1. Treatment Options for Finger Pain

2. Anatomy of Finger Joint Each finger has 3 bones: Each finger has 3 bones: Carpals Carpals Metacarpals Metacarpals Phalanges Phalanges Each finger also has 3 joints (the knuckles): Each finger also has 3 joints (the knuckles): MCP MCP PIP PIP DIP DIP Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v137

3. Causes of Finger Pain Rheumatoid arthritis Rheumatoid arthritis Osteoarthritis (wear and tear) Osteoarthritis (wear and tear) Sprains and fractures Sprains and fractures Joint imbalance Joint imbalance Dupuytren’s Contracture Dupuytren’s Contracture Soft Tissue Systemic Problem (Trigger Finger) Soft Tissue Systemic Problem (Trigger Finger) Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v139

4. Symptoms of Finger Pain Pain Pain During activity During activity At rest or sleeping At rest or sleeping Swelling and tightness Swelling and tightness Deformity Deformity Stiffness and decreased movement Stiffness and decreased movement Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v140

5. Diagnosing Finger Arthritis Physical examination Physical examination Medical history review Medical history review X-Rays X-Rays Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v141

6. How Can My Life Change with Treatment? A return to mobility A return to mobility Regaining a sense of your former lifestyle Regaining a sense of your former lifestyle A change in pain symptoms A change in pain symptoms v142

7. Non-surgical Treatment Options for Finger Pain: Over-the-Counter Medications Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Usually first for treatment Usually first for treatment Reduce pain, swelling and redness Reduce pain, swelling and redness Relief can take several months Relief can take several months Examples: Examples: ibuprofen ( Advil®, Motrin®) ibuprofen ( Advil®, Motrin®) naproxen ( Aleve®) naproxen ( Aleve®) Aspirin Aspirin Reduce joint pain and inflammation Reduce joint pain and inflammation Form of NSAIDs Form of NSAIDs Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v143

8. Non-surgical Treatment Options for Finger Pain: Over-the-Counter Medications Acetaminophen Reduces pain Reduces pain Lowers fever Lowers fever Does not reduce inflammation of arthritis Does not reduce inflammation of arthritis Examples: Examples: Tylenol ® Tylenol ® Datril ® Extra Strength Datril ® Extra Strength Tempra ® Tempra ® Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v144

9. Non-surgical Treatment Options for Finger Pain: Prescription Medications NSAIDS NSAIDS Most popular type for osteoarthritis treatment Most popular type for osteoarthritis treatment Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Analgesics Analgesics Provide pain relief, but do not reduce inflammation Provide pain relief, but do not reduce inflammation Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

10. Non-surgical Treatment Options for Finger Pain: Prescription Medications Biological Response Modifiers Biological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the joints Treat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® ) Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® )Remicade ® Remicade ® Glucocorticoids or Corticosteroids Glucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammation Treat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) DMARDS DMARDS Treat rheumatoid arthritis; slow joint destruction Treat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Source: www. AllAboutArthritis.com, 2003www. AllAboutArthritis.com

11. Non-surgical Treatment Options for Finger Pain Steroid injections Steroid injections Activity Modification Activity Modification Physical Therapy Physical Therapy Assistive devices, like a doorknob grip, for daily tasks such as: Assistive devices, like a doorknob grip, for daily tasks such as: Writing Writing Phoning Phoning Getting Dressed Getting Dressed Cooking Cooking Bathing Bathing Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v148

12. Surgical Options for Finger Pain Finger joint fusion Finger joint fusion Excisional arthroplasty Excisional arthroplasty Finger joint replacement Finger joint replacement v149

13. Finger Joint Fusion Fuses bones of joint to grow together Fuses bones of joint to grow together Results in: Results in: Eliminating pain Eliminating pain Immobile joint Immobile joint No range of motion No range of motion Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v150

14. Finger Joint Fusion Incision is made. Incision is made. Two joint surfaces are held together with: Two joint surfaces are held together with: Pins Pins Plates Plates Screws Screws Usually six weeks for bones to fuse together. Usually six weeks for bones to fuse together. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v151

15. Finger Joint Fusion Benefits of Joint Fusion: Removes pain of arthritis Removes pain of arthritis Durable and strong Durable and strong Disadvantages of Joint Fusion: Immobile joint; little or no range of motion Immobile joint; little or no range of motion Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v152

16. Excisional Arthroplasty Excisional Arthroplasty Used for the basal joint (thumb). Used for the basal joint (thumb). Removes the arthritic joint surfaces. Removes the arthritic joint surfaces. Combined with reconstruction of the joint. Combined with reconstruction of the joint. A standard method used for many years. A standard method used for many years. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v153

17. Excisional Arthroplasty, continued Excisional Arthroplasty, continued Remove arthritic joint surfaces. Remove arthritic joint surfaces. After surgery, tendons form a flexible connection between bones. After surgery, tendons form a flexible connection between bones. Holds thumb in place and keeps space between bones from collapsing. Holds thumb in place and keeps space between bones from collapsing. Skin is sutured together. Skin is sutured together. Splint is applied for about six weeks. Splint is applied for about six weeks. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com v154

