Treatment Options for Finger Pain. Anatomy of Finger Joint Each finger has 3 bones: Each finger has...

Treatment Options Treatment Options for Finger Painfor Finger Pain

Anatomy of Finger JointAnatomy of Finger Joint Each finger has 3 Each finger has 3

bones:bones: CarpalsCarpals MetacarpalsMetacarpals PhalangesPhalanges

Each finger also Each finger also has 3 joints (the has 3 joints (the knuckles):knuckles): MCPMCP PIPPIP DIPDIP

Source: www.AllAboutArthritis.com, 2003 v137

Causes of Finger PainCauses of Finger Pain

Rheumatoid arthritis Rheumatoid arthritis Osteoarthritis (wear and Osteoarthritis (wear and

tear)tear) Sprains and fracturesSprains and fractures Joint imbalanceJoint imbalance Dupuytren’s ContractureDupuytren’s Contracture Soft Tissue Systemic Soft Tissue Systemic

Problem (Trigger Finger)Problem (Trigger Finger)


Symptoms of Finger PainSymptoms of Finger Pain

PainPain During activity During activity At rest or sleepingAt rest or sleeping

Swelling and tightnessSwelling and tightness DeformityDeformity Stiffness and decreased movementStiffness and decreased movement


Diagnosing Finger ArthritisDiagnosing Finger Arthritis

Physical examinationPhysical examination Medical history reviewMedical history review X-RaysX-Rays


How Can My Life ChangeHow Can My Life Change with Treatment? with Treatment?

A return to mobilityA return to mobility Regaining a sense of Regaining a sense of

your former lifestyleyour former lifestyle A change in pain A change in pain

symptomssymptoms

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Non-surgical Treatment Options for Non-surgical Treatment Options for Finger Pain: Over-the-Counter Finger Pain: Over-the-Counter

MedicationsMedications Nonsteroidal Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs

(NSAIDS)(NSAIDS) Usually first for treatmentUsually first for treatment Reduce pain, swelling and rednessReduce pain, swelling and redness Relief can take several monthsRelief can take several months Examples:Examples:

ibuprofen (ibuprofen (Advil®, Motrin®)Advil®, Motrin®) naproxen (naproxen (Aleve®)Aleve®)

AspirinAspirin Reduce joint pain and inflammationReduce joint pain and inflammation Form of NSAIDsForm of NSAIDs

Source: www.AllAboutArthritis.com , 2003 v143

Non-surgical Treatment Options for Non-surgical Treatment Options for Finger Pain: Over-the-Counter Finger Pain: Over-the-Counter

MedicationsMedicationsAcetaminophenAcetaminophen

Reduces painReduces pain Lowers feverLowers fever Does not reduce inflammation of Does not reduce inflammation of

arthritisarthritis Examples:Examples:

TylenolTylenol®®

DatrilDatril®® Extra Strength Extra Strength TempraTempra®®

Source: www.AllAboutArthritis.com , 2003 v144

Non-surgical Treatment Options for Non-surgical Treatment Options for Finger Pain: Prescription MedicationsFinger Pain: Prescription Medications

NSAIDS NSAIDS Most popular type for osteoarthritis treatmentMost popular type for osteoarthritis treatment Includes ibuprofen (Includes ibuprofen (MotrinMotrin®®), ), naproxen sodium naproxen sodium

((AnaproxAnaprox®®)), oxaprozin , oxaprozin (Daypro(Daypro®®)), sulindac , sulindac (Clinoril(Clinoril®®) ) , etc. , etc.

AnalgesicsAnalgesics Provide pain relief, but do not reduce Provide pain relief, but do not reduce

inflammationinflammation Includes Acetaminophen with codeine (TylenolIncludes Acetaminophen with codeine (Tylenol®®

with Codeine), Oxycodone (OxyContinwith Codeine), Oxycodone (OxyContin®®, , RoxicodoneRoxicodone®®), Hydrocodone with acetaminophen ), Hydrocodone with acetaminophen (Vicodin(Vicodin®®, Dolacet, Dolacet®®), etc.), etc.

