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Joint Disease

Hand osteoarthritis: diagnosis, non-operative management, and surgical options for DIP, PIP, and CMC joints.

Overview

Rheumatoid arthritis necessitates early intervention with disease-modifying antirheumatic drugs (DMARDs) upon diagnosis to improve long-term outcomes, particularly when initiated within the first three months [3]. In psoriatic arthritis, biologic therapy combined with DMARDs constitutes the mainstay of treatment, though patients with end-stage joint destruction may still require surgical intervention [5]. The evolving natural history of rheumatoid arthritis associated with biologic DMARDs has shifted indications and contraindications for procedures such as A1 pulley release [10]. Consequently, indications for silicone metacarpophalangeal arthroplasty and long-term expectations must be carefully re-evaluated in light of improved medical management [7]. While rheumatoid arthritis may deteriorate proximal interphalangeal joint function, overall results remain acceptable with proper indications and technique [11].

Surgical management of specific joint pathologies varies by location and disease stage. For advanced thumb metacarpophalangeal joint arthritis, fusion serves as the benchmark treatment, while arthroplasty offers a viable option to reduce pain, preserve motion, and limit adjacent joint disease progression [22]. Treatment for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint ranges from non-operative measures to surgical options including cheilectomy, arthroplasty, and arthrodesis, with selection dependent on disease stage and patient factors [25]. Patients generally prefer arthroplasty attributes such as preserved joint motion and grip strength, whereas arthrodesis is associated with decreased reoperation needs, lower costs, and shorter reoperation times [47].

Joint replacement procedures relieve pain and improve function more effectively than other current operative treatments, though they are limited by the inability of synthetic materials to duplicate articular cartilage properties [56]. Procedures that restore rather than replace the joint may offer advantages for young patients or those with less advanced disease [56]. For rheumatoid arthritis involving the distal radioulnar joint, surgical outcomes are best when performed before severe joint destruction, fixed contractures, subluxation, or dislocation occurs [58]. Further detailed study is required to clarify indications and outcomes for rheumatoid hand operations, which will allow for consistent advice to patients from all members of the multidisciplinary team [61].

Anatomy & Pathophysiology

Osseous and Articular Degeneration

Thumb basal joint arthritis is a progressive disease, with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [48]. Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis [66]. In women with hand osteoarthritis, intrinsic hand forces are significantly lower compared to healthy women, with a mean decrease of 30% across most force types [36].

Ligamentous and Capsular Biomechanics

Recent information regarding the anatomy, physiology, and biomechanics of the ligamentous joint capsule of the MCP, PIP, and DIP joints provides a view to new clinical approaches for these common problems [69]. A rationale for dynamic stabilization of the thumb is based on the unique anatomy of the thumb [52]. Incongruous radiocarpal joints are well tolerated due to wrist biomechanics, particularly the role of the midcarpal joint in the dart-throwing motion [60].

Rheumatoid Deformity and Tendon Pathology

The most important factor in the development of finger deformities caused by rheumatoid arthritis is the changes occurring in the tendons and related structures, especially in early stages [83]. Rheumatoid arthritis may lead to deterioration in proximal interphalangeal joint function [11]. A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis can detect advanced deformity earlier and is more strongly correlated with hand function [19].

Congenital Disorders and Functional Principles

Classification and understanding of congenital hand and upper extremity disorders focuses on achieving optimal function through recognizing deformities, identifying surgical options, and managing patient expectations [28]. Hand surgery principles emphasize the balance between restoring function and maintaining aesthetic appearance [85]. Ergonomic solutions are necessary to decrease thumb motions or strenuous effort encountered at work, especially for women, to address occupational risk factors for thumb carpometacarpal joint osteoarthritis [67].

Classification

Palindromic Rheumatism: An unusual cause of inflammatory joint disease [1]. Final diagnosis requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [1].

