Adult
Arthritis
Hand, wrist and elbow
What it is
Osteoarthritis is wear of the cartilage lining the joint surfaces. In the hand it most often affects the base of the thumb and the joints nearest the nails. Cartilage thins, bone responds by forming spurs, and the joint loses its shape.
Inflammatory arthritis, such as rheumatoid, works differently: the lining membrane of the joint becomes inflamed, and it also weakens the neighbouring ligaments and tendons. It tends to affect the knuckles and the wrist, often on both sides.
Symptoms
Pain comes with pinch and grip: opening a jar, turning a key, wringing out a cloth. It settles in after use and at the end of the day.
Morning stiffness, swelling, grinding, bumps at the finger joints and a gradual loss of strength follow. In inflammatory arthritis the morning stiffness lasts longer and the joints are warm and swollen.
Non-operative treatment
A great deal helps, and it is offered first: a thumb splint worn during the activities that hurt, hand therapy, joint protection and adapting tools and handles, anti-inflammatories, and a corticosteroid injection.
In inflammatory arthritis, priority goes to the disease-modifying medication prescribed and monitored by rheumatology: it changes the course of the disease, which no operation does.
Surgical treatment
Surgery is considered when pain persists despite these measures. At the base of the thumb, the small worn bone can be removed (trapeziectomy), with or without ligament reconstruction, or the joint can be replaced.
In the fingers, two approaches coexist: fusion gives a stable, pain-free joint where stability matters most, and replacement preserves movement where that is what counts. In the wrist, depending on the pattern of wear, the choice lies between a partial fusion, removing the first row of carpal bones, or a whole-joint solution.
Recovery expectations
How long the hand is immobilised depends on the procedure, after which therapy takes over.
Pain relief is the most reliable gain. Strength returns over several months, and one thing should be said plainly: after thumb surgery, grip mainly becomes less painful — it is not necessarily stronger than it was before the arthritis. Tasks reorganise themselves, often differently.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.