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Distal Interphalangeal Joint Arthritis

Distal Interphalangeal Joint(DIPJ) Arthritis

What is DIPJ arthritis?

  • 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

What is DIPJ?
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What causes a DIPJ arthritis?

  • 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.

What are the causes?

How does it present?

How does it present?

  • 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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What can be done?

  • 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.

What can be done?

When is surgery considered?

  • 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.

When is surgery needed?

How does surgery work?

  • This surgery is usually done under local anaesthetic

  • The anaesthetist 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

How does surgery work?

What do we do in surgery?

  • A skin incision is made directly over the joint

  • 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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What do we do in surgery?
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After the Surgery

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.

After the surgery

The recovery

  • 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.

The recovery

What can go wrong?

  • 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 fingertip.

  • 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.

What can go wrong?

What can you expect the final outcome to be?

  • 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.

What can you expect?
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