Rheumatoid Arthritis: The 1958 revised criteria were established to aid in obtaining more uniformity in the classification of patients with rheumatoid arthritis [39]. A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis could detect advanced deformity earlier and was more strongly correlated with hand function [19]. Synovial pathology types correlate with clinical characteristics, and related risk factors for synovial pathological changes have been investigated [51].

Osteoarthritis: Expert consensus has identified putative risk factors for finger interphalangeal joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [9]. Familial clustering of severe thumb carpometacarpal joint osteoarthritis was observed in a statewide population, indicating that genetic and environmental factors contribute to the disease process [59]. Osteoarthritis of the distal interphalangeal joint involves roles of cartilage, subchondral bone, and soft tissue structures [68]. The American Society of Hand Therapists provided a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA based on expert consensus [24].

Congenital Hand and Upper Extremity Disorders: Classification and understanding of these disorders has vastly improved since the 1970s, with a primary focus on achieving optimal function through recognizing deformities, identifying surgical options, and managing patient expectations [28].

Other Considerations: Subtle differences in history, examination, laboratory values, and imaging can improve diagnostic acumen for monoarticular arthritis of the hand and wrist [2]. Treatment of the arthritic wrist requires a diversity of treatment options due to the complex integrated system of joints, rather than a single effective treatment [18]. Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores on numerous scoring systems devised to evaluate patients with knee symptoms [54]. Recommendations for the clinical management of trapeziometacarpal joint infections align with principles from large-joint infection management but are tailored to the anatomical and clinical context of the hand [57]. A total of 13% of proximal interphalangeal joints treated with pyrocarbon implants required a secondary surgical procedure [76].

Clinical Presentation

The diagnostic approach to monoarticular arthritis of the hand and wrist relies on subtle differences in history, examination, laboratory values, and imaging to improve diagnostic acumen and expedite treatment [2]. For sea urchin spine arthritis, diagnosis is based on injury history, a symptom-free period, and the absence of laboratory abnormalities [4]. In periodic disease (familial Mediterranean fever), articular manifestations are diagnosed clinically through the association of monoarticular arthritis with recurrent fever and abdominal pain, as no specific laboratory aids exist [13].

Palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time for final diagnosis [1]. Early diagnosis of rheumatoid arthritis is important for improving outcomes [12]. Although many osteoarthritis-related biomarkers are available, none can be considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time [14]. Expert consensus identifies putative risk factors for finger interphalangeal joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [9].

The articular lesion in chronic post-rheumatic-fever arthritis (Jaccoud’s arthritis) is distinctly different from rheumatoid arthritis, characterized by periarticular fibrosis and the absence of chronic synovitis [37]. Physicians should be aware of Charcot joint disease presentation in patients with insensate joints to avoid overtreatment [16]. Patients should be informed of the risk of destructive arthropathy following revascularization after degloving hand injury, and follow-up X-ray examination is necessary even in cases with no fracture at the time of injury [8].

Camptodactyly-arthropathy-coxa vara-pericarditis presents with diagnostic challenges and rare early cardiac involvement, underscoring the importance of considering CACP in the differential diagnosis of early-onset joint involvement with serosal effusions [34].

Investigations

Plain radiography: Follow-up X-ray examination is necessary after revascularization for degloving hand injury to monitor for destructive arthropathy, even if no fracture was present at the time of injury [8]. In patients with established hand osteoarthritis, radiological involvement of the trapeziometacarpal joint is associated with older age and more structural abnormalities [93]. Unrecognized joint incongruity in early-stage trapeziometacarpal arthritis is likely to lead to progression of joint degeneration, and recognition of this incongruity can lead to measures that may prevent or delay this progression [21]. Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis following trapeziometacarpal arthrodesis, intervention for these joints was rarely warranted [20]. Pseudogout can mimic synovial chondromatosis clinically and roentgenographically due to extensive calcification of synovial tissue, but the two diseases have different treatments [86]. Augmenting plain radiographs with additional imaging modalities like ultrasound or dark-field imaging may aid in the diagnosis of septic arthritis of the proximal interphalangeal joint after rattlesnake bite [72].

