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Arthrosis of the small finger joints (PIP and DIP)

What is arthrosis of the small finger joints?

The little finger joints are the joints between the first and middle phalanx (PIP joint) and between the middle and last phalanx (DIP joint). Wear and tear on these joints is called PIP arthrosis and DIP arthrosis, respectively.

In arthrosis, the joint cartilage is affected. Cartilage is smooth tissue at the end of bones (in this case, the phalanges). Cartilage allows the bones in a joint to move properly relative to each other. Cartilage can become thin and eventually disappear altogether; this is called arthrosis. When cartilage becomes thin, or when bone meets bone, the mobility of the joint decreases. It also increases the pressure on the underlying bone. To better distribute the pressure, bone formation can occur at the edges of the joint, causing the joint to thicken. In addition, an inflammation of the inner lining of the joint (synovitis) occurs which can cause complaints of pain, swelling and warmth.

What are the symptoms in PIP and DIP arthrosis?

Complaints associated with osteoarthritis are pain, stiffness (especially in the morning), swelling, the appearance of lumps (deformity) and warmth to the joint. In arthrosis of the PIP joint it sometimes becomes more difficult to grasp things firmly because the fingers can no longer bend properly. In arthrosis of the DIP joint it is typical that painful lumps appear on the joints which, besides being painful, can also be experienced as unsightly. A position deviation in the joint can occur. A cyst may also develop next to the joint. Sometimes, as the lumps grow larger, the pain in the joint actually decreases.

Diagnosis

Based on the pattern of symptoms and physical examination, the diagnosis is made. In addition, X-rays are taken to determine the severity of the wear and tear. If the diagnosis of osteoarthritis is definitive, then depending on the severity of the symptoms and the overall condition of the patient, treatment plan will be made.

Treatment

Non-operative (conservative) treatment

A joint with wear often reacts more strongly to load. This is usually due to the synovitis present. By decreasing the load on the joint, the synovitis decreases and the symptoms may decrease as well. In cases of PIP arthrosis, wearing a splint to support the joint may reduce symptoms. Modifying or performing daily activities differently can also improve symptoms. In the case of DIP arthrosis, treatment is mainly aimed at pain relief. The use of painkillers such as paracetamol and anti-inflammatories (only if the overall condition of the patient allows it) can reduce the pain.

Surgical treatment

If conservative options are not effective enough, then surgical treatment may be chosen. For PIP and DIP arthrosis, several options exist. In the case of arthrosis of the PIP joint, depending on which finger is affected, what the functional requirements of the patient are, and how well the joint can still move, a joint replacement (prosthesis) or joint fixation (arthrodesis) can be chosen.

The surgery is done in day treatment. The entire arm is numbed by a nerve block or general anesthesia is applied. After placing a prosthesis, there is still mobility in the joint; after fixing the joint, there is no more mobility possible but the joint pain is eliminated.

The wound is sutured with stitches that can be removed after 10-14 days. After the procedure, you will have a finger bandage for several days. An X-ray will be taken after 6 weeks. In case of arthrosis of the DIP joint, fixation of this joint (arthrodesis) is chosen.

This operation is also performed in an outpatient clinic. The finger will be numbed with local anesthesia and the joint will be fixed with 2 iron wires. After the surgery you will not be able to bend the joint anymore but the joint pain will be gone. The wound is stitched with sutures that can be removed after 10-14 days. After the procedure you will have a finger bandage for a few days. After 6 weeks an X-ray is taken and when the bone has completely fused the iron wires can be removed.

During the consultation you will receive detailed information about which procedure is most suitable for your problem as well as the post-treatment and recovery and you will be given an information brochure about the procedure.

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