Osteoarthritis and the Hand

Osteoarthritis and the Hand

By Caroline Hayes

Osteoarthritis (OA), often lumped in the baskets of both “old age” and  “joint wear and tear,” is a condition that affects the whole joint including bone, cartilage, ligaments, and muscles. It is commonly found in the hips, knees, hands, and feet however it can affect any joint in the body.

OA is associated with

• previous joint injury (e.g. a broken bone where the joint surface has been disrupted)
• ligament injury which has made the joint less stable
• increased use or overuse
• excess load
• genetics (more common in women than men and also with family history of OA)
• age (increased incidence over 40yrs but may affect younger)

There is a breakdown of the smooth surface of the joint and its cushioning (cartilage) which may result in swelling, deformity, pain, reduced movement, and reduced function.

In the hand, it most commonly affects the base of the thumb, first Carpometacarpal (CMC) Joint and the Distal Interphalangeal (DIP) joints, although it may affect any joint.

The joint may become hot to touch and swollen. It may develop a bump or a nodule (Heberden’s nodes). It may become deformed and over time the joint may fuse. Once the joint has fused all symptoms of pain and discomfort tend to settle as there is no longer stress on the joint.

What can Hand Physiotherapy do?

Specialists physios assess each joint especially in the context of function and determine what factors are at play regarding muscle balance and forces applied through each joint. Various strengthening and stretching exercises specific to the joint and individual may be prescribed with the aim of improving function, range of motion and relieving symptoms of swelling and inflammation. Custom made removable thermoplastic or neoprene splinting, bracing and/or taping may be used to assist this retraining process, and sometimes a splint is needed long term for specific tasks where the deformity is not able to be controlled via muscles retraining alone. Compression with gloves or lycra or coban may also be of great benefit as well as massage, trigger point relief, dry needling, and traction stretching.

Hand Physiotherapists will also provide detailed specific education regarding global joint protection and therefore prevention of further disease progression.

Sometimes it is necessary to see a Hand Surgeon (Specialist Doctor) for their opinion regarding use of steroid injection, or possible surgery such as a joint fusion or replacement. Most of the time the Surgeon will then refer back to the Hand Physiotherapist for specific exercises or splinting and rehabilitation following any procedure.

Tips to start implementing now

• use more joints rather than less joints (e.g. use both hands to carry the dinner plate)
• use larger joints in preference smaller joints
• use levers to your advantage (lever taps instead of twist taps)
• make the surface grippy by using a grip mat or gloves (this means you need less force)
• increase the size of the grip (eg a large barrel pen rather than a thin biro)

If you have any issues with your hand Caroline is a clinical specialist in hand therapy. You can book in online any time via our website or you can call the clinic 9416 4410.