HAND & ARM PROBLEMS

What is it?

Rheumatoid arthritis is a medical condition in which the immune system attacks and damages many parts of the body, including the hands. Rheumatoid arthritis is primarily treated by medical doctors, and may require treatment by an arthritis specialist. Medical resources on rheumatoid and other arthritic conditions are available through the American College of Rheumatology.

 

What caused it?

The reasons for developing rheumatoid arthritis are not currently known. What is known is that people with rheumatoid arthritis have inflammation or irritation of many of the moving parts of their bodies, including the joints and tendons. This causes pain, swelling, weakness, and over time, loss of the normal shape and alignment of joints. Swelling around the tendons can lead to trigger fingers and carpal tunnel syndrome.

In the hand, any joint can be affected, but common problem areas include the big knuckles of the fingers (the metacarpophalangeal joints) and the wrist bone on the side of the small finger (the ulnar head and distal radioulnar joint). Osteoarthritis is a more common type of arthritis, and different than rheumatoid in that it is much less likely to affect these joints.

 

What can you do to help?

  • If you have any questions about the overall picture of rheumatoid arthritis, you should discuss them with your medical doctor. Rheumatoid is first and foremost a medical disorder, treated with medication, and surgery is an option to consider if medical treatment does not provide adequate control.
  • If you have rheumatoid arthritis, you should do all you can to learn about the disorder and what you can do to promote your own health.

 

What can a therapist do to help?

  • A hand therapist can provide advice on living with rheumatoid, and give helpful information on how to live one's life without aggravating or accelerating the damage caused by rheumatoid. This is often referred to as a "joint protection program".
  • Therapists can also provide some special tools to assist people whose hands have been damaged by rheumatoid perform routine daily activities. These are called "adaptive devices".
  • If surgery is required, therapy after surgery is very important. Custom splints may need to be made and maintained by a skilled hand therapist.

 

What can a doctor do to help?

  • The main treatment of rheumatoid is with medicines. Your medical doctor is your best resource to provide an evaluation with examination, X-rays and blood tests. Some medicines used to treat rheumatoid need to be monitored with periodic blood tests.
  • Cortisone shots into sore areas may be very helpful in relieving pain and swelling.
  • If your medical doctor feels that you have a problem which would benefit from surgery, you will be referred to an appropriate specialist. Generally, this is a consideration only if your condition is not adequately relieved with medicines.
  • Problems which might be helped by a hand surgeon include:
    • Persistent joint pain and swelling despite medication.
    • Pain when bending or straightening the fingers.
    • Numbness or tingling in the fingers.
    • Stiff, bent or locking fingers.
    • Inability to straighten the fingers.
  • Surgery may be helpful to correct deformities caused by rheumatoid, but may also be recommended to prevent problems before they occur - such as tendon rupture.

 

How successful is treatment?

It really depends on what the problem is, but in general, carefully planned surgery is worthwhile. Surgery is most helpful for correction of deformity and for preventing tendon rupture. Surgery is less likely to help improve the strength of the hand.

 

What happens if you have no treatment?

This really can't be predicted. Simple surgery to prevent tendon rupture can help avoid complications which would require more extensive surgery to correct. Surgery to correct nerve problems such as carpal tunnel syndrome may prevent progressive nerve damage. Other than that, it is a quality of life choice.

Some people have deformities which develop over a short period of time, and then don't get much worse. Others gradually get worse and worse. Hands injured by rheumatoid can not be made normal, but very often can be made better with careful planning.

Not all problems require surgery, but the right operation can sometimes make a big difference in the appearance and function of the hand.

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