In most cases, finger deformities are caused by acute injuries and can be easily corrected with surgery. When the underlying cause of deformities is inflammatory arthritis, the treatment can be more complex. There are several short- and long-term management strategies to reduce pain and increase functionality.
Address Problems Early
When you start to notice changes in your hands, such as the inability to completely stretch or flex finger joints, now is the time to speak with your doctor. Early intervention can help you maintain joint function longer. The options at this stage are usually splinting the fingers and physical therapy. In early stage deformities, the finger can usually be extended or flexed passively, such as by your doctor. Your doctor will likely want to refer you to a physical therapist for further evaluation.
The way your fingers need to be splinted will depend on the type of deformity. In most cases, a simple splint can be used, such as a firm piece of material placed on the palmar or dorsal side of the finger and held in place with tape. Ring splints are an excellent alternative, since they resemble a piece of jewelry and simply slide off and on between uses. It can be difficult to maintain adequate function of the fingers during splinting, so your physical therapist will likely recommend wearing a splint for specific amounts of time throughout the day.
Additionally, while deformities are in their early stage, keeping the finger mobile is important through the use of physical therapy and at-home exercises. You may have weekly sessions with your physical therapist designed to maintain or increase range of motion in the affected joints. After a few weeks of therapy, you may only need additional therapy sessions if there are new changes in your fingers or if your at-home exercises are no longer effective.
Your therapy sessions may include extending and flexing the affected joint on your own or with the help of the physical therapist, in addition to simple exercises, such as grasping objects. Another part of physical therapy may be adapting to the changes in your fingers by learning to rely on your other fingers more or using assistive devices. For example, you may learn techniques for grasping objects that rely more on a combination of your unaffected fingers and palm to adequately secure objects.
Consider Surgical Repairs
In many cases, even when hand changes have been addressed early, they will likely progress. For example, changes consistent with swan-neck and boutonnieres deformities will eventually become fixed, meaning the joints will be frozen in their flexed or hyperextended position. Depending on how impactful these deformities are on activities of daily living, it may be time to consider surgical options for repair. In some cases, long-standing deformities require additional treatment after surgery to improve functionality. Physical therapy may be required post-operatively to help increase the range of motion and improve muscle function of a joint that has been in a fixed position for many years.
Although surgical repairs are helpful in many cases, they are not always successful long-term. Since the underlying disease process is the cause, you may experience subsequent ruptures of soft tissues, causing damage to a previous repair. If this occurs, your next course of action may be to have the joint permanently fused. There are benefits to having a joint fusion, such as decreased pain in the joint, since the synovial membrane is removed. You will need to weigh the benefits of a joint fusion against the limitations it will cause. Since there is no longer a joint, the finger will not be movable, which may not be a significant factor if deformities have left the joint unusable.
Deformities of the fingers are a common problem with some forms of inflammatory arthritis. These changes can quickly make daily tasks more difficult. Fortunately, there are ways to improve functionality, especially when deformities are treated early. For more information, check out websites like http://www.towncenterorthopaedics.com.