The joints of the fingers and thumb can be damaged by trauma, by deterioration with use and/or by inflammatory conditions such as rheumatoid arthritis. This leads to pain and deformity along with reduced function.
Some joints are particularly vulnerable. The joint at the base of the thumb is particularly prone to wear with time and for its structure to deteriorate. It is the commonest worn joint in the body. Some joint deterioration can be managed conservatively, other joints can be fused, yet others can be removed while some joints can be replaced.
There are various options of treatment depending on the underlying issue.
Inflammatory joint conditions such as rheumatoid arthritis will generally be confirmed by blood tests. Other forms of deterioration, such as that secondary to trauma or wear and tear, will need investigating by x-rays and/or scans.
Many such conditions will require management in a number of simultaneous forms. Pain relieving and anti-inflammatory medication can be prescribed. Splints may be worn to relieve stress on a joint and reduce pain and deformity as well as slow down further progression.
If the joint architecture is deteriorated surgical options may become necessary.
Some joints, such as the end joints of the fingers and thumb can be fused (made solid) without significant compromise of function. Indeed, abolishing pain and instability of such a joint can improve function overall, even if movement in the particular joint is abolished. This treatment usually requires wires in the bone to hold it in place until it knits and these may have to be removed at a separate, small, operation some weeks later.
This method is commonly used for the joint at the base of the thumb. The deteriorated bone (the trapezium) at the base of the thumb is removed and this also removes the pain from the grinding of worn, irregular bone surfaces. In many cases the space left by the removal of the trapezium is filled using part of a tendon which stabilises the thumb and places a cushion at the contact area. This sort of surgery is very successful in relieving pain. It requires careful and frequent hand therapy following the surgery as well as support with a splint until all is secure.
This is a method of choice in certain joints but is not suitable for all. The joint can be removed and a suitable artificial joint can be inserted in the space to permit movement. This surgery requires the support of splints following the procedure as well as some weeks of physiotherapy to restore movement.
In some joints, such as the MP joints (the knuckles) this method is generally successful. In other joints, such as the PIP joint (the second joint in the fingers) the outcome is less certain - pain can usually be relieved but movement is not improved and may be reduced. In each case, careful analysis and discussion of the options between surgeon and patient, is key.