Article published in the The Triangle Physician Magazine, November 2013
Osteoarthritis (OA) is a common, progressive degenerative joint disorder which can cause pain, impaired mobility, and decreased health-related quality of life. As our population ages, there has been increased public interest in effective treatment options for OA. Total joint arthroplasty (joint replacement) is a well-established surgical option for patients with advanced degenerative disease of the knee and hip joints. Lower extremity joint replacement has demonstrated mostly good-to-excellent outcomes in the orthopaedic literature, resulting in pain relief, functional improvement, and high satisfaction for many patients. Public awareness of lower extremity OA treatment has increased as advancements in joint replacement surgeries have been reported.
In contrast, the treatment options for patients with hand and wrist OA are often misunderstood by the general public. Often patients say, “I didn’t know there was anything that could be done for arthritis in my hands” or “I thought I just had to live with my arthritis pain.” While it is true that there is currently no cure for degenerative joint disease, there are many non-surgical and surgical treatments which effectively relieve symptoms. In our practice, the emphasis is always on the most conservative and least invasive approach when possible. Most patients improve with conservative care, and therefore do not undergo surgery. Effective non-surgical options include off-the-shelf and custom splints, corticosteroid injections, oral and topical anti-inflammatory medications (NSAIDs), hand therapy modalities, and activity modification education. The use of oral glucosamine and chondroitin sulfate supplementation is also gaining acceptance for use in patients with hand OA. A recent randomized, controlled trial showed a significant improvement in hand function, pain scores, and morning stiffness in patients in the treatment group compared to placebo. These supplements are available over-the-counter and are not to subject to FDA oversight. Other remedies patients often try prior to consulting a physician are herbal supplements, topical ointments, anti-oxidant diets, warm water soaks, and paraffin wax kits, which may or may not provide durable symptom relief.
When conservative treatment fails to satisfactorily improve symptoms, there are well-established surgical interventions available to many patients. For example, thumb carpometacarpal (CMC) joint arthroplasty is a commonly performed surgery for patients with debilitating basilar thumb arthritis pain. This procedure was first reported in the 1940s and has a long track record of favorable results. Several 10-year outcomes studies have demonstrated that CMC joint surgery provides long-lasting pain relief for the majority of patients. During this outpatient procedure, the trapezium bone at the base of the thumb metacarpal is removed which eliminates the “bone-on-bone” grinding characteristic of OA pain. Typically a tendon from the patient’s forearm is used to fill the trapezial void and support/cushion the base of the thumb metacarpal. Most patients report improved hand function, decreased pain, and satisfaction with the long-term results. However, this procedure is not a “quick fix,” as recovery can take three months or more to achieve full benefit. The risks and benefits of thumb CMC joint surgery are carefully assessed for each patient, and not all patients are candidates for surgery.
Author Bio:
John M. Erickson, MD is a hand and upper extremity surgeon at the Raleigh Hand Center. He is board-certified in orthopaedic surgery and completed additional fellowship training in hand and upper extremity surgery at Vanderbilt University. Dr. Erickson received his medical degree from the University of Texas Southwestern Medical Center in Dallas and completed his orthopaedic surgery training at the University of Michigan Hospitals in Ann Arbor.