The hands and wrists represent a complex series of joints. Their overall health and fluidity of motion play an important role in your overall quality of life. Arthritis and other conditions can affect the health of your hands in a variety of ways.
Arthritis can develop in the wrist as well as the joints of the hands and fingers. It’s more likely to occur with age and injury which essentially wears away the once smooth cartilage of the joints. This can lead to stiffness, as well as complications with swelling and inflammation.
The overall strength and mobility of your hands and wrists are directly related to a range of muscles and tendons.
Understanding The Structure Of The Hands And Wrists
The hands and wrist tend to work together. A structural problem in the wrist could complicate symptoms of a condition in the hands or could influence the treatment plan needed to address arthritis.
There is a flexor group, found on the inside and the front of your arms. They are largely responsible for controlling how you bend your wrist as well as your fingers. Many of these important flexors pass directly over the front of your wrist. Most are held securely in place by a flexor retinaculum or carpal tunnel ligament which is a durable fibrous band of connective tissue.
Opposing the flexor group is the extensors, which are located on the outside or back of your forearm. It helps to open your hand. They work in tandem with a series of small muscles in your hand, which are known as the lumbricals and interossei which play an important role in executing fine movements. The tendons in your hands are covered by a layer of synovium as well as a tendon sheath.
At the same time, two main nerves are responsible for your sense of touch. As the name implies, the carpal tunnel nerve or median nerve passes under the carpal tunnel ligament. This nerve provides the primary sense of touch for your thumb to your ring finger. It also plays an important role in how the muscular structure of your thumb operates.
The ulnar nerve, which is sometimes referred to as the “Funny Bone” provides feeling to your pinky as well as a small portion of your ring finger. It’s also responsible for controlling the strength of many other hand muscles.
Feeding nutrients and oxygen to these important structures are handled by the radial and ulnar arteries. The radial artery is relatively close to your thumb and you can feel your pulse by pressing on it. The ulnar artery is on the other side of your wrist and is typically more difficult to feel.
Types of Issues That Can Affect The Wrist And Hands
There are several issues that can affect the strength, feeling, and range of motion in the hands and wrist. Some of them are directly related to arthritis or can exacerbate existing arthritis symptoms. This includes:
Carpal Tunnel Syndrome
Which tends to cause pain and possible numbness or tingling in the hands as well as the lower arm. It’s often related to a compression issue in the median nerve communicating between the wrist and the hand.
Flexor Tendon Injuries
Many are related to a cut or laceration on the palm side of the hand, where the near the bend in a finger. It can lead to an inability to bend the nearby finger joints or causes strong pain when bending the finger. In some severe cases, significant tenderness and numbness can result.
Fractures
Vary in severity in one or more of the small bones in the wrist, or structure of the hand.
Wrist Sprains
They often occur when the ligaments that support the wrist are stretched beyond its maximum limit. In some severe cases, connective tissue might be torn. The severity of the damage and any surrounding inflammation can also be a factor in the necessary treatment plan.
Ulnar Tunnel Syndrome of the Wrist
This is similar to the carpal tunnel syndrome, affecting the second primary nerve in the hands and wrist.
Compartment Syndrome
This is a painful condition related to an acute increase in the pressure within the muscles. It can decrease blood flow, which severely limits oxygen and other nourishment from reaching the muscle and nerve cells of the wrist and hands. Compartment syndrome in the hands and wrist is often a medical emergency.
Do I Need Hand Surgery For Arthritis?
There are several factors that go into developing an effective treatment plan for musculoskeletal and arthritis-related problems of the hands or wrists.
This includes factors like:
- The severity of your discomfort during specific movements
- Your personal needs and level of discomfort
- How important the range of motion in the hands is for your chosen profession
- How much discomfort and impaired range of motion is impacting your quality of life.
- Past responses to other treatments such as exercise, splinting, or pharmaceutical means.
Surgery Candidates And Procedures
There are a few different surgical procedures that might be called for to treat arthritis in the hands or wrists.
Arthroplasty
Is a surgical procedure that essentially removes the damaged joint to replace it with an artificial implant. This treatment plan is designed to effectively relieve pain as well as restore the shape and most of the basic function of the compromised joint.
Most of the replacement joints are made from silicone rubber, which is flexible but as time goes on it could potentially break or slip. The average lifespan of one of these implants tends to be ten years.
Whether or not you are a good candidate for arthroplasty can vary depending on your age, activity level, pain tolerance, and overall loss of motion.
Knuckles Arthroplasty
Knuckles Arthroplasty is often called for to repair the knuckles at the base of the fingers. Also known as metacarpophalangeal or MCP joints they tend to be large and play an important role in the overall range of motion in the hand. They also tend to be affected more by Rheumatoid Arthritis.
Proximal Interphalangeal Arthroplasty
Is used for treating finger joints that are the second from the base of the hand, which can be prone to stiffness which impairs their range of motion Dysfunction in these joins is often the result of osteoarthritis.
Arthrodesis
Is more commonly used to treat arthritis discomfort in the distal interphalangeal joints near the ends of the fingers.
What To Expect Success Rate
Early success rates with arthroplasty and Arthrodesis is often rather high. As time goes on the lifespan of replacement joints in the hands can be influenced by overall use, as well as the age of the individual. On average you should expect the lifespan of an arthroplasty-replaced joint to be a decade or less.
Complications
With Arthrodesis there is a slight risk of the replacement joint not fully fusing with the surrounding bone tissues. This is a short-term complication which your physician will detect during follow up exams. It can by age.
With Proximal Interphalangeal Arthroplasty individuals who have a profession or hobby that calls for a lot of gripping, might see a slightly higher failure rate in the artificial joint.
As with all joint replacements, post-operative inflammation can lead to further complications. This can include impeding the artificial joint’s ability to properly fuse to the bone. Your physician might attempt to remediate these problems with prescription anti-inflammatory medications, rehabilitative exercises, and other recovery recommendations.