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Distal Interphalangeal Joint Arthritis

Distal Interphalangeal Joint(DIPJ) Arthritis

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  • The cartilage in the joint at the end of a finger becomes damaged

  • It eventually can result in ‘bone on bone in the joint’

  • Bone spurs can form around the joint as a result of the arthritis

  • The finger can become gradually more bent over time

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  • Osteo arthritis is a common cause – it naturally occurs as a part of normal aging, but in some people it happens at a younger age. This often runs in families

  • An injury, heavy use, or infection can cause more rapid wear of the cartilage.

  • Inflammatory conditions such as Psoriatic arthritis or Rheumatoid arthritis can cause destruction of the joint cartilage.

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  • The joint becomes more painful and stiff over time

  • It becomes larger because of inflammation and bone spur formation.

  • The joint can become bent sideways over time (as in the picture)

  • Pain in the joint often fluctuates depending on how heavily it is used

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  • Avoid activities that aggravate the joint

  • Take simples pain relief when the joint flares up (paracetamol and/or an anti inflammatory such as Ibuprofen)

  • Taping the joint or wearing a splint can relieve pain when the joint flares up.

  • A steroid injection can often give significant relief.

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  • If there is constant pain or discomfort 

  • Non operative treatments have been exhausted.

  • If pain in the finger

  • –Stops you doing the 'things you have to do' and/or

  • –The 'things you love to do' in life

  • If appearance is unacceptable, surgery is an option, but the risks must be carefully considered.

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  • This surgery is usually done under local anaesthetic

  • The anaethetist commonly gives some sedation (a twilight anaesthetic) and a dose of antibiotics

  • It is done as a day case in a hospital

  • –but you cannot drive home after the procedure

  • –and you should not be home alone on the night of your surgery

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  • A skin incision is made directly over the joint

  • The the remaining cartilage is removed from the joint

  • Some of the bone spurs around the joint are removed

  • A screw is inserted through a small incision at the fingertip. The screw is completely inside the bone once inserted.

  • The two bones at the tip of the finger is turned into one bone (fused).

  • The wound is closed. A dressing and bandage are applied.

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In Hospital

  • A bandage is applied to the hand.

  • It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling

  • If the bandage feels too tight, do not hesitate to remove it.

  • It is usual to leave hospital 2-3 hrs after surgery

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At Home

  • Continue to elevate your arm until swelling in your fingers subside.

  • Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day). Except of course for the joint that has been fused.

  • Keep the wound dry covered and clean.

  • If it is not uncomfortable, leave the bandage in place until your first appointment after surgery

  • Blood thinning medication (if you are on any) can be started 2 days after surgery

  • An appointment usually arranged with my practice nurse at about 1-2 weeks after surgery.

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  • The wound usually heals over 1-2 weeks and any sutures are then removed

  • Self care (washing, dressing, eating) with the operated hand – usually around 5 days

  • Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 5-10 days post surgery)

  • It usually takes around 6 – 8 weeks for the bones to fuse. Pinch grip with the operated finger must be avoided in this time.

  • Most moderate activities(equivalent to lifting a pot of the stove or pouring a full kettle) can usually be achieved by 6-8 weeks,

  • It can take 3-6 months for sensitivity and deep scarring in the site of the operation to resolve.

  • Golf, fishing, cycling etc.: usually around 6-12 weeks, but it can be longer.

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  • Infection - may need antibiotics and occasionally further surgery.

  • It very occasionally happens that the bones do not fuse and that further surgery is needed.

  • The  fingertip can appear slightly ‘twisted’. We try very hard to get this right in surgery but is hard to get perfect.

  • It is common to have a bit of numbness next to the scar. Sometimes the scar can be sensitive for a long time due to unavoidable damage to small skin nerves

  • Rarely, damage to the nail can occur due to the surgery or screw insertion. It can result in a permanent groove in the nail, the nail falling of or lifting away from the finger tip.

  • Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.

  • An anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

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  • The joint at the tip of the finger is permanently stiff

  • Pain from the worn-out joint is usually completely resolved

  • Good pinch strength is usually recovered

  • The finger is usually a lot straighter.

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