Introduction

Physical Therapy in Pittsburgh for Hand

Welcome to Greater Pittsburgh Physical Therapy & Sports Medicine's patient resource about Arthritis of the Finger Joints.

When you stop to think about how much you use your hands, it's easy to see why the joints of the fingers are so important. Arthritis of the finger joints has many causes, and arthritic finger joints can make it hard to do daily activities due to pain and deformity. Unbearable pain or progressive deformity from arthritis may signal the need for surgical treatment.

This guide will help you understand:

how arthritis of the finger joints develops
how doctors diagnose the condition
what treatment options are available

Anatomy

How do the finger joints normally work?

The bones in the palm of the hand are called metacarpals. One metacarpal connects to each finger and thumb. Small bone shafts called phalanges line up to form each finger and thumb.

The main knuckle joint is formed by the connection of the phalanges to the metacarpals. This joint is called the metacarpophalangeal joint (MCP joint). The MCP joint acts like a hinge when you bend and straighten your fingers and thumb.

The three phalanges in each finger are separated by two joints, called interphalangeal joints (IP joints). The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint). The joint near the end of the finger is called the distal IP joint (DIP joint). The thumb only has one IP joint between the two thumb bones. The IP joints of the digits also work like hinge joints when you bend and straighten your hand.

The finger and thumb joints are covered on the ends with articular cartilage. This white, shiny material has a rubbery consistency. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to facilitate motion. There is articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate.

Articular Cartilage

Hand Anatomy Introduction

Causes

What causes arthritis?

Degenerative arthritis is a condition in which a joint wears out, or degenerates, usually slowly over a period of many years. Degenerative arthritis is usually called osteoarthritis. The term arthritis means joint inflammation (pain, redness, heat, and swelling). The term degenerative arthritis means inflammation of a joint due to wear and tear. You may also hear the term degenerative arthrosis used. Degenerative arthritis is usually called osteoarthritis.

Degenerative Arthritis

Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. An injury to any of the joints of the fingers, even if it does not injure the articular cartilage directly, can alter how the joint works. After a fracture, the bone fragments may heal in slightly different positions. This may make the joints line up differently. When an injury changes the way the joint lines up and moves, force can start to press against the surface of the articular cartilage. This is similar to how a machine that is out of balance wears out faster.

Articular Cartilage Damage

Over time, this imbalance in the joint can lead to damage to the articular surface. Since articular cartilage cannot heal itself very well, the damage adds up. Eventually, the joint can no longer compensate for the increasing damage, and symptoms begin. The damage in the joint starts well before the symptoms of arthritis appear.

Symptoms

What does arthritis feel like?

Pain is the main problem with arthritis. At first, the pain usually only causes problems when you begin an activity. Once the activity gets underway, the pain eases. But after resting for several minutes the pain and stiffness increase. When the arthritis condition worsens, pain may be felt even at rest. The sensitive joint may feel enlarged and warm to the touch from inflammation.

In rheumatoid arthritis, the fingers often become deformed as the disease progresses. The MCP joints of the fingers may actually begin to point sideways (towards the little finger). This is called ulnar drift. Ulnar drift can cause weakness and pain, making it difficult to use your hand for daily activities.

Ulnar Drift

Both rheumatoid arthritis and osteoarthritis can affect the IP joints of the fingers. The IP joints may begin to flex (bend) or hyperextend (over straighten), causing characteristic finger deformities. Swan neck deformity occurs when the middle finger joint (the PIP joint) becomes loose and hyperextended, while the DIP joint becomes flexed. When the PIP joint flexes and the DIP joint extends, a boutonniere deformity forms.

Swan Neck Deformity

Boutonniere Deformity

Both forms of arthritis can cause enlarged areas over the back of the PIP joints. These areas tend to be sore and swollen. They are known as Bouchard's nodes.

Bouchard's Nodes

Osteoarthritis causes similar enlargements over the DIP joints, called Heberden's nodes.

Heberden's Nodes

Diagnosis

How do health care providers identify arthritis?

The diagnosis of arthritis of the finger joints begins with a history of the problem. When you visit Greater Pittsburgh Physical Therapy & Sports Medicine, our Physical Therapist will want details about any injuries that may have occurred to the hand. This information is important because it may suggest other reasons why the condition exists.

Following the history, we will do a physical examination of the hand and possibly other joints in the body. Our Physical Therapist will need to see how the motion of each joint has been affected.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at Greater Pittsburgh Physical Therapy & Sports Medicine have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

Our Treatment

Non-surgical Rehabilitation

Treatment usually begins when the joint first becomes painful. This may only occur with heavy use and may simply require mild anti-inflammatory medications, such as aspirin or ibuprofen. Reducing the activity, or changing from occupations that require heavy repetitive hand and finger motions, may be necessary to help control the symptoms.

Our primary goal is to help you learn how to control symptoms and maximize the health of your hand and fingers. When you visit Greater Pittsburgh Physical Therapy & Sports Medicine in Pittsburgh, our Physical Therapist will instruct you in ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs.

We will then begin range-of-motion exercises for your finger after your pain eases, followed by a program of strengthening to improve your finger movement. Strengthening exercises for the arm and hand help steady the hand and protect the finger joints from shock and stress. Our therapist may also use dexterity and fine motor exercises to get your hand and fingers moving. We will go over tips on how you can get your tasks done with less strain on the joint.

Your Physical Therapist may recommend a custom finger brace or splint to support your finger joints. These devices are designed to help reduce pain, prevent deformity, or keep a finger deformity from getting worse.

Post-surgical Rehabilitation

Your hand will be bandaged with a well-padded dressing and a finger splint for support after surgery. Although time required for recovery varies among patients, you may need to attend our physical or occupational therapy sessions after surgery for up to eight weeks.

When you begin your Greater Pittsburgh Physical Therapy & Sports Medicine post-surgical Physical Therapy program, the first few treatments will be used to help control the pain and swelling after surgery. Some of the exercises that our Physical Therapist will have you do help strengthen and stabilize the muscles around the finger joint. We’ll recommend other exercises to improve the fine motor control and dexterity of your hand. Our Physical Therapist will also give you tips on ways to do your activities while avoiding extra strain on the finger joint.

At Greater Pittsburgh Physical Therapy & Sports Medicine, our goal is to help you keep your pain under control, improve your range of motion, and maximize strength and control in your finger. When your recovery is well under way, regular visits to our office will end. Our Physical Therapist will give you tips on keeping your symptoms controlled. We will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.

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Surgery

Fusion

A fusion (or arthrodesis) of any joint is designed to eliminate pain by allowing the bones that make up the joint to grow together, or fuse, into one solid bone. Fusions are used in many joints and were very common before the invention of artificial joints for the replacement of arthritic joints. Even today, joint fusions are still very commonly used in many different joints for treating the pain and potential deformity of arthritis. Fusions are more commonly used in the PIP or the DIP joints in the fingers. A fusion of these joints is far easier and more reliable than trying to save the motion by replacing the joint.

Artificial Joint Replacement

Artificial joints are available for the finger joints. These plastic or metal prostheses are used by some hand surgeons to replace the arthritic joint. The prosthesis forms a new hinge, giving the joint freedom of motion and pain relief. The procedure for putting in a new joint is called arthroplasty.