Anteroposterior radiograph of the hand
Lateral radiograph of the right ring finger
A 72-year-old man presents with pain and stiffness in his right hand. The pain is worse in his fingers, especially the ring finger. He is an avid golfer and is having difficulty swinging his club due to the pain. Anteroposterior radiograph of the hand and lateral of the right ring finger (Figures 1 and 2) show severe arthritis throughout the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints. He is looking for surgical treatment options, as he has tried years of rest, ice, and NSAIDs.
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Arthritis of the fingers is a common condition that can be found in most adults of advanced age, especially in women. As many as 70% of women older than age 80 will have arthritis at the DIP joint, and hand arthritis is seen as a 10:1 female-to-male ratio. Most patients will not be symptomatic despite arthritis on radiograph. There is very little correlation between the degree of arthritis on radiograph and pain level. Osteoarthritis affects the DIP joints more than the PIP and MCP joints. Symptoms of finger arthritis include intermittent pain and stiffness when using the hands. Arthritic deformities can also be present in the fingers. Heberden’s nodules are osteophytes at the DIP joints, and Bouchard’s nodules are osteophytes at the PIP joint.1,2
The first-line treatment for finger arthritis is ice, NSAIDs, and activity modification. Intra-articular injections can be performed for temporary relief, although the injections can be technically difficult and the relief is usually short lived. The two most common surgical options include arthroplasty (replacement) or arthrodesis (fusion). DIP joint arthritis is generally treated with an arthrodesis. The bone stock of the distal phalanx is limited and does not support an implant required for arthroplasty. Arthroplasty with a silicone implant is the preferred surgical treatment for PIP arthritis. Arthroplasty better preserves joint motion and function compared with arthrodesis.2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- McKean J. DIP and POP joint arthritis. Available at: https://www.orthobullets.com/hand/6055/dip-and-pip-joint-arthritis. Accessed on February 20, 2018.
- Beldner S, Polatsch DB. Arthrodesis of the metacarpophalangeal joint and interphalangeal joints of the hand: current concepts. J Am Acad Orthop Surg. 2016;24:290-297.