Metacarpophalangeal Joint Arthritis

Elderly woman with Arthritis in her hands
Metacarpophalangeal (MP) Joint Arthritis: Causes, Diagnosis, and Treatment

The metacarpophalangeal (MP or MCP) joints are large joints at the base of each finger. These complex hinge joints play an important role in both power grip and pinch activities.

Causes of Metacarpophalangeal Joint Arthritis

The MP joints are less commonly affected by arthritis than smaller hand joints or the joints where the thumb meets the wrist (CMC). However, several conditions can affect the MP joints, including:

  • Rheumatoid arthritis: The most common arthritic condition affecting the MP joints. It causes inflammation of the joint lining (synovium), leading to cartilage and soft tissue destruction, resulting in ulnar drift of the fingers toward the little finger.
  • Post-traumatic arthritis: Occurs after injury, leading to gradual loss of cartilage and progressive pain and stiffness.
  • Osteoarthritis: A form of arthritis that affects the MP joints, causing pain and stiffness, particularly in the thumb, index, and middle fingers.
  • Gout, psoriasis, and infection: Less common causes of MP joint arthritis.
Diagnosis of Metacarpophalangeal Joint Arthritis

The symptoms of MP joint arthritis vary based on the underlying cause:

  • Rheumatoid arthritis: Characterized by pain, swelling, and deformity in multiple joints, with an ulnar drift of the fingers and loss of motion, especially in extending (straightening) the fingers.
  • Osteoarthritis and post-traumatic arthritis: Involves deep, aching joint pain, particularly with grip and pinch activities. Swelling, especially between large knuckles, may also be present.

The doctor can confirm the presence of MP arthritis through x-rays, and special x-rays may be necessary to assess the metacarpal head in milder cases.

Treatment Options for MP Arthritis

There are various treatment options depending on the severity of joint destruction and the symptoms experienced:

  • Rheumatoid arthritis: Medications to combat the inflammatory process are typically the first line of treatment. If medications are ineffective, synovectomy (removal of the inflamed synovium) may be considered to slow the destructive process and preserve cartilage.
  • Post-traumatic arthritis: Anti-inflammatory medications, activity modification, and splints may offer relief. If symptoms worsen, surgical treatment may be necessary.
MP Joint Fusion or Replacement

For severe joint destruction, patients may benefit from joint fusion or replacement. Key options include:

  • Joint fusion: While effective for the thumb, joint fusion can result in a loss of motion in the fingers.
  • Joint replacement: Typically preferred over fusion, especially in younger or more active patients.
  • Salastic hinged implants: Provide reasonable pain relief and are often used in older, less active patients.
  • Advanced implants: Newer implants that replicate joint surfaces may offer improved outcomes for younger, more active individuals.

If you’re suffering from metacarpophalangeal joint arthritis, make an appointment with South Florida Hand and Orthopaedic Center.

Numbness and Tingling

Numbness and Tingling
Hand Numbness and Tingling: Causes and Diagnosis

Hand tingling and numbness are common symptoms, but they are not always caused by carpal tunnel syndrome (CTS). Compression neuropathy, which occurs when local pressure is applied to a nerve, can also result in these sensations. This pressure often causes numbness in distinct patterns based on the area supplied by the affected nerve. Additionally, muscle weakness, wasting, or twitching may occur.

Causes of Nerve Compression
  • Thickened Muscles
  • Bands of Connective Tissue
  • Enlarged Blood Vessels
  • Ganglion Cysts
  • Arthritic Spurs
Common Types of Nerve Compression

Ulnar Nerve Compression:

  • Occurs at the wrist or elbow.
  • Causes numbness and tingling in the little finger, part of the ring finger, and the ulnar side of the palm.
  • Ulnar nerve pressure at the elbow also causes numbness on the back of the ulnar side of the hand.

Radial Nerve Compression:

  • Occurs in the forearm or above the wrist.
  • Results in numbness over the back of the thumb, index finger, and the web between these two digits.

Median Nerve Compression:

  • Occurs at or below the elbow.
  • Causes numbness similar to carpal tunnel syndrome but also affects the palm at the base of the thumb.
Other Causes of Hand Numbness and Tingling

In addition to compression neuropathies, several other factors may cause numbness and tingling in the hand:

Pressure on Nerves in the Neck:

  • Nerves in the hand and forearm originate from the neck, and pressure on these nerves can lead to symptoms in the arm, forearm, or hand.
  • Conditions such as arthritis, degenerating discs, or narrowing of the spinal canal can cause nerve compression.

Diseases of the Central Nervous System:

  • Conditions like multiple sclerosis or a stroke can cause numbness, tingling, or aching in the arm, forearm, or hand.

Infections, Blood Vessel Abnormalities, or Spinal Cord Conditions:

  • These can also cause pressure on the nerves, leading to hand numbness or tingling.

