Osteoarthritis wears away at the cartilage of a joint, which is the cushioning material that covers the ends of all bones in a joint. As the cartilage is thinning, you have more bone-on-bone grinding, this is what causes the pain that you feel when moving your finger joints. As the grinding and friction increase over time, your body will compensate by increasing the inflammation in and around the joint. A fluid that allows for smooth sliding of the connecting surface is called synovial fluid. The joint surface destruction accelerates the production of synovial fluid and inflammatory swelling. This build-up causes pressure around the joint which in turn limits joint motion and stiffens your fingers.

Repetitive tasks aggravate the friction inside the joint space, which flares up the scraping, locking, grinding, and clicking of the fingers. The balance between too much and too little movement is the safe zone.

A joint is any part of the body where two bones come together forming a hinge where movement takes place.

Inside the joint are the two ends of the bones that are not directly connected. There is a space between them. Smooth cartilage and synovial fluid fill the space. This protective lining makes the movement smooth and frictionless. To keep the joint stable, as the bones are not directly attached, you have a ligament structure called the joint capsule that forms a sleeve around the joint. This sleeve has an inner lining made up of a synovial membrane. The synovial membrane has the job of producing fluid inside the joint space which acts like oil that allows moving parts of your engine to remain lubricated.

To further strengthen the joint you have extra ligament structures on the sides and the bottom of the joints to protect it from easy displacement or dislocation. These ligaments (collateral on the sides and volar plate at the bottom) attach from one bone to the other and provides a strong hold to keep everything in place.

In each finger, you have three joints. The joints starting at the tips of your fingers are called the Distal Interphalangeal joint (DIPJ), then the Proximal Interphalangeal joint (PIPJ), and your knuckles are known as the Metacarpal Phalangeal joint (MCPJ). Osteoarthritis usually starts in the DIPJ’s and PIPJ’s first.

DIP, PIP, and MCP joints must provide smooth gliding and sliding of the joint surfaces and permit compression forces to be transferred through the bones, as you grip, grasp, squeeze, catch, carry, and twist things.

Wear and tear plays a significant role in the rate at which your joints wear down just like tires on a car. Excessive and abusive repetitive tasks tend to accelerate the destruction of the joint space. However, human body parts age with time, and a certain degree of erosion is considered normal within your age group.

Various reasons compound to speed up the Osteoarthritic process, faster than expected.

Stage 1 ~ Early

In the early stages of Osteoarthritis the articular cartilage is smooth and without fissuring the bone is unaffected, and the synovial fluid becomes thicker and sticker which usually looks swollen. The finger joints can move through the whole range without pain or restriction.

Stage2 ~ Mild

Though the joint space appears normal the cartilage has begun to break down from a combination of wear en tear and increase production of degrading enzymes inside the joint. Bone spurs (Osteophytes) form over the edges of the joint. These osteophytes form in a response to adapt and redistribute forces along the joint. Pain at the end of the available range of motion, and often discomfort in your finger joints.

Stage 3 ~ Moderate

The changes in your finger are much more visible. The cartilage surface erodes narrowing the gap between the bones. Hyaluronic acid (which lubricates the joint) becomes even more sticky, glue-like, and bundled up. Subchondral bone normally oxygenates and hydrates the cartilage, and in this stage the bone is deprived due to the weakening of this essential role. Cytokines and proteins further add to the destruction as the normal repair response breaks down even healthy tissue. Osteophytes increase in size and number making the bone rougher. At this stage your pain is more regular, severe and intense. Stiffness is guaranteed.

Stage 4 ~ Severe

Conditions worsen dramatically, causing more rapid and severe destruction of cartilage. Synovial fluid is decreased, increasing friction and constant pain during movement. Destructive proteins further degrade cartilage and soft tissue around the joint.Osteophytes continue to grow and invade the joint space, where bone scratches against bone. At this stage there’s little escape from the pain, even at rest.

Age. The older you are the more likely it is to develop osteoartritis.

Gender. Studies have shown that females have double the risk of developing osteoarthritis when compared to males.

Ethnicity. Rates of arthritis are lower in darker skin colors.

Weight. Being overweight increases the forces through the joints and amplifies joint destruction.

Previous injuries. Trauma and damage to cartilage, ligaments, and bones put you at higher risk of Osteoarthritis, like a broken or dislocated finger.

