This article focuses on Hand Osteoarthritis. For detailed work on osteoarthritis read Osteoarthritis Presentation and Treatment
Osteoarthritis of Hand
Human hand is a magnificent organ formed by numerous small multiple joints that work together to produce fine motion. Osteoarthritis and various other types of joints can affect hand leading to difficulty in conducting activities of daily living.
Over a period, untreated osteoarthritis can lead to deformities and affect the function of hand further.
Osteoarthritis destroys the cartilage and makes joints painful. Osteoarthritis of the hands usually occurs as part of nodal osteoarthritis, a form of osteoarthritis that runs in families. This mainly affects women and often starts around the menopause.
Persons with nodal osteoarthritis in middle age are more likely to develop osteoarthritis of the knee, and other joints with age.
Nodal osteoarthritis is especially likely to be passed from mother to daughter.
Causes of Hand Osteoarthritis
Of all the arthritis in hand, osteoarthritis is most common form. It develops gradually and is known as wear and tear arthritis.
It could be a primary osteoarthritis or secondary to some antecedent cause like trauma to joint cartilage.
Presentation of Hand Osteoarthritis
Osteoarthritis of the hands usually affects the base of thumb and interphalangeal joints of the fingers mainly, although other finger joints can also be affected. Distal interphalangeal joints of the fingers are affected more commonly.
At times these joints become swollen and tender, especially when the condition first appears.
Early symptoms of osteoarthritis of the hand are dull pain or burning sensation which occurs after periods of increased joint use, like heavy gripping or grasping.
Morning pain and stiffness that lasts less than half an hour are typical.
Pain might be made worse with use and relieved by rest.
Change of weather may cause increased joint pain.
Activities like opening a jar or starting the car, become difficult due to pain.
There may be a sensation of grating or grinding in the affected joint (crepitus), caused by damaged cartilage surfaces rubbing against one another.
The joint may appear larger than normal due to of bony changes, loss of cartilage, and joint swelling.
Over several years, firm knobbly swellings develop on the finger joints caused by osteophytes.
These are termed as Heberden’s nodes in distal interphalangeal joints. At proximal interphalangeal joints, these are termed as Bouchard’s nodes.
Pain and tenderness improves once the nodes are fully formed.
In spite of being deformed and presence of knobs, the fingers still work quite well.
In some cases, small cysts (mucous cysts) may develop. These may cause ridging or dents in the nail plate of the affected finger.
Early x rays may be absolutely normal. In advanced disease, features suggestive of osteoarthritis such as reduction in joint space and presence of osteophytes may be reported.
A bone scan may help when hand osteoarthritis is in an early stage and x-rays look normal.
The treatment would depend on progression of osteoarthritis, number of joints involved, age and activity levels, other medical conditions, dominant or non dominant hand and expectation of the patient from the treatment.
Till now, no treatment is able to reverse the condition.
- Anti-inflammatory drugs likes acetaminophen and ibuprofen
- Dietary supplements like glucosamine and chondrotoin sulphate though their effect is equivocal
- Steroid injections give relief for sometime but cannot be repeated often due to side effects.
Splints support support the affected joint to ease the stress placed and should be born when joints are painful. Prolonged use of splint can cause muscle atrophy and should be avoided.
Most of the people are well managed by nonsurgical means but some people may require some kind of surgical procedure.
Surgery is chosen for providing long-term pain relief and return to function and should be considered on individual basis.
Surgical options are
- Arthrodesis – Provides pain relief by sacrificing motion of the joint.
- Joint replacement – Restores function and provides pain relief but sacrifices original joint.
There is increased interest in preservation of damaged joint. An earlier diagnosis and intervention would help to achieve this goal. These interventions in future could be
- Cartilage repair and replacement surgeries
- Stem cell use to regenerate damaged joint surfaces.
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