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about the Hand & Wrist> Osteoarthritis of
the DIP and PIP Joints What is Osteoarthritis of the DIP and PIP Joints of the Finger? Osteoarthritis is a fairly common disease that usually occurs in later life, much more commonly affecting women than men. Also called degenerative joint disease, it is a slowly progressive condition that may be hereditary or aggravated by injuries earlier in life. In women, it often develops within a few years of menopause, perhaps affecting the hands, feet, shoulders, or large weight-bearing joints of the body. Some people develop osteoarthritis in the bones of the neck. By the age of 70, nearly everyone has some degree of osteoarthritis, although only some people experience symptoms. When osteoarthritis develops in the joints of the fingers, the cartilage cushioning these joints begins to wear out. While everyone experiences wear and tear in their joints as they age, the development of osteoarthritis represents increased stress on these joints. There are usually changes in the appearance of the fingers, pain and tenderness in the specific joints, and a progressive loss of motion. Bony growths known as osteophytes may develop around the finger joints. Arthritis in the DIP (distal interphalangeal) joint in the fingertip and PIP (proximal interphalangeal) joint at the middle of the finger is characterized by sometimes painful nodes. The hand is a complex structure with a skeletal framework of 27 bones. There are 8 bones in the wrist, connected to the metacarpal bones of the fingers and thumb. These metacarpal bones meet the phalanxes, or smaller bones of the fingers, and form the knuckle joints. If osteoarthritis develops in the PIP joints, it is likely to be present in the DIP joints also. It tends to be symmetrical, affecting both hands, with markedly different effects on individual fingers. The joints at the knuckles, which may be severely damaged by rheumatoid arthritis (a systemic arthritic condition), are not usually as involved when osteoarthritis is present in the hands. Osteoarthritis also appears quite often in the basilar joint of the thumb, the second most common joint in the hand to be affected by this condition. Some people have a more aggressive form of the disease, known as erosive osteoarthritis. In this form, the joints become more greatly inflamed, with an increase in the incidence of swelling and pain. Bone destruction may be more dramatic as well, resulting in greater instability in the joints. Causes of Osteoarthritis of the DIP and PIP Joints of the Finger? There are either primary or secondary causes of osteoarthritis. Primary osteoarthritis is commonly linked to old age when the cartilage naturally breaks down due to wear and tear of the joint. Physical conditions, such as congenital defects and obesity cause secondary osteoarthritis. Other risk factors of osteoarthritis include:
Cartilage is a slick elastic connective tissue that enables the joints to flex and extend with smooth gliding movements. Very tough and malleable (such as the cartilage we can feel in our earlobes), cartilage protects the surfaces of the bones. As the cartilage in the DIP and PIP joints wears away, the ends of the bones become exposed. When unprotected joint surfaces rub against each other, the result is a painful sensation known as crepitation. Unfortunately for people who suffer from forms of arthritis, cartilage does not regenerate well in the human body. Unlike damaged bones, which gradually repair if they are protected, cartilage does not heal over time. Symptoms of Osteoarthritis of the DIP and PIP Joints of the Fingers? Osteoarthritis of the DIP and PIP joints of the hand varies in its effects from person to person. For some people, the consequences of the disease are minimal. Others may experience great discomfort and noticeable impairment of the functions of the hand. Having osteoarthritis in the joints of the hand does not necessarily mean that you will develop the disease in other joints of the body. One feature of osteoarthritis of the DIP joint is the development of bumps or nodes on the side of the bone known as Heberden’s nodes. These are found much more often in women than in men, and they tend to be a hereditary symptom. With arthritis of the PIP joint, similar nodes, called Bouchard’s nodes, are common signs of the disease. When nodes develop, there may be tenderness and signs of inflammation around the joints for a year or two. The inflammation often subsides after that time, leaving visible bumps that are relatively painless. People with osteoarthritis of the DIP joints sometimes develop mucus cysts around the fingernail. This is the result of underlying pressure from bony growths (or osteophytes) in the joint capsule. If these cysts rupture or are drained using an unsterile technique, infection may result. Treatments of Osteoarthritis of the DIP and PIP Joints of the Fingers? The goal of treatment for osteoarthritis in the finger joints is to minimize pain and limit the loss of motion in the hands. This can often be done with conservative treatment methods such as rest, anti-inflammatory medication, and physical therapy. Sometimes surgical techniques are also used, especially in cases where the joints become unstable. In diagnosing osteoarthritis in the finger joints, your doctor will ask about your medical history and any other persistent or previous conditions of the hand, wrist, and forearm. He or she will inquire about your activities and occupation, as they may play a role in the progression of the disease. One of the treatment objectives may be to help you change habitual ways of using the hands, as this often helps limit discomfort and the progression of the disease. Treatment for osteoarthritis of the finger joints is tailored to the level of impairment and pain experienced by a patient. Some people have signs of the disease but no sustained discomfort or marked change in the function of their hands. Others find the condition to be more disruptive, and they may be concerned about changes to the appearance of their hands. Pain management is an important feature of any form of arthritis treatment. Inflammation and pain in the finger joints is usually treated with over-the-counter medications, such as aspirin or NSAIDs (non-steroidal anti-inflammatory drugs). Slow-release NSAIDS may be effective for as long as 24 hours, providing a more constant level of pain relief. Ibuprofen is an example of a medicine often used to treat symptoms of osteoarthritis. Sometimes acetaminophen is recommended. Occasionally, when a patient experiences an extreme flare-up of inflammation in a single joint, corticosteroid drugs may be injected directly into the joint to relieve local swelling and limit the pain. Surgical treatment for specific finger joints may be recommended in cases where functional problems develop because of limited motion or instability in the joints. Surgery is usually performed on an outpatient basis under local anesthetic. The most common surgical treatment for osteoarthritis of the DIP joint is called joint arthrodesis. With this procedure, the joint is fused in a neutral or slightly flexed position in order to restore stability and eliminate pain. Despite the fact that a fused joint can no longer flex and extend, almost all but the most specialized activities can usually be performed—sometimes more easily than before, when motion resulted in pain. The joint is fixed using wiring or compression screws, and bone grafts are required only in cases where there is marked deformity or bone loss. There are sometimes unusual circumstances when a DIP or PIP joint can be improved by surgery and there is a need to maintain some motion in the joint. In these cases, it is possible to use a silastic implant inside the joint. For prosthetic surgery such as this, the joint must be of sufficient size. It is important to realize that post-operative motion in the joint rarely exceeds 30 to 40 degrees. A prosthesis has a limited lifespan and may eventually require replacement or joint arthrodesis to fuse the bones. Hand surgery for patients with various forms of arthritis has progressed rapidly in recent years. Surgery to the basilar joint of the thumb is especially effective. Sometimes surgery can stabilize individual joints and deliver pain relief. It may also improve the appearance of the hands. Living with any form of arthritis requires pain management and lifestyle adjustments. Very often occupational and recreational changes are required. Gentle physiotherapy can be helpful, as can whirlpool treatments and the application of heat. Many people benefit from hot wax treatments, in which the hands are exercised gently within a bowl of soft warm wax. Heat increases the flow of blood and nutrients to the hands. The application of ice to the joints can also be beneficial. This information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |