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The most common initial symptom of wrist osteoarthritis is joint pain. The pain is brought on by activity and increases when there is activity after resting. Other signs and symptoms, as with any joint affected by osteoarthritis, include:
- Morning stiffness, which usually lasts less than 30 minutes. This is also present in patients with rheumatoid arthritis, but in those patients this typically lasts for more than 45 minutes.
- Swelling of the wrist.
- Crepitus (crackling), which is felt when the hand is moved passively.
- Joint locking, where the joint is fixed in an extended position.
- Joint instability.
These symptoms can lead to loss of function and less daily activity.
The primary and most common symptom in patients with CMC OA of the thumb is pain. Pain at the base of the thumb is mainly experienced when moving the thumb or when applying pressure with the thumb. However, in advanced stages of CMC OA, pain might persist at rest. Another prominent symptom is loss of strength of the thumb. Patients struggle to grab or hold an object due to weakening of the thumb. For example, tying a knot or holding a saucepan becomes increasingly difficult.
If patients present themselves with similar symptoms, physicians should also consider De Quervain syndrome, rheumatoid arthritis or flexor carpi radialis and flexor pollicis longus tendinopathy as a possible cause.
Typical signs of CMC OA can be observed from the outside of the hand. For example, the area near the base of the thumb can be swollen and could appear inflamed. Advanced stages of CMC OA can eventually lead to deformity of the thumb. This deformity, also called a ‘zigzag’ deformity, is characterized by a deviation of the thenar eminence towards the middle of the hand, whilst the thumb phalanges overextend. Also a grinding sound, known as crepitus, can be heard when the CMC1 joint is moved.
Trapeziometacarpal osteoarthritis, also known as carpometacarpal (CMC) osteoarthritis (OA) of the thumb or osteoarthritis at the base of the thumb, is a reparitive joint disease affecting the first carpometacarpal joint (CMC1). This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb. Because of its relative instability, this joint is a frequent site for osteoarthritis. Carpometacarpal osteoarthritis (CMC OA) of the thumb occurs when the cushioning cartilage of the joint surfaces wears away, resulting in damage of the joint.
The main complaint of patients is pain. Pain at the base of the thumb occurs when moving the thumb and might eventually persist at rest. Other symptoms include stiffness, swelling and loss of strength of the thumb. Treatment options include conservative and surgical therapies.
While ligamentous laxity may be genetic and affect an individual from a very early age, it can also be the result of an injury. Injuries, especially those involving the joints, invariably damage ligaments either by stretching them abnormally or even tearing them.
Loose or lax ligaments in turn are not capable of supporting joints as effectively as healthy ones, making the affected individual prone to further injury as well as compensation for the weakness using other parts of the body. Afflicted individuals may improve over time and lose some of their juvenile hyperlaxity as they age. Individuals over age 40 often have recurrent joint problems and almost always suffer from chronic pain. Back patients with ligamentous laxity in the area of the spine may also experience osteoarthritis and disc degeneration.
In the case of extreme laxity, or hypermobility, affected individuals often have a decreased ability to sense joint position, which can contribute to joint damage. The resulting poor limb positions can lead to the acceleration of degenerative joint conditions. Many hypermobility patients suffer from osteoarthritis, disorders involving nerve compression, chondromalacia patellae, excessive anterior mandibular movement, mitral valve prolapse, uterine prolapse and varicose veins.
Finger injuries are usually diagnosed with x-ray and can get to be considerably painful. The majority of finger injuries can be dealt with conservative care and splints. However, if the bone presents an abnormal angularity or if it is displaced, one may need surgery and pins to hold the bones in place.
Osteoarthritis of the wrist is predominantly a clinical diagnosis, and thus is primarily based on the patients medical history, physical examination and wrist X-rays.
Arthritis of the hand is common in females. Osteoarthritis of the hand joints is much less common than rheumatoid arthritis. As the arthritis progresses, the finger gets deformed and lose its functions. Moreover, many patients with rheumatoid arthritis have this dysfunction present in both hands and become disabled due to chronic pain. Osteoarthritis is most common at the base of thumb and is usually treated with pain pills, splinting or steroid injections.