Source: www.AllAboutArthritis.com , 2003

Non-surgical Treatment Options for Non-surgical Treatment Options for Finger Pain: Prescription Finger Pain: Prescription

MedicationsMedications Biological Response ModifiersBiological Response Modifiers

Treat rheumatoid arthritis; may postpone injury to the jointsTreat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (RemicadeIncludes: Infliximab (Remicade®®), Etanercept (Enbrel ), Etanercept (Enbrel ®®))

Glucocorticoids or CorticosteroidsGlucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammationTreat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (CortefIncludes: cortisone, hydrocortisone (Cortef®®, Hydrocortone, Hydrocortone®®), ),

Prednisolone (PrelonePrednisolone (Prelone®®) ) DMARDSDMARDS

Treat rheumatoid arthritis; slow joint destructionTreat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (DepenIncludes: methotrexate, injectable gold, penicillamine (Depen®®), ),

Azathioprine (ImuranAzathioprine (Imuran®®), etc.), etc.

Source: www.AllAboutArthritis.com , 2003

Non-surgical Treatment Non-surgical Treatment Options for Finger PainOptions for Finger Pain

Steroid injectionsSteroid injections Activity ModificationActivity Modification Physical TherapyPhysical Therapy Assistive devices, like a doorknob grip, Assistive devices, like a doorknob grip,

for daily tasks such as:for daily tasks such as: WritingWriting PhoningPhoning Getting DressedGetting Dressed CookingCooking BathingBathing


Surgical Options for Finger Surgical Options for Finger PainPain

Finger joint fusionFinger joint fusion Excisional arthroplastyExcisional arthroplasty Finger joint replacementFinger joint replacement

v149

Finger Joint FusionFinger Joint Fusion

Fuses bones of joint to grow Fuses bones of joint to grow togethertogether

Results in:Results in: Eliminating painEliminating pain Immobile jointImmobile joint No range of motionNo range of motion



Incision is made.Incision is made. Two joint surfaces are held Two joint surfaces are held

together with:together with: PinsPins PlatesPlates ScrewsScrews

Usually six weeks for bones to fuse Usually six weeks for bones to fuse together.together.



Benefits of Joint Fusion:Benefits of Joint Fusion: Removes pain of arthritisRemoves pain of arthritis Durable and strongDurable and strong

Disadvantages of Joint Fusion:Disadvantages of Joint Fusion: Immobile joint; little or no range of Immobile joint; little or no range of

motionmotion


Excisional ArthroplastyExcisional 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 Combined with reconstruction of the

joint.joint. A standard method used for many A standard method used for many

years.years.


Excisional Arthroplasty, Excisional Arthroplasty, continuedcontinued

Remove arthritic joint surfaces.Remove arthritic joint surfaces. After surgery, tendons form a flexible After surgery, tendons form a flexible

connection between bones.connection between bones. Holds thumb in place and keeps space Holds thumb in place and keeps space

between bones from collapsing.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.


Excisional Arthroplasty, Excisional Arthroplasty, continuedcontinued

BenefitsBenefits Used for many years.Used for many years. Can help take away pain, while Can help take away pain, while

allowing the joint to retain some allowing the joint to retain some movement.movement.

DisadvantagesDisadvantages Does not allow the joint full mobility, Does not allow the joint full mobility,

retains only some movement.retains only some movement.

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Finger Replacement SurgeryFinger Replacement Surgery

Patients typically Patients typically choose this treatment choose this treatment option to improve option to improve their mobility and their mobility and reduce pain.reduce pain.

An estimated 10,000 An estimated 10,000 total finger total finger replacements in replacements in 2003.2003.

*Copyright 2002 by Solucient LLC v156

When is Finger Replacement When is Finger Replacement Surgery Right for You?Surgery Right for You?

Significant pain, even when Significant pain, even when sleeping.sleeping.

Loss of function, despite non-Loss of function, despite non-surgical treatments.surgical treatments.

Fingers start drifting to the side- Fingers start drifting to the side- “ulnar drift”.“ulnar drift”.

