Other Arthritides of Hand
Arthritis of the hand can be caused by other systemic diseases. These include Lupus, psoriasis, scleroderma, and rheumatoid arthritis. Initial treatment consists of conservative management including anti-inflammatories, more sophisticated anti-arthritis drugs under the supervision of a rheumatologist, and/or splinting. If these measures are not successful, then surgical reconstruction can be entertained. Classically in patients with deformity at the level of the metacarpal phalangeal joints, i.e., the large knuckles within the hand, surgical reconstruction can offer significant improvement.
This can be as simple as performing a synovectomy of the joint, i.e., removal of the offending inflammatory tissue and realigning the tendons over the level of the joint and/or, if there is significant joint destruction, placement of an artificial joint. If an artificial implant is placed, then specialized splinting under the supervision of an occupational therapist is need for approximately 6 weeks subsequent to the surgical procedure. These implants allow the fingers to be better aligned and also help with motion of the joint.
The implants are made of Silastic and usually have a long lifespan. There is, however, the possibility that these implants can fracture over time which may warrant subsequent surgery for removal. Often, however, even with fracture of the implants, function is not impaired and surgery can be avoided. In addition to the implantation of an artificial joint, soft tissue reconstruction is performed in conjunction with this procedure. This includes realignment of the tendons over the joint in a more effective position preventing deformity forces at the level of the joint.