Carpal tunnel syndrome is a common disorder of the hand. This disorder results from compression of an important nerve in the wrist. Disorders like diabetes mellitus, thyroid or rheumatoid arthritis can narrow the tunnel and cause impingement of the nerve. Carpal tunnel syndrome also occurs in people who overuse their hand or perform repetitive actions like using a computer key board, a cashiers machine or a musical instrument. When the nerve is compressed, it can result in disabling symptoms like numbness, tingling, or pain in the middle three fingers. As the condition progresses, it can lead to muscle weakness and inability to hold objects. The pain frequently occurs at night and can even radiate to the shoulder. Even though the diagnosis is straightforward, the treatment is not satisfactory.
Dupuytren's contracture is another disorder of the fingers that is due to thickening of the underlying skin tissues of the palm. The disorder results in a deformed finger which appears thin and has small bumps on the surface. Dupuytren's contracture does run in families, but is also associated with diabetes, smoking, seizure recurrence and other vascular disorders. Dupuytren's does not need any treatment as the condition can resolve on its own. However, if finger function is compromised, then surgery may be required.
Ganglion cysts are soft globular structures that occur on the back of the hand usually near the junction of the wrist joint. These small swellings are usually painless when small but can affect hand motion when they become large. The cysts contain a jelly like substance and usually do disappear on their own. If the ganglion cyst is not bothersome, it should be left alone. Just removing the fluid from the cyst is not curative because fluid will come back in less than a week. Surgery is often done for large cysts but the results are poor. Recurrences are common, and there is always the possibility of nerve or joint damage.
Tendinitis is disorder when tendons of the hands become inflamed. Tendons are thick fibrous cords that attach small muscles of the hand to bones. A Tendon is useful for generation of power to bend or extend the finger. When repetitive action is performed, tendons often get inflamed and present with pain and difficulty for moving the finger. In most cases, tendinitis can be treated with rest, ice and wearing splints. In some cases, an injection of corticosteroid may help. Tendinitis is primarily a disorder from overuse but if not treated properly, can become chronic.
Trigger finger is a common disorder which occurs when the sheath through which tendons pass, become swollen or irritated. Initially, the finger may catch during movement but symptoms like pain, swelling and a snap may occur with time. The finger often gets locked in one position and it may be difficult to straighten or bend the finger. Trigger finger has been found to be associated with diabetes, gout and rheumatoid arthritis.
Ligamentous laxity, or ligament laxity, means loose ligaments. Ligamentous laxity is a cause of chronic body pain characterized by loose ligaments. When this condition affects joints in the entire body, it is called "generalized joint hypermobility", which occurs in about ten percent of the population, and may be genetic. Loose ligaments can appear in a variety of ways and levels of severity. It also does not always affect the entire body. One could have loose ligaments of the feet, but not of the arms.
Someone with ligamentous laxity, by definition, has loose ligaments. Unlike other, more pervasive diseases, the diagnosis does not require the presence of loose tendons, muscles or blood vessels, hyperlax skin or other connective tissue problems. In heritable connective tissue disorders associated with joint hyper-mobility (such as Marfan syndrome and Ehlers–Danlos syndrome types I–III, VII, and XI), the joint laxity usually is apparent before adulthood. However, age of onset and extent of joint laxity are variable in Marfan syndrome, and joint laxity may be confined to the hands alone, as in Ehlers–Danlos syndrome type IV.
Symptoms of Bennett fracture are instability of the CMC joint of the thumb, accompanied by pain and weakness of the pinch grasp. Characteristic signs include pain, swelling, and ecchymosis around the base of the thumb and thenar eminence, and especially over the CMC joint of the thumb. Physical examination demonstrates instability of the CMC joint of the thumb. The patient will often manifest a weakened ability to grasp objects or perform such tasks as tying shoes and tearing a piece of paper. Other complaints include intense pain experienced upon catching the thumb on an object, such as when reaching into a pants pocket.
