Arthritis of the hand and wrist


Arthritis is a condition of the joints where the cartilage lining the moving surface of the joints becomes thin, cracked and eventually lost. The cartilage enables smooth painless movements of the joints in the normal situation. Once arthritis develops it is a progressive condition which gradually deteriorates. Depending on the cause, the speed of deterioration can vary from few months to many decades.

All joints of the hand and wrist may be affected. The most commonly affected joints are the base of the thumb and distal interphalangeal joints of the fingers.


Broadly speaking arthritis is caused by inflammatory or non-inflammatory conditions.

Inflammatory arthritis occurs in conditions like gout "gout", rheumatoid arthritis "rheumatoid arthritis" and psoriatic arthritis "psoriatic arthritis". These conditions cause destruction of the cartilage by inflammation and may occur in joints elsewhere in the body and in addition to the hands and wrists.

The most common non-inflammatory arthritis is caused by osteoarthritis "osteoarthritis". This condition may have a genetic basis and may also be age related as it is more common the older one is. However, from the age of 40 onwards many people start to develop the condition within many joints including those of the hand & wrist. Previous injuries to cartilage or ligament or bone fractures around the joints may also result in osteoarthritis.



The pain of arthritic joints does vary in severity and does not always reflect the severity of the cartilage deterioration. The pain can fluctuate and may be related to the severity of the inflammation within the joint.

Often the pain is noted sometime after activity but may also occur during the activity.

In gout, the pain may come on suddenly over a few hours and be extremely painful for a few days. It is also accompanied by swelling, warmth and sometimes, redness. A  rare condition called septic arthritis, which is an infection of the joint, can also have these same rapid onset of these symptoms. If you do not have a known history of gout, or you have conditions which suppress your immune system, then you must seek urgent medical attention if you develop these symptoms.


In both inflammatory and non-inflammatory arthritis, the joints can become stiff to move after a period of inactivity, such as upon waking in the morning. The inflammatory arthritis tends to produce stiffness lasting much longer, perhaps over an hour after starting to move the joint.


The swelling of arthritic  joint is due to synovial fluid produced by the lining of the joint called synovium. The amount of fluid within the joint can vary from week to week. When the joint is swollen it is often also painful as it is frequently related to the amount of inflammation within the joint.

In osteoarthritic joints, the bony edges of the joint produce bony outgrowths called osteophytes. These too, can cause swelling in addition to the synovial fluid.


A joint which has arthritis may also be warmer than the rest of the limb. This is due to the inflammation.


The diagnosis is made by a history of the above symptoms. The doctor will also consider your full medical history, such as family history, injury, other medical conditions, medications. An examination of the affected joint, limb  and perhaps other areas will be required.

Blood tests for inflammatory causes may be needed depending on the possible diagnosis. X-rays of the affected joint are frequently needed to assess the severity of damage to the joint and for surgical treatment if any is planned.


Non-surgical Treatment

Nothing apart from making a diagnosis may be needed. Adjustment of activities. Splints to support the hand or wrist during painful activities. Anti-inflammatory medication and painkillers are also prescribed. If you have inflammatory arthritis, then specific drugs for these conditions may be prescribed under the care of your GP and sometimes a Rheumatologist.

Surgical Treatment

The goals of surgical treatment are pain relief, improve function, correct deformity and prevent future deterioration. Broadly speaking surgical treatment is best at pain relief. With certain joints and certain causes of arthritis it may also be helpful in improving function and correcting deformity.

The options for surgical treatment are joint replacement, joint fusion, joint excision, interposition of material (synthetic or natural), or osteotomy (realignment of the joint).

Mr Miranda will discuss with you the treatment options along with the risks and benefits of the various options. If surgical treatment is chosen he will also discuss with you the about the recovery from this. There is no substitute for a consultation even just to discuss the options.