MRI: Up to 40% of patients with rheumatoid arthritis demonstrated progressive erosive disease detected by MRI despite DAS28 improvement or EULAR remission [26]. Synovial chondromatosis can be invasive, and even the best preoperative imaging may not demonstrate the degree of local tissue involvement [62].

Laboratory: Palindromic rheumatism diagnosis requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [1]. Subtle differences in history, examination, laboratory values, and imaging can improve diagnostic acumen and expedite treatment for monoarticular arthritis of the hand and wrist [2]. Diagnosis of sea urchin spine arthritis is based on injury history, a symptom-free period, and absence of laboratory abnormalities [4]. The diagnosis of the articular manifestations of periodic disease (familial Mediterranean fever) is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain, as there are no specific laboratory aids [13]. No currently available OA-related biomarkers can be considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease [14].

Other Considerations: Expert consensus can identify putative risk factors for finger interphalangeal joint osteoarthritis, though the number identified was low and often required multiple Delphi rounds [9]. Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents improves outcomes [12]. Physicians should be aware of Charcot joint disease presentation in patients with insensate joints to avoid overtreatment [16]. Silicone metacarpophalangeal joint arthroplasty survivorship is 97% clinically and 90% radiographically, and radiographic fracture does not imply clinical deterioration [31]. In patients with established hand osteoarthritis, clinical involvement of the trapeziometacarpal joint is associated with a higher clinical burden [93].

Treatment

Rheumatoid Arthritis

Medical Management: All patients with rheumatoid arthritis should receive one or more disease-modifying antirheumatic drugs (DMARDs) as soon as the diagnosis is established [3]. Long-term outcomes improve when DMARD treatment begins within the first 3 months of disease [3]. Early and aggressive treatment is standard, with complete resolution of signs and symptoms achievable in perhaps 10% of patients [6]. Health systems should provide first-line treatment to improve compliance and clinical outcomes, particularly in vulnerable populations [45]. Management of nonrheumatoid inflammatory arthroses is typically medical and continues to evolve with biologically targeted medications [49].

Perioperative Medication Management: For minor procedures, rheumatoid medications should be continued perioperatively [70]. For larger procedures, DMARDs should be discontinued 3 half-lives before surgery and resumed approximately 2 weeks after [70].

Surgical Considerations: The mainstay of treatment for psoriatic arthritis is biologic therapy in conjunction with DMARDs [5]. Patients with psoriatic arthritis and end-stage joint destruction may require surgery [5]. Indications and contraindications for A1 pulley release in rheumatoid arthritis patients are evolving alongside the improved natural history of the disease associated with biologic DMARDs [10]. Silicone metacarpophalangeal arthroplasty indications and long-term expectations must be carefully examined in light of improvements in medical management [7]. Rheumatoid arthritis may lead to deterioration in proximal interphalangeal joint function, but overall results remain acceptable with proper indications and technique for silicone-rubber implant arthroplasty [11].

Osteoarthritis (General and Hand)

Non-Operative: No disease-modifying treatment exists for hand osteoarthritis, but multiple options are available for managing the condition with the goal of achieving symptom relief and optimizing hand function [15]. The efficacy of glucosamine and chondroitin sulfate is currently unknown, although recent clinical evidence holds promise [32]. A study protocol is investigating whether topical corticosteroids reduce pain over 6 weeks to inform clinical practice guidelines [44]. Nonoperative treatment is almost always initiated for primary and posttraumatic arthritis of the elbow, with surgical treatment indicated in cases refractory to conservative management [42]. Nonoperative modalities should be utilized before surgical options for shoulder osteoarthritis, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases [43]. The handbook on diagnosis and nonsurgical management of osteoarthritis offers an overview of epidemiology, evaluation methods, and non-operative treatment [73].

