Finger Interphalangeal arthritis

Background

Osteoarthritis of the distal interphalangeal joint (DIP joint- the joint near the nail) and proximal interphalangeal joint (PIP joint- the adjacent joint) in the fingers is very common and associated with pain, deformity, cysts and nail deformity.

Causes

The DIP joint has the maximal forces passing through it and therefore is prone to wear and tear. This is also the case with the PIP joint but to a lesser degree. The cartilage in the joint wears out- and this will lead to bone rubbing on bone (osteoarthritis)- causing the pain.

Symptoms

Patients will complain of pain and a loss of movement. As the bone wears out you can get deformities in the fingers. Bony spurs are prominent and are called Herberden's nodes at the DIP joint and Bouchard nodes at the PIP joint.

Cysts can also form, which can swell and reduce in size and occasionally leak through the skin. The cysts can press on the nail causing ridging/deformity.

Operative treatment

Non-operative treatment has a very limited role in arthritis. When symptoms are mild, observation and oral painkillers can be used. Steroid injections can occasionally help but only help reduce pain in the short term.

DIP Joint

In early disease, or when there is an isolated bony prominence, it is possible to remove the spur/cyst. This however does not treat the underlying arthritis.

Fusion of the DIP joint is a predictable and reliable way to treat the arthritis. The surgery takes place under local anaesthetic, under x-ray control. An H-shaped incision is made on the back of the joint. The tendons are divided and the underlying bone exposed. The majority of the spurs are removed and a screw is inserted. This will usually help the angular deformity. In severe cases it may not be possible to perfect as there may be significant bone loss. The screw generally does not require removal unless it causes and issue (infection, irritation or backing out which are rare complications). The screw does not cause issues at airports.

Once a joint is fused there will be no residual movement in that joint. Usually by the time a fusion is performed there is limited range of motion in the joint already. The fusion is usually very well tolerated at the DIP joint and doesn't cause significant loss of function.

PIP joint

Fusions are often performed at this joint however the loss in range of motion is less tolerated. Another option is a joint replacement however this is not always possible.

Post-operative rehabilitation

The skin is stitched with non-absorbable stitches. A small plaster may be applied depending on how adequate the quality of the bone is during the fixation. If a plaster is applied it stays on for about 2 weeks.

An appointment will be made to see a hand therapist at 2 weeks. The scar can be sensitive for a few weeks and usually settles by 3 months.

Return to activities of daily living

Once the bone has grown across the joint, a rapid return to function can be expected.

Complications

The main risk is the bones not growing together. This occurs in approximately 5-10% of cases. In the vast majority of those cases the ongoing symptoms are mild and much improved compared with pre-operatively.

The vast majority of patients undergoing this operation are very happy.

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