Osteoarthritis Of Hands

Arthritis is an inflammatory joint disease. Most common arthritis of the hand is osteoarthritis and rheumatoid arthritis. Twenty one million American suffer with arthritis. Arthritis is more common in elderly population. Osteoarthritis is less common in younger population. Osteoarthritis of the hand is also known as degenerative disease because of wear and tear of the cartilage and soft tissue of the joint. Osteoarthritis is more often seen in hand and weight bearing joint like hip and knee joint. Osteoarthritis of the hand in younger patient is caused by injury and genetic bone disease. Joints of hand include joints in palm and fingers. The other inflammatory joint disease, which may affect hand joints are rheumatoid arthritis and psoriatic arthritis. Hand arthritis is also observed in metabolic disorders causing gout and pseudogout. There are 19 bones in hand and fingers. Each hand has 19 bones and 19 joints.

Osteoarthritis Of Hands

Risk Factors for Osteoarthritis Of Hands

  • Obesity- Obese patients often suffer with osteoarthritis of weight bearing joint such as knee and hip joint. Obesity also is associated with osteoarthritis of hand in young patients.
  • Manual Worker- Osteoarthritis causes wear and tear of cartilages and joint capsule. Continuous manual work with heavy and vibrating equipment causes wear and tear of joint cartilages in palm and fingers resulting in early development of osteoarthritis.
  • Joint Infection- Joint infection causes destruction of cartilages and synovial membrane resulting in triggering of osteoarthritis development.
  • Age- Osteoarthritis is more common in younger females and older males.

Symptoms for Osteoarthritis Of Hands

Chronic Pain Symptoms for Osteoarthritis Of Hands

Initial Phase

  • Pain Intensity- none to mild at rest and mild to moderate with joint movement.
  • Pain limited to joint.
  • Patient may not feel pain for several days. Pain is on and off with periodic pain free period of few days to weeks.

Late or Chronic Phase

  • Pain Intensity- Mild to moderate at rest and severe to extremely severe with joint movement.
  • Pain spreads in adjacent tissue and joint
  • Pain is continuous.

Grinding or Grating Sound Symptoms Of Osteoarthritis Of Hands

Joint movement causes grinding and grating sounds.

Signs Of Osteoarthritis Of Hands

Range of Joint Movement in Hand

  • Range of movement is restricted in the joint of the hand, which is affected by osteoarthritis.
  • Range of movement is restricted because of pain in inter-phalangeal joint or metacarpo-phalangeal joint.

Signs Of Osteoarthritis Of Hands

Joint Stiffness

Joint is stiff because of severe degeneration of the cartilage and joint capsule.

Mucus Cysts

Mucosal cyst is often seen in-patient suffering with osteoarthritis of the hand. Mucosal cyst is observed near the ends of fingers.

Joint Swelling

Joint swelling is observed secondary to osteophytes and hypertrophy of the bones forming the joint. Joint swelling was observed at the base of the thumb or metacarpo-carpal joint.

Heberden's Node

  • Heberden's node is observed as a bump at the end of the finger closest to the nail.
  • Patient is often unable to grip or pinch the object with the finger affected by Heberden's node.

Osteoarthritis Of Hands

Bouchard's Node

Bouchard's node is a bump observed in middle finger phalange. Bouchard's node is seen in-patient suffering with osteoarthritis of the hand.

Joint Movement

  • Restricted joint movement is observed in joint of the hand and fingers as the disease progresses.
  • Restricted joint movement with grating sound suggests cartilages are severely damaged.

Joint Swelling

  • Joints in palm and finger are small joint and swelling is caused by edematous inflammatory soft tissue.
  • Joints of the finger often look red and tender to the touch.
  • Swelling may be secondary to joint deformity and osteophyte of the bones forming the joint.

Weakness in Hands

  • Finger movement are weak
  • Patient is often unable to close the fist.

Investigations and Lab Tests To Evaluate Osteoarthritis Of Hands

X-Ray Findings To Evaluate Osteoarthritis Of Hands

  • Irregular and narrowed joint space secondary to worn out cartilages.
  • Osteophytes (bony outgrowth) are observed at the edges or margin of the joint.

MRI Findings To Evaluate Osteoarthritis Of Hands

  • Thin cartilages are seen in inflamed joints.
  • Joint is Irregular and narrow.
  • Osteophytes (bony outgrowth) are observed at the edges or margin of the joint.
  • Soft tissue changes are observed in tendons and ligaments.

