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Want more information on anatomy before you begin looking at conditions? Head to our article on Bones of the Hand for more information!
Dupuytren’s contracture is the localised thickening and contraction of the palmar aponeurosis leading to flexion deformity of the adjacent fingers. Risk factors include: smoking, alcohol, hypothyroidism and HIV.
It presents with fixed flexion of the fingers, most commonly the 4th and 5th digits, associated with the palpable thickening of the palmar aponeurosis.
Early Dupuytren’s contracture is often managed conservatively with observation. Interventional options for functionally significant contractures include collagenase injections, needle aponeurotomy or surgery, with other approaches used less commonly in selected cases.
Image - The hand of a patient with Dupuytren's contracture
Creative commons source by Frank C. Müller, Baden-Baden [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Rheumatoid Arthritis of Finger Joints
Rheumatoid arthritis causes pain and swelling of the finger joints, often bilateral. It can cause two types of deformity:
- Swan neck deformity - hyperextension of the proximal interphalangeal joint with flexion of the distal interphalangeal joint. This is due to lax tissues on the palmar aspect of the proximal interphalangeal joint as a result of adjacent synovitis.
Image - A patient with swan neck deformity
Creative commons source by Phoenix119 [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
- Boutonnière deformity - flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint.
Image - A patient with Boutonnière deformity
Creative commons source by Prashanthns [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Osteoarthritis of Finger Joints
Osteoarthritis most commonly affects the 1st carpometacarpal joint and it is more common in women than in men. It presents with pain, swelling, squaring of the hand, stiffness and Heberden’s nodes (swellings of the distal interphalangeal joints) or Bouchard’s nodes (swellings of the proximal interphalangeal joints).
Image - An X-Ray of osteoarthritis affecting the finger joints, with Heberden's and Bouchard's nodes
Creative commons source by J. Lengerke 21:37, 27. Mai 2009 (CEST) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Psoriatic arthritis is a variable inflammatory arthritis associated with psoriasis. It may cause asymmetric oligoarthritis, symmetric polyarthritis or axial disease affecting the spine and sacroiliac joints. Distal interphalangeal joints may be involved. Other features include dactylitis (swelling of a whole digit), enthesitis (inflammation where a tendon or ligament attaches to bone), and nail changes such as pitting or onycholysis.
Mild cases can be treated with NSAIDs alone, but more severe cases may require disease-modifying anti-rheumatic drugs (DMARDs).
Image - An MRI scan of a patient with psoriatic arthropathy
Creative commons source by Fiona McQueen, Marissa Lassere and Mikkel Østergaard [CC BY 2.0]; converted to JPEG and resized for this article
Rheumatoid nodules are an extra-articular manifestation of rheumatoid arthritis. They affect around 20% of people with rheumatoid arthritis and are usually found in smokers with a more aggressive form of rheumatoid arthritis. The nodules are usually non-tender and occur in regions exposed to minor trauma.
They do not always require treatment, but if they restrict movement or cause pain, management focuses on overall control of rheumatoid arthritis. The effect of individual DMARDs on nodules can vary.
Gouty tophi are nodular masses of monosodium urate crystals that are deposited in soft tissues. They are a late complication of hyperuricaemia. This condition is most commonly seen on the fingers but can be found on the ears or elbows. The nodular masses themselves are usually painless.
People with gout and tophi should be offered urate-lowering therapy, using a treat-to-target strategy, as recommended by NICE. Tophi do not routinely need local surgical excision; medical treatment of the underlying gout remains indicated. Specialist surgical assessment may be needed for local complications.
Image - Gouty tophi nodules on a patient's fingers
Creative commons source by Michael (a.k.a. moik) McCullough [CC BY 2.0]; resized for this article
Reviewed by: Dr. Thomas Burnell
Edited by: Dr. Maddie Swannack
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