What do these deformities look like and how can they affect the function of your hands and wrists by causing pain and a reduced range of motion?
We’ve compiled a gallery of images that illustrate the effects of arthritis on the hands, but it’s important to note that these deformities are becoming much less common with early treatment of rheumatoid arthritis (RA) and other forms of inflammatory arthritis.
The combination of disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor inhibitors (TNF blockers) has given many people the opportunity to prevent these problems. At the current time, it’s thought that at least 50% of people living with RA are in remission.
As you look at these pictures, you can see evidence of common arthritis issues, such as rheumatoid nodules, swelling, ulnar drift, contractures, and other problems.
Keep in mind that everyone is different. The ages and deformities present in these photos are not necessarily an indication of what the average person can expect, and the degree of symptoms any particular person will experience varies widely.
Many of these deformities are also related to disease which was present before the newer treatments for arthritis were approved.
These images will also be used to describe some of the complications as well as treatment decisions faced by those living with arthritis.
In addition to disease-modifying drugs, surgery may be used to correct damage which is interfering with function. The person in this image had carpal tunnel release surgery.
This image illustrates the contractures which can occur with long-standing arthritis. Though this man’s hand looks like he has had hand surgery, he has not, and contractures can appear as if surgery was performed.
In general, the prognosis for JRA is more favorable than that of arthritis in adults.
The image here demonstrates significant swelling along with some mild joint deformity. This person has not had hand surgery.
What the woman’s smile in this photo also illustrates is that many people live fulfilling and enjoyable lives even with the symptoms of arthritis.
Three hand surgeons declined to perform hand surgery because this person had no pain and has good grip strength and hand function.
This person has rheumatoid arthritis and had surgery—a wrist synovectomy (removal of inflamed synovial tissue) and tendon transfers involving both hands.
This photo also shows an example of the rheumatoid nodules that can occur in patients with rheumatoid arthritis. (This person did not have hand surgery.)
She had surgery on her left hand twice for trigger finger release of her ring finger and had a tenodesis (a surgery that stabilizes a joint by anchoring a tendon to bone) of the left middle finger.
In addition, she had nodules removed from both the right and left thumbs and had bilateral carpal tunnel surgery.
This image of the woman’s right hand and wrist shows joint deformities and contractures, but she has not had surgery on this hand.
Inflammation of the fourth and fifth metatarsals (hand bones) increases the risk of developing ulnar drift due to the increased mobility of these joints.
This child had two separate surgeries to release scar tissue which was causing the contracture.
Early treatment of rheumatoid arthritis is the best way to control the disease and prevent deformity. Pain and stiffness are also associated with rheumatoid arthritis of the hands and must be managed.
Reviewing these images of arthritis is painful, but they are a visible reminder of how we must protect our hands if we have arthritis. Early and aggressive treatment of inflammatory arthritis can make a difference not only in pain and stiffness today, but in our ability to do what we love to do with our hands tomorrow.
If you are living with arthritis, talk to your rheumatologist about joint protection techniques. Keep in mind that overuse (even without any pain) is associated with an increased risk of joint deformity.
Talk about the most appropriate treatment options to slow the progression of the disease and in turn reduce your risk of joint deformity. Ultrasound is one way to detect smoldering synovitis, otherwise known as “silent destruction” of joints.
Hand surgery can be helpful for some people, and when done appropriately, can improve quality of life. That said, it’s important that surgery is focused on improving function alone, rather than on cosmetic results.
Even with joint damage, many people are able to live very comfortable and productive lives. But being proactive and being your own advocate in getting the best care possible raises your chances of enjoying your future with as little pain and as much mobility as possible.
Carpal bones are the eight bones in the wrist. Two are connected to the bones in the forearm, the radius and ulna. Metacarpal bones are the five bones in the middle of the hand. They connect to the fingers and the wrist. Phalanges are the 14 bones in your fingers and thumb.
The distal interphalangeal joint (DIP) is the joint closest to the fingertip. The proximal interphalangeal joint (PIP) is the joint in the middle of the finger. The metacarpophalangeal joint (MCP) is the joint at the base of the finger, where it meets the metacarpal bone.
The thumb has two joints:
The interphalangeal joint is at the top of the thumb. The metacarpophalangeal joint is at the base of the thumb.
The base of the hand has five carpometacarpal joints, where the metacarpal bones meet the carpal bones.
The wrist joints include:
Radiocarpal joint is at the base of the wrist where it meet the radius. Ulnocarpal joint is where the wrist meets the ulna. Distal radioulnar is where the radius and ulna meetScaphotrapeziotrapezoid joint is at the base of the thumb by the wrist.