Ultrasound Findings To Evaluate Osteoarthritis Of Hands

  • Fluid or abscess of the joint
  • Rule out shoulder joint dislocation
  • Rule out shoulder joint fracture

Blood Examination To Evaluate Osteoarthritis Of Hands

Erythrocyte Sedimentation Rate (ESR)

  • ESR is increased in Osteoarthritis.
  • Erythrocyte sedimentation rate (ESR) is increased during active inflammation. ESR is non-specific test.

Rheumatoid Factors (RF)

Absent in osteoarthritis of the hand

ANA Blood Test

ANA is a non-specific antibody test, which is often positive as in all autoimmune disease.

HLA-B27 Genetic Marker

Test is positive in inflammatory joint diseases like Psoriatic hip joint disease, Ankylosing Spondylitis and Reiter's Syndrome.

Joint Fluid Analysis (Arthrocentesis)

  • Rule out gout- Uric acid crystals are observed in gout,
  • Septic Arthritis- Bacterial cells, red blood cells and pus cells are observed in septic arthritis.

Treatment Options For Osteoarthritis Of Hands

1. Conservative Treatment For Osteoarthritis of Hands

Rest For Osteoarthritis Of Hands

  • Inflamed joint of the hand is kept at rest to prevent pain
  • Joint restriction helps during initial stage of osteoarthritis of hand.
  • Inflammation is treated with short-term restriction of joint movement and anti-inflammatory medications.

Exercise For Osteoarthritis Of Hands

Yoga therapy and stretching exercises under supervision are beneficial to prevent muscle weakness and atrophy.

Heat Therapy For Osteoarthritis Of Hands

Moist heat (heated wet towel) or hot water bag treatment is beneficial to reduce pain and improve joint movements.

Cold Therapy For Osteoarthritis Of Hands

  • Direct application of ice covered with plastic or cloth over shoulder for 20 to 30 minutes two or three times a day.
  • Helps as anti-inflammatory
  • Helps for pain.

Dietary Supplements For Osteoarthritis Of Hands

Not supported by any research or scientific evidence.

  • Glucosamine and
  • Chondroitin sulfate.

2. Physical Therapy (PT) To Treat Osteoarthritis Of Hands

Physical therapy includes-

  • Exercise
  • Wax and paraffin bath
  • Heat treatment
  • Ultrasound therapy and
  • Infrared light therapy

Objectives of physical therapy are as follows-

  • Muscle stretching
  • Muscle strengthening
  • Prevent muscle, ligament and tendon atrophy
  • Improve range of joint movement and
  • Prevent joint stiffness.

3. Medications To Treat Osteoarthritis Of Hands

a. Non-Steroidal Anti-Inflammatory Medications (Drugs) - NSAIDS

  • Anti-Inflammatory
  • Non-Opioid Analgesics
  • Side Effects- Stomach Pain, Gastric Ulcer and Bleeding Disorder.
  • Most common NSAIDs prescribed are Motrin, Naproxen, Daypro and Celebrex.

b. Muscle Relaxants For Osteoarthritis of Hands

Most common muscle relaxants prescribed are as follows-

  • Baclofen
  • Flexeril
  • Skelaxin and
  • Robaxin

c. Adjuvant Medications For Osteoarthritis of Hands

  • Anti-Epileptic Analgesics- Most common antiepileptic prescribed as analgesics is Neurontin and Lyrica.
  • Anti-Depressant Analgesics- Most common antidepressant prescribed as analgesics is Cymbalta and Elavil.

d. Dietary Supplements For Osteoarthritis Of Hands

Not supported by any research or scientific evidence.

Glucosamine and Chondroitin sulfate.

4. Interventional Treatment For Osteoarthritis Of Hands

Cortisone Injection Of Inflamed Joint In Palm And Fingers-

  • Decreases inflammation.
  • Cortisone reduces pain.
  • Assist aggressive physical therapy
  • Improve joint movements

5. Surgical Treatment For Osteoarthritis Of Hands

a. Reconstructive Procedure For Osteoarthritis Of Hands

  • Removal of the arthritic bones
  • The gap is replaced with a piece of rolled-up tendon from the forearm
  • Procedure provides excellent pain relief, good range of motion, and restores function to the thumb.

b. Joint Fusion (Also Called Arthrodesis) For Osteoarthritis Of Hands

Procedure is performed to treat arthritis in hand and wrist joints.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: March 10, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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