Osteoarthritis of the hand therapy

Osteoarthritis is a type of arthritis where there is deterioration of cartilage- the pliable tissue 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 or degenerative joint disease.

The exact reason for osteoarthritis is not known.

It tends to run in families, and is probably a genetic condition in many people.

Degenerative joint disease can also occur after injury.

Early self treatment measures include:

A heating pad or warm water soaks for five minutes in the morning to limber up.

Ice for five to fifteen minutes at a time on the area which is most swollen and tender.

Use topical agents (rubs).

"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 aggravating activities and suggest alternative postures.

Administering massage, heat, ice and other treatments aimed at making the area more comfortable.

A hand therapist can provide advice on living with arthritis, and give helpful information on how to live one's life without aggravating or accelerating the damage caused by arthritis. This is often referred to as a "joint protection program".

Therapists can also provide some 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.

Physicians may:

Prescribe stronger NSAID medication or cortisone type medication.

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.

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 to make bones on each side of the joint grow together. Fusion can be very helpful for joints which are stiff and painful, awkwardly crooked, or unstable. Fusion also can reduce the size of an enlarged joint, although this alone is not usually reason enough for surgery.

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 (the same material used in most artificial heart valves) 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. Click to see mini-movies of arthritis surgery options for small finger joints

Many people with mild symptoms will improve with a limited trial of anti-inflammatory medication and avoidance of painful activities.




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