Thumb Basal Joint (CMC) Osteoarthritis

Non-Operative: Non-surgical treatment for thumb base osteoarthritis provides clinically worthwhile improvements in pain and function, with a stepwise approach recommended starting with self-management, followed by splints and injections if symptoms persist [46]. There is a non-pharmacological treatment gap in osteoarthritis care, with most patients reporting no pain or mild pain and having not received non-pharmacological treatment prior to surgical consultation [53]. Patients with thumb basal joint arthritis use cannabis-related products, with mixed reports on efficacy [38]. A factorial randomised controlled trial protocol is evaluating the effectiveness of the Push Brace™ orthosis and corticosteroid injection for managing first carpometacarpal joint osteoarthritis [63].

Operative: There is considerable variation in the practice of both non-surgical and surgical management of base of thumb osteoarthritis [74]. Surgical treatments for mild trapezial-metacarpal arthrosis are supported primarily by inferences from cadaveric studies and small retrospective case series using non-validated, physician-rated outcome measures [55]. For advanced thumb metacarpophalangeal joint arthritis, fusion is the benchmark, while arthroplasty is a viable option to reduce pain, preserve motion, and limit progression of adjacent joint disease [22]. Favorable outcomes, including improvement in range of motion and pain relief, of suture button suspensionplasty (SBS) for thumb carpometacarpal joint osteoarthritis remain durable over a mean 5-year follow-up [41].

Wrist and Other Joints

Wrist: Treatment of the arthritic wrist requires a diversity of treatment options due to the complex integrated system of joints, rather than a single effective treatment [18]. Proximal-row carpectomy should be considered after conservative measures fail for diseases of the proximal row, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur [40].

Hallux Rigidus: Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors [25].

Specific Etiologies

Sea Urchin Spine Arthritis: Diagnosis is based on injury history, a symptom-free period, and absence of laboratory abnormalities [4].

Scaphoid Non-Union: Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop [65].

Complications

Diagnostic Pitfalls and Disease Progression: Palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time for final diagnosis [1]. Subtle differences in history, examination, laboratory values, and imaging can improve diagnostic acumen for monoarticular arthritis of the hand and wrist [2]. While joint involvement in familial Mediterranean fever is typically transient, permanent joint damage can occur, particularly in older children at onset [17]. The diagnosis of blind-loop arthritis syndrome was established based on the patient's history of an intestinal-bypass operation and laboratory findings, and symptoms resolved with indomethacin treatment [87].

Medical Management Complications and Outcomes: All patients with rheumatoid arthritis should receive one or more DMARDs as soon as the diagnosis is established to improve long-term outcomes [3]. Early and aggressive treatment of rheumatoid arthritis is standard, with complete resolution of signs and symptoms achievable in perhaps 10% of patients [6]. The mainstay of treatment for psoriatic arthritis is biologic therapy in conjunction with disease-modifying antirheumatic drugs, while patients with end-stage joint destruction may require surgery [5]. Indications and contraindications for A1 pulley release are evolving along with the improved natural history of RA associated with the use of biologic DMARDs [10]. The earliest possible initiation of therapy for acute gout maximizes the benefit-to-risk ratio, given that the natural history of a gout flare is to resolve spontaneously over 3 to 10 days and that all current therapies have an adverse effect profile that carries some risk [27]. Evidence of very low to low quality indicates that the effects of joint-protection programs compared with usual care/control on pain and hand function are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis [81].

Post-Traumatic and Post-Procedural Complications: Patients should be informed of the risk of destructive arthropathy following revascularization after degloving hand injury, and follow-up X-ray examination is necessary even in cases with no fracture at the time of injury [8]. Recurrent contracture in joints previously successfully treated with collagenase Clostridium histolyticum may be effectively retreated with up to 3 injections of CCH at a short-term follow-up of 1 year [23]. Long-term recurrence rates for Dupuytren's disease suggest recurrence in 67% of MCP joint contractures and 100% of PIP joint contractures, though recurrence was generally less severe than the initial contracture [29]. The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site [30].