Double Crush Syndrome:

  • A condition where a nerve is compressed in two different areas (e.g., in the neck and wrist), exacerbating symptoms.
Peripheral Neuropathy

If the symptoms are more generalized and occur in both the hands and forearms (as well as the legs and feet), peripheral neuropathy may be the cause. This condition causes a glove-like pattern of numbness, which can be constant and may or may not include pain. Common causes include:

  • Diabetes
  • Alcoholism
  • Old Age
  • Poisoning from metals or industrial compounds
Other Causes of Hand Numbness and Tingling
  • Medications: Some medications, such as those used in cancer treatment, can cause numbness and tingling, though these usually resolve after chemotherapy.
  • Nutritional Deficiencies: Deficiencies, such as a lack of vitamin B1, can also cause these symptoms.
Diagnosing Hand Numbness and Tingling

To determine the cause of your symptoms, your doctor will evaluate the pattern and distribution of numbness and tingling. They may consider factors such as nerve compression, disease, medication use, or other underlying conditions.

Further diagnostic testing may include:

  • X-rays or MRIs to assess bone or soft tissue involvement.
  • EMG (electromyography) nerve tests to evaluate nerve function.
  • Blood tests to check for conditions like diabetes or vitamin deficiencies.

Once a diagnosis is confirmed, your doctor will discuss appropriate treatment options to address the cause of the numbness and tingling in your hand.

Mallet Finger

Mallet Finger
Mallet Finger or Baseball Finger

Mallet finger, also known as baseball finger, is an injury to the relatively thin tendon that straightens the end joint of your finger and thumb. With mallet finger, the end joint of your fingertips will bend but will not straighten by itself. You may be able to physically push your finger straight, but it will not naturally hold this position.

What Causes Mallet Finger and Baseball Finger?

The most common cause of mallet finger is when an unyielding object (such as a baseball) hits your thumb or finger and causes it to bend back further than intended. When this happens, the force of the blow tears your extensor tendon. Mallet finger can also occur with a minor force, such as tucking in a bed sheet. After the force or impact has occurred, patients are unable to straighten the thumb or fingertip on their own.

What Happens When You Have Mallet Finger?

A mallet finger injury can either pull the tendon away from where it attaches to the finger bone or outright rupture the tendon. In some instances, a tiny piece of your bone is jerked away with the tendon, which is called an avulsion injury. The most common fingers to be injured are the small finger, ring finger, and long finger on your dominant hand.

Symptoms of Baseball Finger or Mallet Finger

If you have mallet finger, your finger may be bruised, swollen, and painful. Your fingertip will noticeably droop and will only straighten if you push it in place with your other hand. If your nail is detached or if there is blood beneath the nail, it’s vital to seek medical attention to avoid infection. These may be indicators of a cut in the nail bed or a broken finger bone with an open fracture. Each of these injuries places you at risk of infection.

Treatments for Mallet Finger

A mallet finger injury requires the attention of a hand surgeon or hand specialist. Your visit will include a physical examination and an X-ray to determine if the injury forced your bones out of alignment. If you leave this condition untreated, it may result in deformity and stiffness. In children, mallet finger can affect the cartilage, which controls bone growth.

In either case, the hand experts at South Florida Hand and Orthopaedic Center can treat most mallet finger conditions with non-surgical treatments, such as a splint. If your joints are out of line or if there is a large fracture fragment, your physician may consider surgical repair.

Schedule an Appointment with South Florida Hand and Orthopaedic Center

Mallet finger or baseball finger can be frustrating and painful, but South Florida Hand and Orthopaedic Center offers multiple treatment options to remedy this condition. The physicians and staff at South Florida Hand and Orthopaedic Center provide innovative solutions for a wide range of conditions affecting your hands, arms, fingers, and thumb. We treat patients of all ages.

Swan-Neck Deformity

Swan Neck Deformity
Swan-Neck Deformity

Swan-neck deformity is a condition explaining the deformed position of your finger. This condition is a complex ailment where the proximal IP (PIP) joint over straightens because of a lax ligament on the palmar side of the joint. The ligament on the palmar side of the joint is called the volar plate, which is designed to prevent over straightening. When a patient is experiencing a swan-neck deformity, the finger will have a hyperextended PIP joint and a bent distal IP (DIP) joint, making the finger appear in a position that resembles a swan’s neck.

What Causes Swan-Neck Deformity?

The most common cause of swan-neck deformity is rheumatoid arthritis. The chronic inflammation on the PIP joint stretches the volar plate. As the volar plate becomes stretched and weakened, the PIP joint begins to hyperextend. This causes the extensor tendon to get out of balance, which makes the DIP joint get pulled down toward the flexion.

