Question about finger DIP joint arthritis and fusion

[mtomaino]

I recently received this email query:
Your article says that one can resume most activities without impairment after DIP joint fusion. I am a concert pianist, age 58. I have really bad inflammation in my right pinky DIP joint. My doctor says I have significant arthritis in that joint. My finger is bending away from the rest of my fingers. I have been taiking shots every 4-6 months, usually when I can no longer stand the pain. What do you think I should do?

The only surgical option is to have the DIP joint fused. Replacement has never been shown to be any better--probably because this joint only provides about 10-15 percent of the motion of the finger, and the implants have never evolved to be very reliable. Although this might take getting used to when it comes to the inability (after fusion) to make a full fist, the stability and pain relief may very well be an asset when it comes to playing the piano. In terms of your trying to assess how the outcome might impact---have a therapist make a short splint to hold the dip joint stiff. The technique that I have found most reliable, and which allows early motion (after the first few days), is the use of a small intramedullary screw. This is an outpatient surgery that can be performed in about 30 minutes, under a regional anesthesia. The outcomes are very favorable with a small (less that 2 percent) risk of nonunion. .
Best of luck.
MMT