18. Excisional Arthroplasty, continued Benefits Benefits Used for many years. Used for many years. Can help take away pain, while allowing the joint to retain some movement. Can help take away pain, while allowing the joint to retain some movement. Disadvantages Disadvantages Does not allow the joint full mobility, retains only some movement. Does not allow the joint full mobility, retains only some movement. v155

19. Finger Replacement Surgery Patients typically choose this treatment option to improve their mobility and reduce pain. Patients typically choose this treatment option to improve their mobility and reduce pain. An estimated 10,000 total finger replacements in 2003. An estimated 10,000 total finger replacements in 2003. *Copyright 2002 by Solucient LLC v156

20. When is Finger Replacement Surgery Right for You? Significant pain, even when sleeping. Significant pain, even when sleeping. Loss of function, despite non-surgical treatments. Loss of function, despite non-surgical treatments. Fingers start drifting to the side- “ulnar drift”. Fingers start drifting to the side- “ulnar drift”. Source: www.neuflex.com, 2003www.neuflex.com v157

21. Finger Replacement Components Made of silicon, used to replace the MCP (metacarpalphalange al) joint. Made of silicon, used to replace the MCP (metacarpalphalange al) joint. Acts as a spacer to fill the gap of the removed arthritic MCP joint. Acts as a spacer to fill the gap of the removed arthritic MCP joint. Source: www.jointreplacement.com, 2003www.jointreplacement.com v158

22. Benefits to Patient from Surgery Return to mobility Return to mobility Restore lifestyle Restore lifestyle Freedom Freedom v159

23. Surgical Procedure An incision is made. An incision is made. Finger joint is opened. Finger joint is opened. Cartilage is removed from the joint surfaces. Cartilage is removed from the joint surfaces. Source: www.jointreplacement.com, 2003www.jointreplacement.com v160

24. Surgical Procedure Implant is inserted into the canal between the bone of the finger and joint. Implant is inserted into the canal between the bone of the finger and joint. A tight sack holds the implant in place. A tight sack holds the implant in place. Skin is sutured together. Skin is sutured together. A splint, brace or cast will probably be required for up to six weeks. A splint, brace or cast will probably be required for up to six weeks. Source: www.jointreplacement.com, 2003www.jointreplacement.com v161

25. Preparing for Joint Replacement Surgery Ease anxiety by mentally preparing with: Ease anxiety by mentally preparing with: Breathing exercises Breathing exercises Meditation Meditation Talking with friends and family Talking with friends and family Learn more about finger replacement surgery Learn more about finger replacement surgery Brochures Brochures Handouts Handouts Websites Websites Videos Videos Source: www.jointreplacement.com, 2003www.jointreplacement.com v162

26. The Night Before Surgery Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.). Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.). Do not consume any food or liquid after midnight. Do not consume any food or liquid after midnight. Make sure you have everything you’ll need at the hospital. Make sure you have everything you’ll need at the hospital. Ask any questions you may have before surgery. Ask any questions you may have before surgery. Source: www.jointreplacement.com, 2003www.jointreplacement.com v163

27. After Surgery Hand above heart at all times initially. Hand above heart at all times initially. Pain medication and antibiotics may be prescribed. Pain medication and antibiotics may be prescribed. Hospital stay, depending on: Hospital stay, depending on: Number of joints replaced. Number of joints replaced. Any other procedures that have been done. Any other procedures that have been done. Follow instructions to care for hand once discharged. Follow instructions to care for hand once discharged. Source: www.jointreplacement.com, 2003www.jointreplacement.com v164

28. A Caregiver’s Role Provide support and show patience Provide support and show patience Help with needs that the patient can not do, like: Help with needs that the patient can not do, like: Meal preparation Meal preparation Everyday household chores Everyday household chores Writing Writing Source: www.jointreplacement.com, 2003www.jointreplacement.com v165

29. Recovery in the First Week Dressing removed after several days and replaced with lighter one. Dressing removed after several days and replaced with lighter one. Supportive finger splint used during the day and night. Supportive finger splint used during the day and night. If any concern, notify your surgeon immediately. If any concern, notify your surgeon immediately. Source: www.jointreplacement.com, 2003www.jointreplacement.com v166

30. Recovery in the First Month Move fingers depending on comfort level. Move fingers depending on comfort level. Stitches removed usually after 10 days to two weeks after surgery. Stitches removed usually after 10 days to two weeks after surgery. Begin motion exercises within a few days of surgery. Begin motion exercises within a few days of surgery. Source: www.jointreplacement.com, 2003www.jointreplacement.com v167

31. Recovery After Six Weeks May take splint off during the day, but sleep with it at night. May take splint off during the day, but sleep with it at night. Return to normal activities without splints in 2 to 3 months. Return to normal activities without splints in 2 to 3 months. Source: www.jointreplacement.com, 2003www.jointreplacement.com v168

32. Questions?

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