Swan-neck deformity commonly results from an overlooked injury in childhood, adolescence, or young adulthood. The finger can begin bending downward on its own and stay in a fixed over-straightening position. If this happens, this condition can be extremely debilitating. Other causes of swan-neck deformity include:

  • Untreated mallet finger
  • Looseness of the fibrous plate
  • Looseness of the finger ligaments
  • Chronic muscle spasms caused by nerve damage
  • Other types of arthritis
  • Ruptured finger tendon
  • Misalignment
Diagnosis and Treatment of Swan-Neck Deformity

In most instances, swan-neck deformity can be diagnosed from a physical examination. However, an X-ray may be ordered to allow the physician to examine joint alignment, check the condition of joint surfaces, and determine if a fracture is present. After diagnosis is complete, physicians can use either non-surgical or surgical treatment options.

Non-surgical Treatments

Non-surgical treatments are based on restoring balance in the fingers and hand. The goal of non-surgical treatment is to realign the PIP joint and prevent hyperextension, which should restore DIP extension. Stints are commonly used to protect the joint from hyperextending and line PIP joints up.

Physicians may also prescribe physical and occupational therapy in order to restore function and alignment.

Surgical Treatments

If non-surgical techniques are unable to treat the swan-neck case, surgery may be used to reconstruct the hand around the PIP joint. Your physician may use soft tissue repair, PIP joint arthroplasty, and/or finger joint fusion to remedy your swan-neck deformity.

Schedule an Appointment with South Florida Hand and Orthopaedic Center

Swan-neck deformity is a debilitating condition that can affect every area of your life. The experts at South Florida Hand and Orthopaedic Center offer several years of experience treating this condition and other conditions of the hands and fingers. We treat patients of all ages.

Joint Pain

adult female with her muscle pain on gray background. Woman havi
Get Help for Joint Pain from South Florida Hand and Orthopaedic Center in Boca Raton

The joints are links between bones that allow flexibility, movement, and support. Your body has a number of joints, and pain can be experienced from your shoulders down to your toes. Certain diseases or injuries can increase the likelihood of joint pain.

Pain in the joints can range from an annoying twinge to absolutely debilitating. The good news is that joint pain can usually be managed at home. Read below for more information on joint pain from the doctors at South Florida Hand and Orthopaedic Center.

What Causes Joint Pain?

A disease or an injury affecting parts of the joint like the bone, bursae, or tendons can lead to uncomfortable symptoms. Because joint pain is a fairly general term, there can be many causes that can produce pain.

Joint pain can be caused by the following factors:

  • Autoimmune diseases like lupus
  • Gout
  • Arthritis like rheumatoid arthritis
  • Strains and sprains
  • Tendonitis
  • Avascular necrosis
  • Fibromyalgia
  • Bone cancer
  • Leukemia
  • Viral infections
  • Lyme disease
  • Fractures and broken bones
Symptoms of Joint Pain

Depending on the severity of joint pain, symptoms can be serious or treated with over-the-counter medications. Common symptoms of joint pain include:

  • Redness
  • Swelling
  • Tenderness
  • Warmth
  • Locking of the joint

See a doctor if symptoms like fever develop, or if pain lasts more than three days.

Diagnosis & Treatments

To find out what is causing your pain, a doctor will assess your medical history and ask you a number of questions about your symptoms and if you have participated in any activities that may have caused the onset of your discomfort. Doctors may perform blood tests, X-rays, and other imaging tests to diagnose more serious cases.

Depending on what these tests find, treatments for joint pain can range from home remedies to surgical operations. At-home care will require you to rest, ice the area multiple times, and take over-the-counter anti-inflammatory medications. Surgical procedures vary depending on the severity of your condition.

Boutonniere Deformity

Boutonniere,Deformity,On,Pinky,Finger
Boutonniere Deformity: Causes, Symptoms, and Treatment

There are several tendons running along the top and side of your fingers that work simultaneously to help it straighten and bend. The central slip of tendon on the top of your finger is connected to the middle bone in your finger. If this integral tendon is injured, you may be unable to straighten your finger fully, which explains boutonniere deformity. If boutonniere deformity is left untreated, the condition may worsen and result in impaired function and deformity.

What Causes Boutonniere Deformity?

In most instances, boutonniere deformity is caused by a “jammed finger” or an impactful blow to the top side of the middle joint in a bent finger. This ailment can also be the result of a cut on the top of your finger. If the cut is deep enough, it can actually sever the tendon from its connection to your bone. When this happens, the tear looks similar to a French “boutonniere” or buttonhole. In rare instances, the bone could start protruding through the opening. A third cause of the boutonniere deformity is arthritis.

