Arthritis of the small joints of the hand is very common. In fact the joint closest to the nail is one of the commonest locations in the body to develop arthritis; but it can also affect the knuckles. When this happens, many patients don’t experience any pain at all, and generally if that is the case no treatment is needed.

However, if this happens and it is painful Mr Wharton recommends hand therapy for splinting, and steroid injections in the first instance. Often the steroid injections are done with x-ray or ultrasound guidance, and that may require a referral to the radiologist, and a separate visit.

When injections and splints can no longer help with the pain Mr Wharton offers both joint replacement and joint fusion operations. The joint replacements stop the worn out bone ends from knocking against each other, and allow movement, but can only reliably achieve the movement that patients already have in that particular joint. Sometimes the joint is so stiff from arthritis that it doesn’t move much anymore. Under those circumstance Mr Wharton also offers joint fusion (arthrodesis) surgery where the worn out cartilage is removed and the bone ends are held with metalwork so that new bone grows across the joint. If the joint doesn’t move it often doesn’t cause pain, and so this treatment can be very effective at improving hand pain.