Osteo-arthritis is extremely common in the hands, particularly in the end and middle joints of the fingers, and at the base of the thumb. Osteo-arthritis also develops within the wrist and can be a significant cause of pain and stiffness and weakness of grip.

For painful terminal joints in the fingers, the most effective treatment is fusion, which leaves permanent stiffening, but provides a very functional grip. For painful and/or stiff proximal interphalangeal joints, options include fusion and also surface replacement arthroplasty. The latter is akin to knee and hip replacements and seeks to relieve pain and preserve mobility, which, for most patients, is the preferred option.

Thumb-base arthritis typically causes pain with gripping and turning, such as the removal of tight bottle tops and jar tops. Eventually the pain may have a significant impact on hand function and is usually managed by a surgical excision of the small wrist bone that the thumb rests upon, which is called the trapezium. Trapeziectomy is very effective in relieving pain and preserving mobility and also restores the grip strength to almost normal levels. Recovery following trapeziectomy is slow, and I warn patients that it will take approximately four months to get their grip back to comfortable levels for most daily activities, although the thumb is used right from the start following this procedure. Following trapeziectomy, driving a car is not possible for approximately six weeks, not least because of the use of a splint to protect the thumb after surgery for the first month.

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