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Summary:While there are a number of nonsurgical options to address the symptoms of arthritis pain, these treatments will not necessarily work for every person or remain effective as arthritis symptoms worsen. Arthritis surgery is designed to repair or replace the affected joints through either joint fusion or joint reconstruction. This article discusses these surgical options in more detail, focusing on treatment of arthritis in the hand and wrist joints.

Acute pain in a hand

Nonsurgical Treatments

The typical first step in managing hand and wrist pain associated with osteoarthritis or rheumatoid arthritis is to prescribe analgesics with anti-inflammatory properties (non-steroidal anti-inflammatory drugs, or NSAIDs). These drugs may be accompanied by joint health supplements, use of hot or cold compresses, or even alternative pain management techniques such as acupuncture or meditation.

Exercise of the joint can help to manage pain and maintain range of motion, though too much activity can actually increase pain for many people with arthritis. Some patients find that corticosteroid injections in the hands or wrists provide additional short-term relief. People with rheumatoid arthritis can benefit from the treatments mentioned above and also may be prescribed antirheumatic drugs to slow the progression of the disease and immunosuppressants to regulate the immune system.

Joint Fusion in the Hand

Also known as arthrodesis, joint fusion involves removing the arthritic surface of joint bones and permanently connecting the two bones on either end of the joint. This procedure eliminates the joint itself, which results in loss of mobility and flexibility in than hand or wrist but creates a more stable joint and can significantly decrease overall discomfort.

Our surgeons may use two different methods to achieve joint fusion:

  • A bone graft involves taking bone from another part of the body, using bone from a donor, and/or using synthetic bone substitutes. The material is placed in between the two bones that the doctor wants to fuse. The body’s healing process will join the bones together over time.
  • Metal implants instead may be used to bring the bones together and encourage them to heal as one. In some cases this approach may be combined with a bone graft for improved healing.

Joint Reconstruction in the Hand

In cases of less severe bone degradation, joint reconstruction may be an option. It tends to be most effective for patients in the early stages of osteoarthritis, and provides the advantage of retaining more joint function compared to joint fusion procedures. During this surgical procedure, the doctor will smooth and clean the cartilage in the affected joints and also remove bone spurs and other damaged tissue. Reconstruction may involve replacing damaged areas of the joint with other tissue or with a synthetic implant. This surgery can be particularly beneficial in treating the thumb (basal joint) and wrist, so that patients can decrease pain without as significant a reduction in range of motion.

Your Treatment Plan

Your doctor will work closely with you to develop a treatment approach that fully addresses the painful symptoms of arthritis in your hands or wrists. If nonsurgical treatment options have not provided relief or have become less effective over time, it may be time to explore surgical options. Like all arthritis treatments, the goal of arthritis surgery is to maintain as much range of motion as possible while relieving symptoms.

This means that where possible, a reconstructive approach is favored before more extensive joint replacement or joint fusion techniques are recommended. Modern surgical treatments of arthritis in the hand have allowed hundreds of thousands of people suffering from osteoarthritis and rheumatoid arthritis to live healthier, more productive, and more comfortable lives.

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