Prosthetic and Surgical Considerations: Indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined in light of improvements in the medical management of rheumatoid disease [7]. Survivorship of silicone metacarpophalangeal joint arthroplasty for osteoarthritis is 97% clinically and 90% radiographically, and radiographic fracture does not imply clinical deterioration [31]. Short-term results of synovectomy in children are no less favorable than in adults, and the danger of abnormal growth from rheumatoid inflammation is an indication for synovectomy, especially in children with unilateral knee involvement [64].

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the current evidence base.

Full activity (months): Specific timelines for full activity are not defined in the current evidence base.

Complete recovery / outcome plateau (months): Long-term outcomes vary by pathology. The long-term survival rate of single-mobility uncemented prostheses in trapeziometacarpal osteoarthritis is satisfactory, with a critical period in the first years ranging from 83% after 5 years to 50% after 30 years [75]. Early results of glenohumeral joint preservation procedures indicate satisfactory short-term outcomes, though these procedures have yet to show they can halt arthritic progression [78]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity after autologous matrix-induced chondrogenesis for focal cartilage defects in the knee [82].

Rehabilitation protocol: Specific rehabilitation protocols are not defined in the current evidence base.

Functional milestones: Disease activity was associated with hand function impairment in rheumatoid arthritis patients with variable follow-up [71]. Up to 40% of rheumatoid arthritis patients demonstrated progressive erosive disease detected by MRI despite DAS28 improvement or EULAR remission [26].

Other Considerations: Palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time for final diagnosis [1]. Subtle differences in history, examination, laboratory values, and imaging can improve diagnostic acumen and expedite treatment for monoarticular arthritis of the hand and wrist [2]. Diagnosis of sea urchin spine arthritis is based on injury history, a symptom-free period, and absence of laboratory abnormalities [4]. Patients should be informed of the risk of destructive arthropathy following revascularization after degloving hand injury, and follow-up X-ray examination is necessary even in cases with no fracture at the time of injury [8]. Recurrent contracture in joints previously successfully treated with collagenase Clostridium histolyticum (CCH) may be effectively retreated with up to 3 injections of CCH at a short-term follow-up of 1 year [23].

