We have had a Wrecking-Ball Winter here! What, you ask, is a “Wrecking-Ball Winter?” It is a winter in which there are many weather changes – for the worse. These kinds of changes frequently affect people with RA and fibromyalgia. So, with all the weather changes, I frequently have felt like I’ve been hit with a wrecking-ball. Often flat on my back or curled up in a little ball from pain and stiffness. Many times joints have felt like nails were being driven into them. Of especial problems have been hands and feet. Right knee and hip are very tender, low back is inflamed and tender – doesn’t bend very well. Right elbow and shoulder have been affected more, too. The left side of my body is affected, too, but less so – probably because I am right-handed and right-legged and right-footed. So I use the right side of my body more often and put more stress on it than the left side. This is a frequent thing with RA. Even my poor Ol’ Curmudgeon has been affected by the weather changes. His joints are stiff and his back hurts all day. Between us, we aren’t worth “powder” in terms of keeping house, getting work done and taking care of each other!
So, last time I talked about RA, I showed the joints of the hands that are affected, particularly the swan-neck deformity. This time, I’m talking about the Boutonniere Deformity.
Boutonniere Deformity is another finger joint problem of RA. It occurs when there is injury of the extensor tendon at it’s insertion. This is called the Central Slip. RA causes Boutonniere Deformity from the chronic inflammation of the central slip. The PIP joint becomes bent, and the DIP joint is pulled into too much extension.
NOTE: this illustration is copyright by Multi-Media Group and is taken from eOrthopod. Please notify me if you wish this illustration removed.
In RA, treatment for Boutonniere Deformity is in two parts. First, there is prevention, or at least delaying onset. An Occupational Therapist can give special exercises to keep the joints flexible longer. In addition, there are special splints that can also help delay onset of this deformity.
Once Boutonniere Deformity occurs, there are other special splints that can help relieve the deformity and increase flexibility. These must be prescribed by an Occupational Therapist with MD agreement. Some of these splints look like jewelry and come in stainless steel, sterling silver and even gold! They are called “ring splints.” There is a good discussion of them HERE.
Surgery to repair, fuse or even pin the joints involved may be necessary. A specialist in hand surgery should be involved, along with a rheumatologist in planning the procedures.
This information and the graphic were taken from eOrthopod.com. This is a good site for excellent information in an understandable format about bone and joint problems.
As I have mentioned before, my mother died from complications of RA. In the more than 35 years since then, there have been so many advances and discoveries about RA that it is a completely different ballgame. From new drugs that suppress RA, to new OT modalities, to new surgical procedures, the outlook for RA is certainly a lot better than during my mother’s all-too-short lifetime. But that doesn’t mean there is no longer any pain. RA is still one of the most painful and most disabling diseases both of adults and of children. But not just pain is involved. Fatigue is a frequent and debilitating problem in people with RA. During flares, time from work is lost and non-work tasks are set aside. However, during periods when fatigue is an issue, there is essentially doubling of the time lost from work and from non-work tasks over similar periods when fatigue is not an issue.
I am developing very early Boutonniere’s deformity on the index finger of my right hand, and a beginning Swan-neck deformity on the ring-finger of my left hand. As a result, I work on my exercises daily, and wear splints at night. Some days I exercise more diligently than others – depending on the pain and stiffness involved.
But mostly I do my prescribed exercises. And, as I am getting a bit worse a bit faster at the moment, visits for new OT and PT prescriptions probably will be ordered at my next rheumatology appointment.