Arthritis
What is it: Degenerative or inflammatory joint disease of the hand and wrist.
How does it present: Arthritis of the hand and wrist may present with gradually increasing pain and stiffness, sometimes with associated swelling. Patients may present with it diffusely in the fingers, hand or wrist or it may be isolated to particular joints.
Common exam findings: Physical exam findings may include swelling, tenderness to palpation and decreased range of motion in the affected joints. Patients with osteoarthritis of the hands may develop Heberden's nodes at the DIP joint or Bouchard's nodes at the PIP joints. These nodules may be painful initially. Patients with advanced rheumatoid arthritis may get the classic ulnar deviation of the fingers or a boutonniere or swan neck deformity of the fingers.
Tests and treatment: X-rays should be sufficient to evaluate for the presence of arthritis. Treatments include pain medication and other conservative pain measures. For osteoarthritis, steroid injections into certain joints can be considered to provide temporary relief. For some joints, surgical treatment can be considered if pain and disability are significant and not responding to conservative measures. Inflammatory arthritis conditions should be managed on consultation with a rheumatologist.