Key Evidence

  • [L5] Subtle differences in history, examination, laboratory values, and imaging, rather than one pathognomonic finding, can improve the diagnostic acumen and expedite appropriate treatment options for monoarticular arthritis of the hand and wrist. (10.1016/j.jhsa.2012.04.010)
  • [L5] All patients with rheumatoid arthritis should receive one or more DMARDs as soon as the diagnosis is established, as evidence suggests long-term outcomes are improved when treatment begins within the first 3 months of disease. (10.1016/j.jhsa.2008.12.008)
  • [L4] Diagnosis of sea urchin spine arthritis is based on injury history, a symptom-free period, and absence of laboratory abnormalities. (10.1016/j.jhsa.2007.11.016)
  • [L5] The mainstay of treatment is biologic therapy in conjunction with disease-modifying antirheumatic drugs, while patients with end-stage joint destruction may require surgery. (10.5435/jaaos-20-01-028)
  • [L5] Early and aggressive treatment of rheumatoid arthritis is now standard, and complete resolution of signs and symptoms is achievable in perhaps 10% of patients. (10.1016/j.jhsa.2008.11.010)
  • [L4] Given these findings, the indications for and long-term expectations of silicone metacarpophalangeal arthroplasty must be carefully examined in light of the improvements in the medical management of rheumatoid disease. (10.2106/00004623-200310000-00001)
  • [Case_report] Patients should be informed of the risk of destructive arthropathy, and follow-up X-ray examination is necessary even in cases with no fracture at the time of injury. (10.1177/15589447211003174)
  • [L4] Expert consensus can be reached to identify putative risk factors for IP joint OA, though the number identified was low and often required multiple Delphi rounds. (10.1177/1753193419865872)
  • [L4] Indications and contraindications for A1 pulley release are evolving along with the improved natural history of RA associated with the use of biologic DMARDs. (10.1177/1558944720975137)
  • [L4] While rheumatoid arthritis may lead to deterioration in proximal interphalangeal joint function, the overall result remains acceptable with proper indications and technique. (10.2106/00004623-199301000-00002)
  • [L5] Early diagnosis of rheumatoid arthritis is important, and referral to a rheumatologist followed by treatment with disease-modifying antirheumatic agents has been shown to improve outcomes. (10.1016/j.jhsa.2011.01.036)
  • [L4] The diagnosis is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain, as there are no specific laboratory aids. (10.2106/00004623-196547080-00016)
  • [L5] Although many OA-related biomarkers are currently available, none can be considered as a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time. (10.1186/1471-2474-16-s1-s2)
  • [L4] Although no disease-modifying treatment exists, multiple options are available for managing hand OA in rheumatology practice with the goal of achieving symptom relief and optimizing hand function. (10.1016/j.jht.2022.08.001)
  • [Case_report] Physicians should be aware of this presentation in patients with insensate joints to avoid overtreatment. (10.2106/00004623-199274090-00017)
  • [L4] While joint involvement is typically transient, this report emphasizes that permanent joint damage can occur, particularly in older children at onset. (10.2106/00004623-197557020-00023)
  • [Paper] Treatment of the arthritic wrist is fascinating and challenging, requiring a diversity of treatment options due to the complex integrated system of joints, rather than a single effective treatment. (10.1016/j.hcl.2005.08.013)
  • [L3] The modified classification could detect advanced deformity earlier and was more strongly correlated with hand function. (10.1177/1753193419886719)
  • [L4] Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis, intervention for these joints was rarely warranted. (10.1016/j.jhsa.2008.09.022)
  • [L5] Unrecognized joint incongruity in early-stage trapeziometacarpal arthritis is likely to lead to progression of joint degeneration, and recognition of this incongruity can lead to measures that may prevent or delay this progression. (10.1177/17531934221137780)
  • [L5] For more advanced disease, fusion is the benchmark, while arthroplasty is a viable option to reduce pain, preserve motion, and limit progression of adjacent joint disease. (10.5435/jaaos-d-18-00683)
  • [L4] At a short-term follow-up of 1 year, recurrent contracture in joints previously successfully treated with CCH may be effectively retreated with up to 3 injections of CCH. (10.1016/j.jhsa.2017.02.010)
  • [L5] The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA. (10.1016/j.jht.2023.08.008)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L3] Up to 40% of patients demonstrated a progressive erosive disease detected by MRI despite DAS28 improvement or EULAR remission. (10.1186/s12891-017-1528-y)
  • [L5] The earliest possible initiation of therapy maximizes the benefit-to-risk ratio and clinically justifies therapy, given that the natural history of a gout flare is to resolve spontaneously over 3 to 10 days and that all current therapies have an adverse effect profile that carries some risk. (10.1016/j.jhsa.2012.04.041)
