
This is an inflammatory type of arthritis. The hand is often affected. The aims of surgery in the rheumatoid hand are:

a) relieve pain
b) improve function
c) prevent further deformity
d) aid cosmesis

Surgery can be helpful in these circumstances:

MCP joints (knuckle joints)
These can be replaced. This offers worthwhile pain relief and may correct the tendency for the fingers to drift towards the little finger.

Rheumatoid arthritis can make the hand unusable.
Rheumatoid arthritis xray

PIP joints
These are the middle joints of the three joints in the finger. They can be replaced or stiffened.

Tendon ruptures

Ruptured tendon in hand surgery

Ruptured tendon in hand surgery

Sometimes the tendons on the back of the wrist become frayed and snap. This may mean that the fingers can no longer be straightened. This sometimes occurs also in the thumb. Surgery can help prevent further tendon rupture and sometimes grafts or transfers can be used to improve function.

The wrist is a common site of disease. The wrist can be stiffened or replaced depending on circumstances.

This is a wear and tear type of arthritis. It commonly affects the end joints of the fingers which can be swollen and lumpy. This condition can be unsightly, but rarely requires treatment. Sometimes a small cyst (a mucous cyst) develops and requires removal.

Osteoarthritis can affect the joint at the base of the thumb. This is sometimes a very painful condition.

What treatment is available?
In the early stages simple painkillers may be enough to help. A splint may protect the thumb and relieve pain. If this fails steroid (cortisone) injections may be helpful. If all of these measures your surgeon may offer you an operation.

Several different operations are available to stiffen, replace or excise the joint – a trapezectomy.

What is a trapezectomy?

Trapezectomy xray

What will the surgery aim to do?
The operation removes one of the bones in your wrist (the trapezium). This stops the two diseased bones from rubbing together. There are small differences in technique; some surgeons use a strip of tendon to fill the gap left by the removal of the bone, others use a wire to hold the thumb straight, others simply remove the trapezium.

What kind of scar will I have?
All surgeons make a slightly different incision. This will either be in the heel of the hand or over the thumb side of the wrist. It is usually about two inches long. You will have stitches in the wound and a bulky dressing or a plaster cast. The stitches will be removed 10 to 14 days after the operation. You will be in plaster for two to six weeks.

What should I do if I have pain after the operation?
We recommend that you routinely take painkillers for 48 hours after the operation. After this, take painkillers as required. If at this stage you have increasing pain you should seek medical advice.

Will I require physiotherapy?
You will usually require some help from the physiotherapist who works with your surgeon.

Do I need to do anything else?
You should move your fingers as soon as possible. When the stitches are removed, massage the wound with cream (E45, Neutrogena, Atrixo). Keep the wound dry until then.

How long will I be off work?
Desk job: Two weeks if you can work in plaster
Light manual: Six weeks
Heavy manual: Eight to twelve weeks
Driving: Six to eight weeks

What complications can occur?
All operations have a small risk of infection – perhaps 1%

All operations on the upper limb can be complicated by an abnormal pain response known as complex regional pain syndrome. It is not possible to tell in advance if this is likely to occur, although it is commoner if you have already had the condition.

You may have some residual pain.

Your thumb may be rather stiff and weak, and you may lose some span