This page was last reviewed 10-04-20
Joint inflammation is indicated by pain, swelling, stiffness and loss of function, that can result from degenerative osteoarthritis (OA) or systemic, autoimmune arthritis. The former commonly affects the thumb base CMC joints and the DIP joints (Heberden’s nodes) or PIP joints (Bouchard’s nodes) of the fingers. Middle age and older adults are predominantly affected although other risk factors include previous major or repetitive joint trauma or joint instability. Management is primarily conservative, making use of rest, anti-inflammatory medications and splints for use at night and during specific activities. Physiotherapy is often helpful.
What we will see
- Diagnostic difficulties
- Patients with a diagnosis of Rheumatoid arthritis who are having functional issues with their hands
- Pain unresponsive to simple non-interventional measures
What we won’t see
- Straightforward diagnosis with no functional deficit
Specific tests
- Clinical examination of joint – palpation, range of movement
- X-ray of affected part (be specific about digit and joint on request)
Trial of therapy pre-referral
- If no functional deficit then no treatment required
- Trial of oral analgesia or topical NSAID gel
- Activity modification
- Consider appropriate splintage
Whom to direct referral to
- Any hand surgeon
- Plastic Surg – PIL BSSH CARPAL TUNNEL Aug18
- Plastic Surg – PIL BSSH GANGLIA Aug18
- Plastic Surg – PIL BSSH OA THUMB Aug18
- Plastic Surg – PIL BSSH TRIGGER FINGERAug18
- National Institute for Health and Care Excellence (NICE)
- Scottish Intercollegiate Guidelines Network (SIGN)
- Wrist Pain Algorithm of Differential Diagnoses
- BSSH OA THUMB
