Osteoarthritis

Background

At the end of our bones, there is a smooth surface covered in cartilage, which allows the bones to slide freely over one another as we move. This articular cartilage can be damaged during an injury or it can wear down, or degenerate, over time as we age. The most common places for osteoarthritis include the knees, hips, and hands, particularly the thumb Carpometacarpal (CMC) joint. 

Causes

  • Injury to the bones, joints, ligaments, tendons, or cartilage can cause osteoarthritis
  • Genetics and family history
  • Repetitive tasks like repetitive jobs in a trade
  • High use of steroids throughout lifespan
  • Diseases of joint cartilage
 

Symptoms

  • Pain in the arthritic joint
  • Weakness
  • Swelling
  • Decreased range of motion/stiffness, especially in the morning
  • Visible deformity of arthritic joints
  • Cracking, crunching sound and sensation at arthritic joints

What causes arthritis flare-ups?

Numerous muscles, ligaments, tendons, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers. The tendons connect muscles in the arm or hand to the bone to allow movement.

Prevention

  • Maintain a healthy lifestyle including diet, exercise, and no smoking¬†
  • Avoid injuries when playing sports and during repetitive work
  • For repetitive jobs using your hands, take precautions to use appropriate positions, use tools functionally, stretch your hands, and allow yourself to rest

Diagnostic Tests

  • X-rays are done to determine how much space is in a joint. Cartilage itself does not show up on an x-ray, but the joint space does. If there is a wearing down of the cartilage, typically this will be seen on an x-ray as a narrowing of the joint space
  • Blood work may be done if other types of arthritis are suspected such as Rheumatoid Arthritis

Medical Treatment

  • Medications such as NSAIDs or steroids
  • Splints
  • Cortisone injections to decrease inflammation
  • Various types of injections such as Platelet Rich Plasma (PRP) or Lubrication injections
  • Surgery including joint fusions or joint replacements

Hand Therapy Interventions

  • Hand therapy typically focuses on education including activity modification to increase function, decrease inflammation, pain, and continued deformation of joints
  • Education on joint protection principles
  • Custom thermoplastic splinting for affected joint to place joint into rested position
  • Gentle range of motion exercises to maintain range of motion
  • Modalities like heat, paraffin, e-stim, ultrasound, and infrared laser to help reduce inflammation and pain
  • Strengthening in surrounding joints to stabilize affected area

Hand Injuries

Carpal Tunnel Syndrome

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Finger Sprain

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Rheumatoid Arthritis

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Tendon Injuries & Lacerations

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Trigger Finger

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Hand Fracture

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Mallet Finger

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Swan Neck Deformity

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Skier's Thumb

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Dupuytren's Contracture

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Osteoarthritis

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