Hand and Wrist Arthritis and Surgical Interventions with Dr Matthew White

In this podcast, Dr. Matt White, an orthopaedic hand and wrist surgeon based in Sydney, shares insights on the management and treatment of common arthritis conditions of the hand. Drawing on his extensive training and firsthand clinical experience, he addresses the various types of hand arthritis, emphasizing the significance of understanding a patient's symptoms and functional capacity over merely relying on x-ray results.

Dr. White begins by discussing the prevalence of arthritis in the hand joints, particularly highlighting that the distal interphalangeal (DIP) joint arthritis is the most common, with nearly everyone experiencing it by their 80s. He also mentions the commonality of thumb basal joint (CMC) arthritis, noting that while metacarpophalangeal (MCP) and proximal interphalangeal (PIP) arthritis are less frequent, wrist arthritis is relatively rare. The crux of his argument is that x-ray findings can often be misleading; patients may exhibit severe x-ray changes but might function effectively without pain. He illustrates this with a case study of a woman with significant wrist joint destruction due to rheumatoid arthritis but who remains asymptomatic and active in her daily life.

As the lecture progresses, Dr. White discusses the physical manifestation of arthritis in aging hands. He describes how patients may develop noticeable changes, such as joint deformities, yet often report minimal or no pain. This reinforces his point that the approach to treatment ought to be primarily focused on the patient's functionality rather than the severity of their x-ray findings. He stresses that advanced imaging, such as MRIs or ultrasounds, is often unnecessary for diagnosing common hand conditions, as x-rays suffice in most cases.

Dr. White elaborates on treatment options, highlighting that pain management can be challenging in smaller joints of the hand. He discusses the limited effectiveness of over-the-counter medications like Panadol and non-steroidal anti-inflammatory drugs (NSAIDs) for older patients due to adverse side effects. He advocates for providing splints, particularly for DIP joint pain, as a non-invasive means to stabilize the affected joints during activities that might exacerbate symptoms.

Addressing the issue of when to refer patients for specialist care, Dr. White suggests that practitioners should not hesitate to refer if they have doubts about their management of arthritis cases. He encourages clinicians to maintain a strong relationship with hand therapists for providing specialized rehabilitation, which plays a crucial role in the treatment of arthritis in the hands.

The discussion also covers specific types of hand arthritis in detail, particularly focusing on CMC arthritis. Dr. White explains the pathophysiology of CMC arthritis, its demographic patterns, and the emerging theories regarding its higher prevalence in postmenopausal women. He elaborates on the importance of clinically assessing CMC joint pain and differentiating it from other potential sources of discomfort in the radial side of the wrist. He highlights several diagnostic techniques and the practical use of physical tests to ascertain the origin of pain experienced by patients.

Towards the end of the lecture, Dr. White provides an overview of treatment protocols for more advanced cases of arthritis, including surgical options like trapeziectomy and joint replacements. He emphasizes the shift towards non-operative management strategies, particularly in younger patients, to preserve joint functionality while addressing pain. The nuanced discussion of surgical options illustrates the balance between patient quality of life, functional demands, and the long-term implications of surgical decisions.

In conclusion, Dr. White reiterates that while hand and wrist...