Source: www.neuflex.com , 2003 v157

Finger Replacement Finger Replacement ComponentsComponents

Made of silicon, Made of silicon, used to replace the used to replace the MCP MCP (metacarpalphalang(metacarpalphalangeal) joint.eal) joint.

Acts as a spacer to Acts as a spacer to fill the gap of the fill the gap of the removed arthritic removed arthritic MCP joint.MCP joint.

Source: www.jointreplacement.com , 2003 v158

Benefits to Patient from Benefits to Patient from SurgerySurgery

Return to mobilityReturn to mobility Restore lifestyleRestore lifestyle FreedomFreedom

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Surgical ProcedureSurgical Procedure

An incision is made.An incision is made. Finger joint is opened.Finger joint is opened. Cartilage is removed from the joint Cartilage is removed from the joint

surfaces.surfaces.


Surgical ProcedureSurgical Procedure

Implant is inserted into the canal Implant is inserted into the canal between the bone of the finger and between the bone of the finger and joint.joint.

A tight sack holds the implant in A tight sack holds the implant in place.place.

Skin is sutured together.Skin is sutured together. A splint, brace or cast will probably A splint, brace or cast will probably

be required for up to six weeks.be required for up to six weeks.


Preparing for Joint Preparing for Joint Replacement SurgeryReplacement Surgery

Ease anxiety by mentally preparing Ease anxiety by mentally preparing with:with: Breathing exercisesBreathing exercises MeditationMeditation Talking with friends and familyTalking with friends and family

Learn more about finger replacement Learn more about finger replacement surgerysurgery BrochuresBrochures HandoutsHandouts WebsitesWebsites VideosVideosSource: www.jointreplacement.com , 2003 v162

The Night Before SurgeryThe Night Before Surgery Avoid medications, such as “blood Avoid medications, such as “blood

thinners” (aspirin, ibuprofen, etc.).thinners” (aspirin, ibuprofen, etc.). Do not consume any food or liquid Do not consume any food or liquid

after midnight.after midnight. Make sure you have everything Make sure you have everything

you’ll need at the hospital.you’ll need at the hospital. Ask any questions you may have Ask any questions you may have

before surgery.before surgery.


After SurgeryAfter Surgery

Hand above heart at all times initially. Hand above heart at all times initially. Pain medication and antibiotics may be Pain medication and antibiotics may be

prescribed. prescribed. Hospital stay, depending on:Hospital stay, depending on:

Number of joints replaced. Number of joints replaced. Any other procedures that have been Any other procedures that have been

done. done. Follow instructions to care for hand Follow instructions to care for hand

once discharged.once discharged.Source: www.jointreplacement.com , 2003 v164

A Caregiver’s RoleA Caregiver’s Role

Provide support and show patienceProvide support and show patience Help with needs that the patient Help with needs that the patient

can not do, like:can not do, like: Meal preparationMeal preparation Everyday household choresEveryday household chores WritingWriting


Recovery in the First WeekRecovery in the First Week

Dressing removed after several Dressing removed after several days and replaced with lighter one.days and replaced with lighter one.

Supportive finger splint used during Supportive finger splint used during the day and night.the day and night.

If any concern, notify your surgeon If any concern, notify your surgeon immediately.immediately.


Recovery in the First MonthRecovery in the First Month

Move fingers depending on Move fingers depending on comfort level.comfort level.

Stitches removed usually after 10 Stitches removed usually after 10 days to two weeks after surgery.days to two weeks after surgery.

Begin motion exercises within a Begin motion exercises within a few days of surgery.few days of surgery.


Recovery After Six WeeksRecovery After Six Weeks

May take splint off during the day, May take splint off during the day, but sleep with it at night.but sleep with it at night.

Return to normal activities without Return to normal activities without splints in 2 to 3 months.splints in 2 to 3 months.


Questions?Questions?

Thank YouThank You

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Treatment Options for Finger Pain. Anatomy of Finger Joint Each finger has 3 bones: Each finger has...

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