1. Donald Dewar Consultant Plastic Surgeon Leeds General Infirmary
OA and the hand
Donald Dewar
Consultant Plastic Surgeon
Leeds General Infirmary

2. Osteoarthritis degenerative condition
characterised by loss of articular cartilage,
resulting in pain, swelling, loss of movement, and deformity

3. Aetiology mostly age-related and degenerative (“wear and tear”)
relationship to heavy work obscure
post-traumatic (degeneration of damaged joint)
genetic
strong family history
early onset and rapid progression
many joints involved
specific patterns of involvement in the hand

4. Pathophysiology exact mechanism unknown
progressive loss of articular cartilage
stage I softening
stage II fibrillation
stage III fragmentation
stage IV eburnation

5. Sites affected in the hand
wrist
primary
secondary (e.g. SLAC and SNAC)
thumb CMCJ
DIPJs
other joints

6. Symptoms pain (at rest and on movement) swelling restriction of ROM
secondary deformity
osteophytes
joint deviation/subluxation

7. Symptoms loss of function pain (at rest and on movement)  swelling 
restriction of ROM 
secondary deformity 
osteophytes
joint deviation/subluxation
loss of function

8. Signs swelling restriction of ROM secondary deformity
bony (Heberden’s and Bouchard’s nodes)
soft tissue (less than in RA)
restriction of ROM
crepitus
secondary deformity
osteophytes
joint deviation/subluxation (e.g. square thumb, Z-thumb deformity)

9. X-rays loss of joint space sub-chondral sclerosis bone cysts
osteophytes
secondary deformity

10. Assessment assess both deformity and function treatment aims to
reduce pain
improve function
with minimal complications

11. Treatment Analgesia (especially NSAIDs) Activity modification
Appliances (splints)
Articular steroid injection

12. Treatment
soft tissue Alignment
Arthroplasty
Arthrodesis
Amputation

13. Treatment – thumb CMCJ change job/retire splint steroid injection
surgery
trapeziectomy +/- LRTI
capsular tightening
beak ligament reconstruction
arthroplasty

14. Treatment - PIPJs arthroplasty arthrodesis Swanson’s most reliable
pyrocarbon (squeaky)
others
not suitable for the “high-demand” hand
arthrodesis
let patient choose angle
best option for younger patients (reliable)
annoyingly inconvenient

15. Treatment - DIPJs fusion a good option for pain/deformity
many techniques
arthroplasty occasionally used
let patient choose angle (but usually straight)