Symptoms of Boutonniere Deformity

Patients can begin developing signs of boutonniere deformity immediately after an injury to the finger. In some cases, symptoms can develop anywhere from one to three weeks later. Some of the most common symptoms of boutonniere deformity include:

  • The middle joint of the finger swells and starts to hurt
  • You have problems straightening your finger at the middle joint
  • The fingertip cannot be bent
Diagnosing and Treating Boutonniere Deformity

Boutonniere deformity is one of many injuries that can be caused by jamming your finger. Because of this, it’s imperative to consult the hand experts at South Florida Hand for a proper diagnosis. During the diagnosis, your hand specialist will examine your hand and fingers. You may be asked to straighten and bend the fingertip of the affected finger. Your physician may also request x-rays to determine if there are any broken bones.

If you want to keep the full range of motion in your finger, it’s important to seek treatment immediately. There are two different treatment options for boutonniere deformity:

Non-surgical Treatment

Non-surgical options are the preferred solution for boutonniere deformities. A few of the most common treatment options are:

  • Exercises designed to bolster the flexibility and strength in your fingers.
  • Splints can be applied on your finger at the middle joint to keep it straight. Splints allow the end joint of your finger to bend, while preventing the tendon from separating as the finger heals.
  • Protection or taping can be used after the splint has been removed, especially if you play sports.
Surgical Treatment

Although non-surgical methods are preferred, certain instances require surgery, such as:

  • If your tendon has been severed.
  • If your condition doesn’t heal with the splint.
  • A bone fragment is displaced from its normal position.
  • If your deformity is the result of rheumatoid arthritis.
Contact South Florida Hand and Orthopaedic Center

If you suffer from boutonniere deformity, the hand experts at South Florida Hand and Orthopaedic Center offer treatments for relief. The staff and physicians at South Florida Hand and Orthopaedic Center treat patients of all ages for conditions affecting hands, arms, fingers, and thumbs.

Schedule your appointment today to see a hand expert at South Florida Hand and Orthopaedic Center.

Rheumatoid Arthritis in the Hands

Rheumatoid arthritis
Rheumatoid Arthritis Overview

Rheumatoid arthritis affects the cells that lubricate and line joints, causing the tissue (synovium) to become inflamed and swollen. The swollen tissue stretches the ligaments and tendons, causing the joints to deform and become unstable. Joint cartilage and bone also erode. Your knuckle may feel hot and look red. Rheumatoid arthritis in the hands most often occurs in the wrist and knuckles. The disease is symmetric, meaning what occurs in one hand usually occurs in the other.

Signs and Symptoms of Hand Rheumatoid Arthritis

While common arthritis symptoms such as stiffness, swelling, and pain may occur, the classic features of rheumatoid arthritis include:

  • Firm nodules along fingers or the elbow.
  • Soft lump on the back of the hand that moves as the fingers straighten.
  • Angulation or collapse of fingers.
  • Sudden inability to straighten or bend a finger because of tendon rupture.
  • Deformity in which the middle finger joint becomes bent (Boutonniere deformity).
  • Deformity where the end of the finger is bent and the middle joint over-extends (Swan-neck deformity).
  • Prominent bones in the wrist.

You may also experience numbness and tingling in your hands (carpal tunnel syndrome) because the swelling of the tendons causes pressure on the adjacent nerve. They may make a squeaky sound as they move joints (crepitus), and sometimes the joints snap or lock because of the swelling.

How is Hand Rheumatoid Arthritis Diagnosed?

The doctor will perform a clinical examination, x-rays, and lab tests. He will also ask you questions about your symptoms and how the disease has affected your activities. Because rheumatoid arthritis may have a hereditary component, he may ask if any family members suffer from similar symptoms.

The doctor will also complete a detailed examination of your hands. The appearance of your hands will help him diagnose the specific type of arthritis.

An x-ray may reveal characteristics of rheumatoid arthritis including:

  • Swelling of the non-bony structures
  • Joint space narrowing
  • Decreased bone density
  • Erosions near joints

There are also several blood tests that can confirm the clinical diagnosis.

Hand Rheumatoid Arthritis Treatment

Treatment is designed to decrease inflammation, relieve pain, and maintain function. While there is no cure for rheumatoid arthritis, there are medications that slow the progression of the disease.

Hand therapy may help relieve pain and protect the joints. Exercises, splints, and adaptive devices can also help you cope with activities of daily living.

Rheumatoid arthritis can be a progressive disease. Surgical intervention may be necessary to maximize function and minimize deformity. In certain cases, the doctor may recommend preventative surgery which could include:

  • Removing nodules
  • Decreasing pressure on the joints and tendons by removing inflamed tissue.
  • Removing bone spurs that may rub on tendons or ligaments.

Several types of procedures treat joints affected by rheumatoid arthritis including:

  • Removal of inflamed joint lining
  • Joint replacements
  • Joint fusions

The procedure the doctor recommends will depend on many factors including which joint is involved, the degree of damage present, and the condition of surrounding joints.