Hand osteoarthritis – causes, diagnosis and treatment
Overview of osteoarthritis in the hand/wrist
It is very common to develop hand osteoarthritis. It occurs most frequently in the base joint of the thumb and in the fingers. On the other hand, it is very rare to develop osteoarthritis in the wrist. If your thumb joint is affected, it is often difficult to hold on to things. You may also feel that you are losing strength in your hand. Osteoarthritis in the hands is often easy to confuse with rheumatic joint disease so it is important to get a diagnosis as early as possible in the evolution of the disease. Both conditions can be treated, but in different ways.
Signs of hand osteoarthritis
The most common signs of osteoarthritis in the hand, just as in other joints, is stiffness and reduced mobility (with or without a varying degree of pain) and in some cases swelling. Swelling and coarsening of the joints can make your hands look different compared to before. When your hands are affected, osteoarthritis is often also experienced as reduced muscle ability. Overall, it is often difficult to perform daily activities such as opening cans, doing up buttons and brushing your teeth.
Causes of osteoarthritis in the hand
The wrist consists of many small bones, all of which are covered with cartilage to allow the bone components to slide against each other. The points where two bones meet are called joints, and there are very many joints in our hands. When you suffer from osteoarthritis in your hand, the cartilage breaks down. This means that it is more difficult for the bones to slide against each other and the function deteriorates. The disease also changes the surrounding membranes and ligaments.
It is not currently entirely clear what actually causes osteoarthritis, but contributing factors are heredity and previous injuries. However, the disease also depends on how much strain the joints are subjected to throughout your life; long-term negative strain gradually breaks down the cartilage.
Diagnosing osteoarthritis in the hand
The typical signs of osteoarthritis in the hand, which specifically appear as pain and swelling combined with stiffness and difficulties to grip things, form the basis for the diagnosis. Sometimes your thumb looks like it is in the wrong position if it is affected by the disease. X-rays show certain changes (such as bone deposits, reduced articular cartilage and densification of the bone under the cartilage, known as subchondral sclerosis), but an x-ray examination is not necessary to give a diagnosis of osteoarthritis, regardless of which joint is affected. On the other hand, X-ray images can provide information about how far the disease has progressed, which is important in cases where the symptoms are pronounced and an operation may be required.
Treating osteoarthritis in the hand
The first step in the treatment of osteoarthritis in the hand is to obtain information about the diagnosis and what it means. This is often done in conjunction with a physician, a physiotherapist or occupational therapist. A referral to an orthopedic specialist or a hand surgeon may be necessary if the symptoms are so severe that an operation is considered as an option. A physiotherapist or occupational therapy can explain how to use exercise as treatment. An occupational therapist can also give practical advice on how to make daily life easier using aids and can try out soft dressings, known as orthotics. These professionals can all give you more information about osteoarthritis and how to train your hand to reduce the discomfort.
Exercise should be the first step in the treatment of osteoarthritis because it produces good results for many people, and it is also beneficial for people who need an operation at a later stage. Exercise is also completely harmless, it doesn’t have any side effects or exacerbate the disease. Support splints, or orthotics as they are called, can sometimes help reduce the pain. Especially with osteoarthritis of the thumb, a thumb splint can provide relief at work or during heavy physical activities. Simple pain relievers may be used to alleviate the symptoms. These can usually be purchased without a prescription.
Exercise improves both the cartilage in the joints and the joint capsule and the ligaments that surround them. It also increases the grip strength in the hands, which improves their function. This can increase quality of life because we use our hands in almost all activities. It is important to remember not to overexert your hands but to set individual levels of exercise.
Other treatment methods for osteoarthritis in the hand or wrist
If the discomfort of pain and swelling is severe, cortisone injections may be given in the joint affected by osteoarthritis. This can provide temporary relief. These injections are usually only given by very experienced orthopedic specialists or hand surgeons because the hand joints are so small and can be difficult to find. However, cortisone should only be seen as a temporary treatment and should not be repeated too many times. This is because research has shown that cortisone in the long term breaks down the articular cartilage and can speed up the progress of osteoarthritis.
In cases where exercise and analgesic medicines do not reduce the symptoms sufficiently, it may be necessary to operate. This can help reduce the strain on the area of the hand affected by osteoarthritis by removing complete bones or parts of one or more bones. It is also possible to fuse the wrist joint by completely removing the joint affected by osteoarthritis. This causes two bones to grow together into a single bone. A prosthesis is not a common surgical solution for osteoarthritis in the hand, but the method is used in special cases where we want to maintain the mobility of one joint, for example in younger active patients. This operation is carried out by hand surgeons.
It is important to continue to exercise your hands even after the operation to ensure a successful result after the operation. However, your hand will never be as good as before the disease developed – many people are still happy with this because they are pain-free and they have improved movement compared to before the operation.