People with Joint Hypermobility Syndrome may develop other conditions caused by their unstable joints. These conditions include:
- Joint instability causing frequent sprains, tendinitis, or bursitis when doing activities that would not affect others
- Joint pain
- Early-onset osteoarthritis (as early as during teen years)
- Subluxations or dislocations, especially in the shoulder (severe limits to ability to push, pull, grasp, finger, reach, etc., is considered a disability by the US Social Security Administration)
- Knee pain
- Fatigue, even after short periods of exercise
- Back pain, prolapsed discs or spondylolisthesis
- Joints that make clicking noises (also a symptom of osteoarthritis)
- Susceptibility to whiplash
- Temporomandibular Joint Syndrome also known as TMJ
- Increased nerve compression disorders (such as carpal tunnel syndrome)
- The ability of finger locking
- Poor response to anaesthetic or pain medication
- "Growing pains" as described in children in late afternoon or night
Hypermobility generally results from one or more of the following:
- Abnormally shaped ends of one or more bones at a joint
- A Type 1 collagen or other connective tissue defect (as found in Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Marfan syndrome) resulting in weakened ligaments/ligamentous laxity, muscles and tendons. This same defect also results in weakened bones, which may result in osteoporosis and fractures.
- Abnormal joint proprioception (an impaired ability to locate body parts in space and/or monitor an extended joint)
These abnormalities cause abnormal joint stress, meaning that the joints can wear out, leading to osteoarthritis.
The condition tends to run in families, suggesting a genetic basis for at least some forms of hypermobility. The term "double jointed" is often used to describe hypermobility; however, the name is a misnomer and should not be taken literally, as hypermobile joints are not doubled/extra in any sense.
Most people have hypermobility with no other symptoms. Approximately 5% of the healthy population have one or more hypermobile joints. However, people with "joint hypermobility syndrome" are subject to many difficulties. For example, their joints may be easily injured, be more prone to complete dislocation due to the weakly stabilized joint and they may develop problems from muscle fatigue (as muscles must work harder to compensate for weakness in the ligaments that support the joints). Hypermobility syndrome can lead to chronic pain or even disability in severe cases. Musical instrumentalists with hypermobile fingers may have difficulties when fingers collapse into the finger locking position. Or, conversely, they may display superior abilities due to their increased range of motion for fingering, such as in playing a violin or cello.
Hypermobility may be symptomatic of a serious medical condition, such as Stickler Syndrome, Ehlers-Danlos syndrome, Marfan syndrome, Loeys-Dietz syndrome, rheumatoid arthritis, osteogenesis imperfecta, lupus, polio, Down syndrome, morquio syndrome, cleidocranial dysostosis or myotonia congenita.
Hypermobility has been associated with chronic fatigue syndrome and fibromyalgia. Hypermobility causes physical trauma (in the form of joint dislocations, joint subluxations, joint instability, sprains, etc.). These conditions often, in turn, cause physical and/or emotional trauma and are possible triggers for conditions such as fibromyalgia.
Women with hypermobility may experience particular difficulties when pregnant. During pregnancy, the body releases certain hormones that alter ligament physiology, easing the stretching needed to accommodate fetal growth as well as the birthing process. The combination of hypermobility and pregnancy-related pelvic girdle during pregnancy can be debilitating. The pregnant woman with hypermobile joints will often be in significant pain as muscles and joints adapt to the pregnancy. Pain often inhibits such women from standing or walking during pregnancy. The pregnant patient may be forced to use a bedpan and/or a wheelchair during pregnancy and may experience permanent disability.
Symptoms of hypermobility include a dull but intense pain around the knee and ankle joints and the soles of the feet. The pain and discomfort affecting these body parts can be alleviated by using custom orthoses.
Carpometacarpal bossing (or metacarpal/carpal bossing) is a small, immovable mass of bone on the back of the wrist. The mass occurs in one of the joints between the carpus and metacarpus of the hand, called the carpometacarpal joints, where a small immovable protuberance occurs when this joint becomes swollen or bossed.
