Osteoarthritis of the hand therapy
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Osteoarthritis is a type of arthritis where there is deterioration of cartilage- the gristle that covers the ends of long bones. In the hand, osteoarthritis most often affects the small joints of the fingers – most commonly the proximal interphalangeal joints and the distal interphalangeal joints- and the joint at the base of the thumb - the basal joint. This is sometimes referred to a degenerative arthritis.
It tends to run in families, and is probably a genetic condition in many people.
Degenerative joint disease can also occur as a result of trauma.
Self help modalities include:
A heating pad or warm water soaks for five minutes in the morning to loosen up.
Ice for five to fifteen minutes at a time on the area which is most painful.
"Over the counter" non-steroidal anti inflammatory medication (NSAID), such as aspirin, ibuprofen, naprosyn, or ketoprofen.
There is some scientific evidence to suggest that chondroitin / glucosamine preparations may be helpful in osteoarthritis. These preparations are available without a prescription.
A physical therapist can help by:
Providing a variety of hand splints to support the thumb and the wrist.
Helping identify activities that aggravate the condition and suggest alternative ways of doing things.
Administering massage, heat, ice and other treatments aimed at making the area less painful.
A hand therapist can provide advice on living with arthritis, and give helpful information on how to avoid aggravating or accelerating the damage due to the arthritis. This is referred to as a "joint protection program".
Therapists can also provide special tools to assist people whose hands have been affected by arthritis perform routine daily activities. These are called "adaptive devices".
If surgery is required, therapy after surgery is very important. Custom splints may need to be made and maintained by a skilled hand therapist.
Prescribe prescription-strength NSAID medication. Topical NSAIDS such as Voltaren gel may be used instead of orals since they are safer.
Prescribe hand therapy and/or a custom splint.
Give a corticosteroid shot into sore joints. This can be very helpful in controlling pain and swelling.
Alternatively, injection of platelet-rich plasma (PRP) has been demonstrated to heal osteoarthritic joints. PRP is given using ultrasound guidance.
Arthroscopic debridement of the basal thumb joint followed by injection of viscosupplement has been found to have a palliative effect.
Perform surgery to reconstruct or fuse the involved joints. There are two types of surgery commonly performed for joints affected by arthritis, fusion and arthroplasty. Surgery is a consideration when all else has failed.
Fusion (arthrodesis) is an operation that "fuses" two bones.
Arthroplasty, or joint reconstruction, in osteoarthritis is most often performed for thumb basal joint arthritis. Artificial joints have also been developed for the small joints of the fingers. Finger joint replacements made of pyrolytic carbon were FDA approved for use in 2002. These new implants are a reasonable alternative to fusion, and in some cases can be used to restore motion to a joint which has been fused.
Many people with mild symptoms will improve with a limited trial of anti-inflammatory medication and avoidance of painful activities.
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