Finger Arthritis

Osteoarthritis is a wear-related process in which the cartilage lining a joint gradually thins, often with aging, and typically begins in one or a few joints. Inflammatory arthritis arises from an underlying immune-mediated condition such as Rheumatoid arthritis, tends to affect multiple joints in a symmetric pattern, and may begin at a younger age. The distinction matters because the non-surgical treatments differ, and inflammatory arthritis is usually managed jointly with a Rheumatologist.

Arthritis can affect any of the joints in the fingers. The distal interphalangeal (DIP) joints nearest the nail and the proximal interphalangeal (PIP) joints in the middle of the finger are frequently involved in osteoarthritis. The metacarpophalangeal (MCP) joints where the fingers meet the hand are more characteristic of inflammatory arthritis, though any pattern is possible.

Osteoarthritis generally progresses slowly, and the rate varies considerably between individuals. For many patients symptoms stabilize or fluctuate rather than worsening steadily. Inflammatory arthritis, if untreated, tends to be more progressive because the underlying condition remains active. This is one reason that a diagnosis matters even when symptoms are mild.

Joint replacement removes the arthritic bone and inserts an implant that allows for movement, so the joint still bends. Arthrodesis, or fusion, removes the arthritic joint surfaces and holds the bone ends together so they heal as one solid piece — the joint no longer moves at all. Replacement preserves motion but has a limited lifespan; fusion sacrifices motion but produces a durable, stable, pain-free joint. Which is appropriate depends on which finger joint is involved and what you need it to do.

Implant materials utilized include silicone and pyrocarbon. Silicone implants have a long history of use in the hand and are flexible, functioning as a spacer that a new capsule forms around. Pyrocarbon implants are a more rigid option designed to articulate within the joint. Each has its own profile of advantages and potential complications, which your surgeon will discuss with you.

For patients with underlying inflammatory arthritis, a specialized physician such as a Rheumatologist may prescribe specific medications that address the condition itself rather than just the joint symptoms. Those medications — which may include disease-modifying agents — are managed by the Rheumatologist, while your hand surgeon addresses the structural problems the arthritis has caused in the fingers. The two work alongside each other.

Surgery is generally considered when pain and deformity continue to interfere with hand function despite non-operative treatment. The decision regarding nonoperative versus operative treatment is complex and should be discussed with your treating physician. Outcomes after surgery vary, and risks and benefits should be discussed in detail with your treating physician.

Risks include infection, bleeding, stiffness, scarring, implant wear or failure over time, instability, and the possibility that the outcome does not fully meet expectations. Fusion surgery trades motion for stability, which is itself an important consideration. Non-operative treatment also carries risks and benefits which should be discussed with your treating physician.