The joint between the index metacarpal and the capitate is a fibrous non-mobile joint. Some people have a gene that leads to this growth. It looks like arthritis (bone spurs on each side of the joint) on X-ray. It looks like a ganglion on the hand, but more towards the fingertips.
The following factors may be involved in causing this deformity:
- Inherent laxity of the knee ligaments
- Weakness of biceps femoris muscle
- Instability of the knee joint due to ligaments and joint capsule injuries
- Inappropriate alignment of the tibia and femur
- Malunion of the bones around the knee
- Weakness in the hip extensor muscles
- Gastrocnemius muscle weakness (in standing position)
- Upper motor neuron lesion (for example, hemiplegia as the result of a cerebrovascular accident)
- Lower motor neuron lesion (for example, in post-polio syndrome)
- Deficit in joint proprioception
- Lower limb length discrepancy
- Congenital genu recurvatum
- Cerebral palsy
- Multiple sclerosis
- Muscular dystrophy
- Limited dorsiflexion (plantar flexion contracture)
- Popliteus muscle weakness
- Connective tissue disorders. In these disorders, there are excessive joint mobility (joint hypermobility) problems. These disorders include:
- Marfan syndrome
- Ehlers-Danlos syndrome
- Benign hypermobile joint syndrome
- Osteogenesis imperfecta disease
The carpometacarpal joint is usually found at the base of the second and third metacarpal bones at the point where they meet the small bones of the wrist.
Bosses are usually painless and will never cause more than a slight ache. They tend to be of manageable size, but on occasion the extensor tendons can slide over the bump, which can be annoying. Sometimes there is a ganglion cyst along with the boss.
Often, this condition will be mistaken for a ganglion cyst due to its location and external appearance.
Carpometacarpal boss is uncommon and there is not much scientific data. It is likely genetic as often present on both hands. There is no evidence that it is related to hand use.
Typically, this condition will begin to show itself in the 3rd or 4th decade.
When plantar fasciitis occurs, the pain is typically sharp and usually unilateral (70% of cases). Heel pain is worsened by bearing weight on the heel after long periods of rest. Individuals with plantar fasciitis often report their symptoms are most intense during their first steps after getting out of bed or after prolonged periods of sitting. Improvement of symptoms is usually seen with continued walking. Rare, but reported symptoms include numbness, tingling, swelling, or radiating pain. Typically there are no fevers or night sweats.
If the plantar fascia continues to be overused in the setting of plantar fasciitis, the plantar fascia can rupture. Typical signs and symptoms of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.
The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily around the site of the bunion as well.
The presence of bunions can lead to difficulties finding properly fitting footwear and may force a person to buy a larger size shoe to accommodate the width the bunion creates. If the bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes. It is then considered as being a mechanical function problem of the forefoot.
Genu recurvatum is a deformity in the knee joint, so that the knee bends backwards. In this deformity, excessive extension occurs in the tibiofemoral joint. Genu recurvatum is also called knee hyperextension and back knee. This deformity is more common in women and people with familial ligamentous laxity. Hyperextension of the knee may be mild, moderate or severe.
The normal range of motion (ROM) of the knee joint is from 0 to 135 degrees in an adult. Full knee extension should be no more than 10 degrees. In genu recurvatum (back knee), normal extension is increased. The development of genu recurvatum may lead to knee pain and knee osteoarthritis.
Symptoms are pain at the radial side of the wrist, spasms, tenderness, occasional burning sensation in the hand, and swelling over the thumb side of the wrist, and difficulty gripping with the affected side of the hand. The onset is often gradual. Pain is made worse by movement of the thumb and wrist, and may radiate to the thumb or the forearm.
