Get a handle on arthritis pain with specialized wrist and hand treatments

For patients with painful finger motion whose range of movement is reduced to 20-30% of normal in the affected joint, finger joint replacement can be an option. Joint replacement typically restores up to 50% of the normal range of movement, but more importantly, greatly reduces pain.

Procedures vary depending on which of the many joints in the hand and wrist are affected by arthritis. For example:

• Knuckles: The surgeon removes the old joint and replaces it with a silicone device that allows you to move with less pain. The replacement joint has long silicone stems that go into the bones above and below, with flexible silicone sitting in the middle and acting as a plastic joint.
• Where the thumb meets the wrist: The surgeon will remove one of the bones that is grinding – typically the 15mm-wide trapezium bone. The surgeon then creates a hammock from surrounding tendons on which the thumb bone can rest, leaving it free to move without grinding.

Stopping the grinding of bones in a painful joint is the key to easing pain. Sometimes we can stop the grinding by replacing the worn out cartilage. But in some cases, it is better to fuse the bones to restrict movement. By using plates, screws, or wires, the bones of the joint are held still so they heal together and essentially become one.

Fusion surgery is a good option in joints that bear too much force or pressure to replace the joint, such as the first joint of your index finger (the proximal interphalangeal joint), which shares with the thumb the force of pinching or gripping.

Because fusion permanently restricts range of movement, we reserve it for patients with excruciating pain from simple movements. If you choose fusion surgery, our team will work with you to ensure you can still perform everyday tasks such as typing or holding a phone.

Nerve surgery doesn’t treat arthritis, but it allows the patient to use their hand or wrist with less pain.

For example, there are two nerves in the wrist, the anterior and posterior interosseous nerves, that have only one function— to tell your brain that your wrist hurts. By removing these nerves, wrist pain can be greatly decreased without the loss of any feeling or motion in the hand or wrist.

Prior to nerve surgery, we can test whether the procedure will work by injecting the nerve with numbing medication. If the patient notices good pain relief for the rest of the day, it’s a good indication that nerve surgery will help reduce pain symptoms.

Patients with osteoarthritis and post-traumatic arthritis can be good candidates for nerve surgery.

For some patients with moderate arthritis in their wrists, joint resurfacing (interposition arthroplasty) can reduce pain from grinding bones. Rather than removing the damaged joint, this procedure involves placing soft tissues, such as ligaments, between the bones to create a new soft surface, alleviating grinding and pain.