  • [L4] Long-term recurrence rates suggest recurrence in 67% of MCP joint contractures and 100% of PIP joint contractures, though recurrence was generally less severe than the initial contracture. (10.1016/s0363-5023(09)60096-4)
  • [L4] The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site. (10.2106/00004623-198163080-00003)
  • [L4] Survivorship is 97% clinically and 90% radiographically, and radiographic fracture does not imply clinical deterioration. (10.1016/j.jhsa.2016.07.009)
  • [L4] The efficacy of glucosamine and chondroitin sulfate for patients with hand osteoarthritis is currently unknown, although recent clinical evidence holds promise. (10.1016/j.jhsa.2013.05.017)
  • [Case_report] This case illustrates diagnostic challenges and rare early cardiac involvement, underscoring the importance of considering CACP in the differential diagnosis of early-onset joint involvement with serosal effusions. (10.1186/s12891-025-09069-x)
  • [L3] Women with hand osteoarthritis exhibited significantly lower intrinsic hand forces compared to healthy women, with a mean decrease of 30% across most force types. (10.1016/j.jht.2024.02.005)
  • [Case_report] The patient's articular lesion was distinctly different from rheumatoid arthritis, characterized by periarticular fibrosis and the absence of chronic synovitis, consistent with chronic post-rheumatic-fever arthritis (Jaccoud's arthritis). (10.2106/00004623-198466070-00027)
  • [L4] Patients with thumb basal joint arthritis use cannabis-related products, with mixed reports on efficacy. (10.1016/j.jhsa.2021.10.018)
  • [L5] The revised criteria are hoped to aid in obtaining more uniformity in the classification of patients with rheumatoid arthritis and should be reviewed in two or three years. (10.2106/00004623-195941040-00023)
  • [L4] It should be considered after conservative measures fail, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur. (10.2106/00004623-197759040-00004)
  • [L4] Favorable outcomes (improvement in range of motion and pain relief) of SBS remain durable over time. (10.1016/j.jhsa.2017.03.011)
  • [L5] Nonoperative treatment is almost always initiated although surgical treatment may be indicated in cases refractory to conservative management. (10.1155/2013/473259)
  • [L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. (10.1155/2013/370231)
  • [L2] This study will provide high-quality evidence to determine whether topical corticosteroid reduces pain over 6 weeks in patients with hand osteoarthritis, with major clinical and public health importance by informing clinical practice guidelines for the management of hand osteoarthritis and reducing the burden of the disabling disease. (10.1186/s12891-021-04921-2)
  • [L3] Health systems should provide (first line) treatment for RA as a strategy to improve compliance with therapy and clinical outcomes, particularly in vulnerable populations. (10.1186/ar2620)
  • [L1] Non-surgical treatment provides clinically worthwhile improvements in pain and function, with a stepwise approach recommended starting with self-management, followed by splints and injections if symptoms persist. (10.1177/17531934241313206)
  • [L3] In aggregate, patients prefer surgical attributes characteristic of arthroplasty (ability to preserve joint motion and grip strength) relative to those associated with arthrodesis (decreased need for reoperation, lower costs, and shorter reoperation times). (10.1016/j.jhsa.2018.03.001)
  • [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. (10.5435/jaaos-d-17-00374)
  • [L5] Management of nonrheumatoid inflammatory arthroses is typically medical in nature and continues to evolve with the development of biologically targeted medications. (10.1016/j.jhsa.2015.05.029)
  • [L4] The study aims to explore the correlation between synovial pathology types and clinical characteristics in rheumatoid arthritis and to investigate related risk factors for synovial pathological changes. (10.1186/s12891-024-07935-8)
  • [L5] A rationale for a dynamic stabilization approach is presented based on the unique anatomy of the thumb. (10.1016/j.jht.2022.06.007)
  • [L4] The results show a non-pharmacological treatment gap in OA care, with most patients reporting no pain or mild pain and having not received non-pharmacological treatment prior to surgical consultation. (10.1186/s12891-019-2567-3)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L5] Surgical treatments for mild osteoarthritis are supported primarily by inferences from cadaveric studies and by small retrospective case series using non-validated, physician-rated outcome measures. (10.1016/j.jhsa.2012.08.034)
  • [L5] Joint replacement procedures relieve pain and improve function more than other current operative treatments but are limited by the inability of synthetic materials to duplicate the properties of articular cartilage; procedures that restore rather than replace the joint may offer advantages for young patients or those with less advanced disease. (10.2106/00004623-199409000-00019)
  • [L4] Recommendations align with principles from large-joint infection management but are tailored to the anatomical and clinical context of the hand. (10.1177/17531934251385450)
