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Call our offices at: (310) 274-3481 (800) 964-0404
Beverly Hills
9301 Wilshire Boulevard
Suite 406A
Beverly Hills, California 90210
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INSURANCE & WORKERS' COMPENSATION
ACCEPTED!
We accept most types of insurance
providers and specialize in the treatment of workers'
compensation injuries to the hand and upper extremity. |
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Rheumatoid Arthritis in the Hand
Explanation of Rheumatoid Arthritis
Signs & Symptoms in the Hand
Diagnosis of Rheumatoid Arthritis
Non-Surgical & Surgical Treatments
Arthritis in the hand is usually one of three types: osteoarthritis;
post-traumatic arthritis (which shows up after some injury); or rheumatoid
arthritis. All three types take their root from arthritis, which literally
means "inflamed joint." The body's joints, including those
in the hand, wrist, and fingers, are all composed of two bones that
meet with smooth surfaces covered with cartilage that enables them
to move smoothly against each other as a matching set. When the smooth
surfaces no longer fit together well, become uneven, or simply wear
out from use, the joint is called arthritic. Although arthritis can
show up in any joint, when it develops in the hand or fingers, it's
more obvious because these joints are used so much. There are nineteen
major bones in the hand, along with eight small ones and the two forearm
bones that make up the wrist, so there are many joints where arthritis
can present.
While osteoarthritis,
post-traumatic arthritis, and rheumatoid arthritis are the most common,
arthritis in the hand can also come from gout, psoriasis, or infection.
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| Explanation of Rheumatoid Arthritis |
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Rheumatoid arthritis is a condition that impacts the cells that lubricate
the joint and make up the lining, the synoval tissue. This condition
can affect the whole body or many of its joints, usually all over
the body. The synovium, or joint lining, gets inflamed and swells
when rheumatoid arthritis is present, and this leads to the cartilage
and bone eroding. If the swollen tissue stretches the ligaments, which
hold the bones that surround the joint together, the joint may become
unstable or cause a deformity. The inflammation can even influence
the tendons, which are like ropes that tie the bones to the muscle,
and cause them to stretch out and rupture.
Although rheumatoid arthritis can show up anywhere, with respect to
the hand, it most often shows up in the wrist or the middle or end
knuckles of the fingers.
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| Signs & Symptoms in the Hand |
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No matter the type of arthritis, the joint affected will usually be
stiff, swollen, and cause pain when used. If rheumatoid arthritis
is present, some joints may have more swelling than others, and often
the finger will look like a sausage in what's called fusiform. Other
symptoms of rheumatoid arthritis may include:
A soft lump on the back of the hand that moves with the tendon
when the fingers are straightened
Crepitus, or a creaking sound when the joint is used
The fingers may begin edging away from the thumb
The tendons that bend the fingers may become swollen and can cause
the fingers to be numb or tingle, and when they're used there may
be a clicking when the finger bends
If the tendons are ruptured, it may be impossible to straighten
some fingers or the thumb
Wrist, finger, or thumb joints may be unstable
In Boutonnière deformity, the middle joint of the finger
is bent and the end joint hyperextends
The middle joint in a finger may show sway-back, or hyperextension,
in a finger with a bent fingertip in what's called a swan-neck deformity
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| Diagnosis of Rheumatoid Arthritis |
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The joints that are suspect will be compared by the surgeon to see
if they have common symptoms. Hands and fingers will be examined clinically
to help determine which type of arthritis is present. Rheumatoid arthritis
will show certain features which can be seen in x-rays, including
a narrowing of the space inside the joint, swelling and less dense
bone near the joint, and bone erosion. If rheumatoid arthritis is
suspected, blood or other lab tests may be requested.
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| Non-Surgical & Surgical Treatments |
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The goal of treatment for rheumatoid arthritis is to relieve pain
and get back as much use as possible. Medication can help with the
pain and inflammation if rheumatoid arthritis is in the hand, and
can even slow down the growth of the disease. Treatment often includes
anti-inflammatory medication and oral steroid medication, sometimes
with injections of steroids.
New treatments to modify the disease have become available, including
the use of anti-malarial drugs cyclosporine, methotrexate, gold, and
other new drugs such as remicade or enbrel that work to suppress the
natural immune system to lessen the inflammation and reduce the pain.
These and other medications can be prescribed by a rheumatologist,
who will monitor their use.
A hand therapist may also be recommended, who can help with exercises
and splints and also with paraffin or warm wax treatments. Therapists
can offer suggestions and instructions for different ways to use both
the hand and fingers that can protect the joints while relieving the
pain and pressure. They may also help with using devices designed
to facilitate the performance normal, everyday tasks.
Tendons, as well as joints, can be affected by rheumatoid arthritis,
and ones that get inflamed can click or rupture. The fingers may
be stiff and unable to be bent or straightened if this happens,
so the ability to grab or hold items may be reduced. Preventive
surgery may be suggested to treat some cases and in an effort to
remove nodules. To treat the tendons, preventive surgery may be
done to remove either the rough bone or the inflamed tissue that
can scrape or press on them, or the tendons, themselves, may be
reinforced. If the tendon has ruptured, a hand surgeon may repair
it or perform a graft or tendon
transfer in addition to any of the other treatments.
If surgery is used to treat arthritic joints, it most often is done
to remove the linings of the joints that are inflamed, to replace
or fuse the joints, or remove bone that has become damaged or dead.
The particular course of treatment depends on a number of things,
including which joints need treatment, how much damage they show,
the condition of nearby joints as well as the amount and nature of
any loss of hand or finger use. The risks and benefits of any surgery
will be made clear before any decision on a course of action is taken.
There is no cure for rheumatoid arthritis, but some deformities can
be corrected through surgery. Surgery can also help with pain relief
and the return of use of the hand or fingers. The best treatment comes
from a combined effort between the patient and his or her hand therapist,
rheumatologist, and doctor. If surgery is called for, it needs to
be scheduled to take place before more severe deformities develop
and when the joints can be kept for as long as possible.
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