Genes. A high correlation exists in hereditary osteoarthritis.

Joint problems. If you had infections, loose ligaments or a joint that is not aligned in the right way, the overuse of these joints rises your risk.

Surgery: Osteoarthits is accelerated after surgery to a finger joint.

Why not test your own hand and see where you are on the spectrum?

At first, the stiffness is only in the mornings and for a little while (30 min) and goes away for most of the day, later on, osteoarthritis leads to more frequent flare-ups for short periods during the day. At its worst, the stiffness intensifies into pain and relief is more the exception. This involves 3 components, duration, frequency, and intensity which progressively deteriorate. Pain at rest is one of the clear-cut markers for more severe arthritis.

In the initial stages, the stiffness and pain are more a nuisance rather than limiting, but as the joint destruction gets worse the activity necessary to produce the same amount of pain is much less. The threshold of triggering a flare-up drops as you’ll notice that firstly it’s only difficult opening a jar, then wringing a towel and drying your hair, and at its worst even just getting dressed like putting on pants and turning a key is a major challenge.

Osteoarthritis of the fingers usually attacks the thumb first, spilling over to the tips of your fingers. However, with previous trauma, the osteoarthritis appears faster in that specific finger. In the later phase of osteoarthritis, it erodes all the joints, no joint is spared.

Swelling and lumps grow bigger over time, unnoticeable in the beginning but very prominent and obvious that it limits your movement. Numbness spreads over your hand as the nerves get compressed and neglect will only adds fuel to the fire.

As the weakness sets in, the deterioration accelerates. Less motion, more pain, and increased stiffness lead to a pattern of avoidance. This cycle further limits the available joint range, ultimately winding up with even more weakness. Even at rest, there is little relief.

The diagnosis is obvious, but the secondary fallout is the main focus of treatment in the short term. In the long run, the goal is to maintain the condition at a bearable level. The chronic state of joint destruction is easily detected on X-rays, whereas the more niche interactions between joint, tendon, nerve, and muscle pain are poorly understood by the medical field. Osteoarthritis is often ‘accepted’ as an unchangeable fate, however, the acute spurs in pain are rarely the true origin of the immediate problem and overshadow the secondary DeQuervains tendinitis, trigger finger, swan neck deformity or nerve pain.

We are experienced in testing the different severities of joint damage as well as the degree, stage, and course you are heading at.  Our specialists use a range of tests to determine the hierarchy of the damage. We mainly test the three components of the joint, the first involves movement testing and we develop a certain dexterity to identify particular limitations. The second involves testing joint stability and integrity. Thirdly, your endurance and functional capacity in everyday use.

X-ray:

They are helpful to show the available space between joints, abnormal bony growths, and the state of your bones. 5 Yearly X-rays are valuable to clarify the rate of regression. They are beneficial for measuring osteophytes’ location and direction that may block motion. The amount of joint degeneration and the extent of it in each one is classified.

Most patient who consult us have already heard that they have Osteoarthritis, and most have taken X-rays with their GP confirming it.

Sonar (Diagnostic Ultrasound)

A sonar visualizes the capsular thickening and torn ligaments over certain joints but is limited to structures outside of the joint space. This hinders us from clearly checking the articular involvement inside. It is used to grade swelling, secondary problems, and complications.

MRI:

An MRI is rarely done, it is more often used by an Orthopedic specialist as a last resort to clearly map out your hand before surgery.

Osteoarthritis is a progressive disease process. Nobody can change what has already happened within the joint. The focus shifts to maintaining what you currently have. Treatment is aimed at understanding how to manage your stiffness and slow the progression down, by increasing your muscle strength to change the load on certain joints. Doing too much will aggravate your symptoms and doing too little will increase joint stiffness and again cause pain. You have to find the balance between too much and too little in order to keep active, stay mobile and strong. This can be particularly tricky, we approach it by breaking down activities into movement components in order to establish which motion contributes more than others.

It is normal to experience flare-ups of pain. In this time where the stiffness increases the function will decline as a result. This is usually because of secondary problems that develop on top of the chronic state of the joints. This includes tendonitis, trigger fingers, De Quevains tenosynovitis, and carpal tunnel syndrome. These intensify the inflammation within the joint and cause a “grainy” feeling on movement, almost like there is sand within the joint, or even noises, like clicking, cracking or popping sensation when moving.

