Hand Osteoarthritis

December 19, 2024

Hand Osteoarthritis

What is osteoarthritis?

A joint refers to an area of the body in which two bones meet. A joint is held together by a capsule which prevents excessive movement. Within the capsule, there is an inner layer called the synovial membrane. This membrane secretes a thick fluid called synovial fluid which provides the joint with lubrication and nutrition. The articulating (meeting) ends of the bones are lined with smooth cartilage which aids movement. Muscles attach to tendons, which pull on the bones to create movement within the joints.

Arthritis refers to pain within a joint. Osteoarthritis is the most common form of arthritis. It commonly affects the knees, hips, spine, feet and hands. It occurs when then the articular cartilage begins to thin, as the result of age-related changes or previous injury. Over time, the body starts to compensate via a process of wear and repair; extra bone -known as osteophytes are formed, and extra synovial fluid is released within the capsule. These changes can lead to changes of appearance of the joint as the joint capsule stretches and bony lumps appear around the joint.

Osteoarthritis can cause the previously smooth gliding surfaces to roughen, causing a reduction in efficient movement and the development of pain and stiffness. Within the hands, osteoarthritis commonly affects the joints localised at the base of the thumbs or around the wrists. Hand osteoarthritis can also be frequently seen within the joints of the fingers, known as the interphalangeal joints. These can present in the form of bony swellings over the knuckles closest to your fingernails, or those in the middle of your fingers known as Herbeden’s nodes or Bouchard’s nodes respectively. Many individuals report that their dominant hand is frequently affected by osteoarthritis.

Risk factors for osteoarthritis include:

• Sex – females are more likely than males to develop osteoarthritis generally
• Being overweight – increases risk of osteoarthritis due to changes in hormone profile promoting inflammatory changes.
• Smoking – evidence suggests smoking can be associated with worsening arthritis.
• Previous injury – previous injuries to joints can be associated with early development of osteoarthritis.
• Age – prevalence generally increases with age.
• Genetics – there is a weak genetic element with osteoarthritis, some individuals are more likely to develop osteoarthritis based on genetic factors.
• Repetitive activities, often associated with occupation – such as using tools or a typewriter.

As discussed previously, osteoarthritis frequently causes pain and swelling within the joints. As a result of increased swelling and stretching of the joint capsule, sometimes the joints of the hands can become weak or unstable. Typically activities that individuals with hand osteoarthritis can struggle with, include:

• Opening jars
• Using cutlery
• Using buttons and zips
• Using a pen.

Such limitations can significantly negatively impact level of function, ability to participate in sports and activities of daily living, and lower perceived quality of life. People with osteoarthritis, particularly osteoarthritis of the hand and wrist can also be at an increased risk of developing Carpal tunnel syndrome. Carpal tunnel syndrome occurs when one of the nerves which travels through carpal tunnel in the wrist becomes irritated, which can cause tinging of the fingers, hand pain and a loss of function.

Management

Lifestyle changes
Research suggests that making small lifestyle changes often improves the management of osteoarthritis. Losing weight can be helpful in reducing pressure of your joints, particularly those in your lower limbs. Weight loss can also reduce the likelihood of osteoarthritis worsening in the future.

Drug treatments
Medications can help to alleviate some of the symptoms of hand osteoarthritis, but will not prevent or cure the condition in itself. Medications are best used in combination with other forms of management, to continue to allow individuals with osteoarthritis to remain active and reduce the load on their joints. Types of medications commonly used to manage osteoarthritis include:

Non-steroidal anti-inflammatory drugs (NSAIDS) either in oral or topical form. Topical medications are typically well tolerated, but those with health conditions should contact their GP to assess for appropriateness.
Painkillers – simple over the counter medications such as paracetamol. Stronger medications often require prescriptions from a medical professional.
Capsaicin cream – a topical treatment derived from a chilli plant which can improve pain control by desensitising the nerve endings.

Exercise
Completing resistance exercises can also improve the management of hand osteoarthritis – strengthening the muscles of the hands and forearms can help improve joint stability, grip and function.

Splinting
Splinting can be helpful for managing symptoms of hand osteoarthritis. There are two types of splints generally; resting splints and working splints. Resting splints – are for use when resting or overnight if pain affects ability to rest or sleep. Working splints are to assist ability to perform functional tasks. Isotoner (compression) gloves are also a more comfortable option for some individuals which can be worn during the day or night.

Injection therapy
At Physiotherapy Matters, our clinical specialist physiotherapists are able to offer joint injections. One option is the use of an Ostenil injection. Ostenil refers to a brand name Hyaluronic Acid Injections (HA Injections) that contain Sodium Hyaluronate. Ostenil aims to mimic the role of the synovial fluid and can be helpful for improving pain management for individuals with hand osteoarthritis and overall hand function.

Physiotherapy
The National Institute of Clinical Excellence (NICE) recommends physiotherapy as a first line management of hand osteoarthritis. At Physiotherapy Matters, our highly experienced physiotherapy team are able to provide advice on the use of appropriate strength and mobility exercises, splinting, functional rehabilitation and use of joint protection techniques.

Following your initial assessment, you’ll be provided with a bespoke management plan that will help you to work towards your identified goals. For further information or to arrange an appointment, please call us at 0191 285 8701 or email us at info@physiotherapymatters.co.uk.