Hammer toe most frequently results from wearing poorly fitting shoes that can force the toe into a bent position, such as excessively high heels or shoes that are too short or narrow for the foot. Having the toes bent for long periods of time can cause the muscles in them to shorten, resulting in the hammer toe deformity. This is often found in conjunction with bunions or other foot problems (e.g., a bunion can force the big toe to turn inward and push the other toes). It can also be caused by muscle, nerve, or joint damage resulting from conditions such as osteoarthritis, rheumatoid arthritis, stroke, Charcot–Marie–Tooth disease, complex regional pain syndrome or diabetes. Hammer toe can also be found in Friedreich's ataxia (GAA trinucleotide repeat).
Bennett fracture is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint. This intra-articular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint.
A bunion is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. Onset is gradual. Complications may include bursitis or arthritis.
The exact cause is unclear. Proposed factors include wearing overly tight shoes, family history, and rheumatoid arthritis. Diagnosis is generally based on symptoms and supported by X-rays. A similar condition of the little toe is referred to as a bunionette.
Treatment may include proper shoes, orthotics, or NSAIDs. If this is not effective for improving symptoms, surgery may be done. It affects about 23% of adults. Females are affected more often than males. Usual age of onset is between 20 and 50 years old. The condition also becomes more common with age. It was first clearly described in 1870.
The symptoms of facet joint syndrome depend almost entirely on the location of the degenerated joint, the severity of the damage and the amount of pressure that is being placed on the surrounding nerve roots. It's important to note that the amount of pain a person experiences does not correlate well with the amount of degeneration that has occurred within the joint. Many people experience little or no pain while others, with the exact same amount of damage, undergo chronic pain.
Additionally, in symptomatic facet syndrome the location of the degenerated joint plays a significant role in the symptoms that are experienced. People with degenerated joints in the upper spine will often feel pain radiating throughout the upper neck and shoulders. That said, symptoms primarily manifest themselves in the lumbar spine, since the strain is highest here due to the overlying body weight and the strong mobility. Affected persons usually feel dull pain in the cervical or lumbar spine that can radiate into the buttocks and legs. Typically, the pain is worsened by stress on the facet joints, e.g. by diffraction into hollow back (retroflexion) or lateral flexion but also by prolonged standing or walking.
Pain associated with facet syndrome is often called "referred pain" because symptoms do not follow a specific nerve root pattern and the brain can have difficulty localizing the specific area of the spine that is affected. This is why patients experiencing symptomatic facet syndrome can feel pain in their shoulders, legs and even manifested in the form of headaches.
Classification of radial dysplasia is practised through different models. Some only include the different deformities or absences of the radius, where others also include anomalies of the thumb and carpal bones. The Bayne and Klug classification discriminates four different types of radial dysplasia. A fifth type was added by Goldfarb et al. describing a radial dysplasia with participation of the humerus. In this classification only anomalies of the radius and the humerus are taken in consideration. James and colleagues expanded this classification by including deficiencies of the carpal bones with a normal distal radius length as type 0 and isolated thumb anomalies as type N.
Type N: Isolated thumb anomaly
Type 0: Deficiency of the carpal bones
Type I: Short distal radius
Type II: Hypoplastic radius in miniature
Type III: Absent distal radius
Type IV: Complete absent radius
Type V: Complete absent radius and manifestations in the proximal humerus
The term absent radius can refer to the last 3 types.
De Quervain syndrome, is a tenosynovitis of the sheath or tunnel that surrounds two tendons that control movement of the thumb.
Ulnar deviation, also known as ulnar drift, is a hand deformity in which the swelling of the metacarpophalangeal joints (the big knuckles at the base of the fingers) causes the fingers to become displaced, tending towards the little finger. Its name comes from the displacement toward the ulna (as opposed to radial deviation, in which fingers are displaced toward the radius). Ulnar deviation is likely to be a characteristic of rheumatoid arthritis, more than of osteoarthritis. Consideration should also be given to Pigmented Villonodular Synovitis, in the setting of ulnar deviation and metacarpophalangeal synovitis.
Ulnar deviation is also a physiological movement of the wrist, where the hand including the fingers move towards the ulna.
Ulnar deviation is a disorder in which flexion by ulnar nerve innervated muscles is intact while flexion on the median nerve side is not.