Being promised an easy fix. A lot of patients hopefully try a wide variety of treatment options, exercise regimes, medication, supplementations and braces without truly understanding the pathology of osteoarthritis. Unfortunately, there is no easy fix and no way to give you back the strength you had in your hands in your twenties. No supplement can reverse the damage. A good understanding of what’s happening inside the joints, how to load it responsibly, and when to be cautious is the best strategy to manage hand osteoarthritis. Preventing the ripple effects of osteoarthritis is at the core of our approach.

If left unmonitored, secondary problems develop. Carpal tunnel syndrome is one of them. The expansion of the joint space constricts the already tight passage of the nerves. This gives rise to nerve irritation and compression over the delicate nerves in your hand. Osteophyte formation, nerve glide, and joint motion must be measured periodically in order to preserve the nerves.

Trigger finger develops as a result of changes in the joint alignment and abnormal forces across the pulley action of your tendon, which inflames, and thickens. It is still to be proven that there is a direct link between the degree of deviation between two connecting osteoarthritic joint surfaces and the risk of getting a trigger finger.

Braces quicken the weakness and encourage disuse, not to mention the stiffness that gets even worse. Medication is a useful tool to regulate inflammatory spikes and bring them under control, however, irregular dosages actually provokes more frequent flare-ups.

Unfortunately, we cannot reverse the structural changes inside the joint, however, we can relieve a great deal of your pain and assist you in some lifestyle adaptations that will help you minimize your hand pain. By doing things differently you can slow down the deterioration and limit painful episodes.

A trained, skilled, and specialized medical professional must monitor the regression while identifying and treating the secondary complications that appear. This crucial step is often missed by most medical staff, and misunderstood by patients. The monitoring allows for early detection of issues, to prevent the snowball effects that accelerate tissue damage.

This is the core of our osteoarthritis treatment program. It also involves treatments like laser therapy, myofascial release, capsular stretches, neural mobility training, joint stabilization, corrective splinting, and supportive taping.

Early Detection:

This stage involves monitoring the regression of the osteoarthritis. Apart from the immediate short-term problem, this is the long-term evaluation over a 5 to 10 year period. In this stage, we treat the secondary complications and limit further tissue destruction.

Classify joint state:

In this stage, we classify each joint in one of the four stages of osteoarthritis. X-rays are taken to measure the size and width of osteophytes, and inta-articular joint space between the metacarpal, carpal, and phalanxes. Measuring the angle of deviation between joints. This provides the features of each stage of osteoarthritis in your hand.

Rate of regression:

The comparison between two intervals over a period of time (2 years) gives us an estimate of the rate of destruction that could take place in the next period. This guides us on how to adapt your treatment protocol, pace, and frequency of re-assessment.

The major concern is the deterioration of the simple tasks over months, “not being able to do the mundane things, brings the greatest frustration”. Doing what is necessary in a flare-up, knowing how to adapt your activity, perform the simple joint exercises and when to adjust your medications, are tools that you must use to keep the rate of regression to a minimum, and chart a course of the disease that doesn’t end up in despair, depression and regret.

Great strides and improvements are possible if the right tools are used that are specifically designed for you. Remember that arthritis presents differently in every person; your main problem’s uniqueness is rarely similar to another person with the same disease. Getting ahead of the disease needs pinpoint precision in correctly prioritising the hierarchy of importance.

Yes, there are a few clinical markers that must be there for surgery to be considered. This is under the discretion of your orthopedic surgeon and entails a combination of checkboxes such as physical examination and functional limitations. These are some of the factors they may take into account:

• Joint deviation more than 15 degrees sideways
• Nerve damage
• Joint instability
• Grip strength weakness
• Pain

Surgery is often postponed as a last resort, as the recovery after surgery is at high risk of sacrificing some sort of function. Surgery is often very successful, but structural changes are hard to revert.

• Hand osteoarthritis
• Osteoarthritis in both hands
• Arthritis left hand
• Right hand arthritis
• Osteoarthritis right hand

Trigger finger

Your Pain is usually prominent only during motion, with a distinct clicking.

De Quervain’s tenosynovitis

Pain during resisted extension motion of your thumb and localized over the wrist rather than the base of your thumb.

Carpal Tunnel

The pain is described as pins and needles, numbness, and burning more pronounced when your wrist is bent.