Finger Arthritis

Arthritis can occasionally affect the fingers. The fingers can be affected by osteoarthritis (‘wear and tear’ arthritis), rheumatoid (inflammatory) arthritis, or arthritis that occurs because of joint injury (post-traumatic arthritis). There are three finger joints that can be affected. The distal interphalangeal joint (DIJ) is the smallest joint closest to your finger tip. The proximal interphalangeal joint (PIJ) is the joint in the middle of the finger. The metacarpophalangeal joint (MPJ) is the main big knuckle, where the finger attaches to the hand.

Regardless of the cause, the first treatment for finger arthritis is nonoperative. A steroid injection can be very helpful. Splinting or “buddy taping” the finger to its neighbor can help take stress off of the painful joint.

If this fails and the joint is sufficiently painful then surgical treatment may be considered. The DIJ is fused so that it’s stiff, strong and painless. This is a straightforward, relatively predictable surgery. The DIJ is splinted for 2-6 weeks, but the rest of the hand can be used.

The PIJ is either fused, so that’s it’s stiff, stable and pain-free, or replaced so that motion is retained. The decision depends on numerous factors, including which finger it is, what caused the arthritis, what the patient’s demands are, and how much time and effort the patient can commit to therapy. In general, the index finger’s PIJ is fused and the middle, ring or small finger’s PIJ is replaced.

The MPJ is best replaced, as it’s the major joint of the finger. There are two major types of replacement, depending on what caused the arthritis.

Because rheumatoid arthritis destroys the ligaments that support the joint, it is usually best treated with a one-piece linked replacement that provides inherent stability to the joint. If the ligaments are intact, as is usually the case with osteoarthritis and post-traumatic arthritis, it is possible to use one of the new pyrocarbon total joint replacements. These are newer devices that are similar to a total knee replacement, but obviously much smaller. We think that these may last longer than the one-piece linked replacements, but won’t know for sure for another decade or so.

After surgery, the hand is splinted for 1-5 weeks, depending on the cause of the arthritis and the type of joint replacement, and then therapy is begun. Pain relief is usually very good following either fusion or replacement. Following replacement, patients often maintain a very functional (but not totally normal) range of motion.