Facebook Live: Jeffrey Kutsikovich, M.D. on Hand Arthritis

Could you give a bit of introduction about yourself and explain your specialty? 

I’m one of the hand specialists here at the Bone and Joint Institute of Tennessee. Originally I’m from Cleveland, Ohio, but I did my orthopaedic training in Memphis, Tennessee at the Campbell Clinic, then continued on at my fellowship training at the Indiana Hand and Shoulder Institute. There, I sub-specialized in treatment of the hand, wrist, elbow, and shoulder. 

Can you explain a little bit about the specialty? What types of injuries and conditions do you see? 

It’s a pretty broad spectrum of conditions that hand and upper extremity specialists see. Primarily, we take care of any kind of disorder of the muscular skeletal system of the upper extremities, and that really includes fingertip to shoulder. A lot of things that we take care of are traumatic injuries. That includes fractures from basic falls, but also includes more severe injuries such as saw injuries, tendon injuries, and nerve injuries as well. Then there’s more common things that we take care of, such as wear and tear injuries, which include tendonitis problems and tendon tears. It also includes arthritis in the hand and upper extremities as well. 

Can you tell us a bit about arthritis in the hand and where can you get arthritis within the hand? 

Arthritis in the hand is a very common condition that I treat. You essentially can get arthritis unfortunately in pretty much any joint that can move. Arthritis is the wear and tear of our joints and the smooth surfaces on those joints. Any joint in our body is essentially two bones that meet together, and that includes every joint in the fingers, as well as the thumb, hand, and wrist. Over time, some of those joints can lose some of that smooth capped surface that provides good gliding. When that happens, you end up getting raw bone rubbing on raw bone, which induces inflammatory cascade, swelling, and pain, and your body also produces bone spurs. All of this produces the pain from arthritis. 

What kind of treatments can you offer to help arthritis? Can you do it without surgery? 

Most of the arthritis that I take care of is treated primarily without surgery. That’s because hand arthritis can happen almost simultaneously with all the joints in the hand. So you can imagine trying to surgically treat every small joint in the hand – it would be overwhelming. So, a lot of the things that I do for hand arthritis are non-surgical. The basic things to do, that are actually pretty simple, are things that a lot of people can do at home. Heat is very good for arthritis in the hand. A lot of people will have heating pads or things that they can put in the microwave and be placed on the hand. Other really effective methods of heat are moist heat. I tell patients things like paraffin wax baths are very good, where you dip your hand in the warm wax, then you place the bag over that, which produces a bit of steam, and you get that relief. The other thing that you can do is even turning on the sink and putting your hand under a bit of lukewarm water for 5 to 10 minutes, or even less. That really can loosen up the joints and help them to feel a lot better throughout the day. Other things that are pretty effective for arthritis in general are anti-inflammatories. Now, certainly those aren’t necessarily safe for all of our patients, so we always want to touch base about taking those, particularly if there are problems with the kidneys or stomach ulcers. Short of those things, those medicines can be pretty effective in helping ease the pain. I also do little coban tape wraps at the joint, which can provide a little bit of compression. Some of the compression gloves are pretty effective as well. 

When you get to the point that the simple things aren’t working, is that when you move onto surgery? 

The next step before surgery, if simple things are not working, would be injections. A lot of times we’ll try a cortisone injection in an area that’s really sore. That can be done with any small joint pain. For example, the distal interphalangeal joint at the tip of the finger can respond really well to an injection. Also, the hand is a bit of a different part of the body compared to the hip, knee, and ankle – those are weight bearing joints. So, even after steroid injections are done into those joints, you’re still walking on them. Our hands experience different forces that aren’t necessarily bodyweight, so a lot of times if we can get your pain relieved with steroid injections, that may be all that we need to do. 

We do have our rehabilitation services here which offers physical and occupational therapy. Does any kind of therapy help with hand arthritis? 

I do think that therapy is useful for some types of hand arthritis. Now, sometimes therapy can end up exasperating the issue because you’re essentially rubbing raw bone on raw bone vigorously by doing aggressive therapy. However, therapy in the very small joints in the fingers can be helpful for range of motion. The biggest issue with arthritis in the hand is that it can limit the range of motion In the fingers, which makes it difficult to grip or to grasp. For those areas, therapy really can help those things get moving more effectively. 

Is there anything specifically technology-wise that can help hand arthritis? 

Some of the most effective things are some of the most tried-and-true things that we talked about. A lot of the time people are talking about newer medicines or topical medicines. From a technology perspective, our occupational therapists have pretty novel ways of getting the hands moving. They’re very helpful as far as their newer techniques. 

What are your tips for preventing arthritis? Can it be done?

It’s very difficult to prevent arthritis from happening because arthritis is typically related to everyday use. The key is keeping the motion. If you develop pain or arthritis in the hand and you decrease your use of the joint, that will actually exacerbate the pain. So the key is keeping limber, keeping warm, which is why I talked so much about the heat. 

Can you describe the comprehensive care here at the Bone and Joint Institute and how that helps patient experience and patient care? 

Our 360 degree way of treating patients with our comprehensive team, including our hand and upper extremity specialists, as well as our certified hand therapists, is the key. It’s really useful. For example, if I have a patient that I sent to therapy and there’s any sort of issue, I can personally walk down the hall and talk with a therapist, and vice-versa – the therapist will come find me if there’s any issues. From there we can formulate a plan that’s effective and individualized for each patient. So just having a therapist team down the hall to care for our patients under one roof makes things a much better patient experience.

More on the bone and joint institute of tennessee

For more information about hand and wrist pain, call Bone and Joint Institute of Tennessee at (615) 791-2630. You can also schedule an appointment online.