  • [L5] Surgical outcomes are best when performed before the patient displays severe joint destruction, fixed contractures, subluxation, or dislocation. (10.1016/j.hcl.2005.08.009)
  • [L3] Familial clustering of severe CMC joint OA was observed in a statewide population, indicating that genetic and environmental factors contribute to the disease process. (10.1016/j.jhsa.2022.08.004)
  • [Commentary] The author argues that incongruous radiocarpal joints are well tolerated due to wrist biomechanics, particularly the role of the midcarpal joint in the dart-throwing motion, and questions the necessity of aggressive treatment for stepoffs larger than 1 mm. (10.1016/j.jhsa.2013.04.038)
  • [L4] Rheumatoid hand operations require more detailed study, clarifying indications and outcome to allow consistent advice to patients from all members of the multidisciplinary team. (10.1177/1753193411409830)
  • [L4] Synovial chondromatosis can be invasive, and even the best preoperative imaging may not demonstrate the degree of local tissue involvement. (10.1054/jhsb.2001.0677)
  • [L2] Results from this trial will contribute to the evidence on conservative management of first carpometacarpal osteoarthritis. (10.1177/1758998315584835)
  • [L5] Short-term results in children are no less favorable than in adults, and the danger of abnormal growth from rheumatoid inflammation is an indication for synovectomy, especially in children with unilateral knee involvement. (10.2106/00004623-197153040-00001)
  • [L4] Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop. (10.2106/00004623-198567030-00013)
  • [L3] Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis. (10.1177/17531934251383073)
  • [L3] Ergonomic solutions are necessary to decrease thumb motions or strenuous effort encountered at work, especially for women. (10.1016/j.jhsa.2007.01.014)
  • [L5] This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint, highlighting the roles of cartilage, subchondral bone, and soft tissue structures. (10.1016/j.jhsa.2010.09.003)
  • [L5] This review focuses on recent information regarding the anatomy, physiology, and biomechanics of the ligamentous joint capsule of the MCP, PIP, and DIP joints with a view to new clinical approaches for these common problems. (10.1016/j.jhsa.2017.08.024)
  • [L5] For minor procedures, medications should be continued, while for larger procedures, DMARDs should be discontinued 3 half-lives before surgery and resumed approximately 2 weeks after. (10.1016/j.jhsa.2012.04.015)
  • [L3] Disease activity was associated with hand function impairment in RA patients with variable follow-up. (10.1186/s12891-016-1246-x)
  • [L5] Augmenting plain radiographs with additional imaging modalities like ultrasound or dark-field imaging may aid in diagnosis. (10.1016/j.jhsa.2021.04.004)
  • [L5] The handbook is an excellent source of information on the essential facts about osteoarthritis, offering an impressive overview of epidemiology, evaluation methods, and non-operative treatment, and is strongly recommended for orthopaedic surgeons. (10.2106/00004623-199802000-00026)
  • [L4] There is considerable variation in the practice of both non-surgical and surgical management of base of thumb osteoarthritis. (10.1302/0301-620x.102b5.bjj-2019-1464.r2)
  • [L4] The long-term survival rate of single-mobility uncemented prostheses is satisfactory, with a critical period in the first years ranging from 83% after 5 years to 50% after 30 years. (10.1177/17531934231221692)
  • [L4] A total of 13% of the joints required a secondary surgical procedure. (10.1016/j.jhsa.2009.08.010)
  • [L4] Early results indicate satisfactory short-term outcomes, though these procedures have yet to show they can halt arthritic progression. (10.1155/2012/160923)
  • [L1] Evidence of very low to low quality indicates that the effects of JP programs compared with usual care/control on pain and hand function are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis. (10.1016/j.jht.2018.09.012)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] The most important factor in the development of finger deformities is the changes occurring in the tendons and related structures, especially in early stages. (10.2106/00004623-195739030-00006)
  • [L4] Pseudogout can mimic synovial chondromatosis clinically and roentgenographically due to extensive calcification of synovial tissue, but the two diseases have different treatments. (10.2106/00004623-197557060-00030)
  • [Case_report] The diagnosis of blind-loop arthritis syndrome was established based on the patient's history of an intestinal-bypass operation and laboratory findings, and symptoms resolved with indomethacin treatment. (10.2106/00004623-199072090-00023)
  • [L3] In patients with established hand OA clinical involvement of the TBJ is associated with a higher clinical burden whereas radiological involvement of the TBJ is associated with older age and more structural abnormalities. (10.1016/j.jht.2014.01.006)

See Also

  • Dupuytren's Disease

References

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b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.