Diagnosis: Hand and Wrist Arthritis
How Hand and Wrist Arthritis Presents
Hand and wrist osteoarthritis is a degenerative disease affecting joints of the wrist and hand. It is a common source of pain in the over 55 population. It affects 75% of women in the US between the ages of 60 and 70.Hand and wrist osteoarthritis is a degenerative disease affecting joints of the wrist and hand. #performbetter @pogophysio Click To Tweet
Patients presenting to clinic with hand and wrist osteoarthritis will often complain of the following symptoms:
- In the early stages, pain can be localised to joints in the hand and wrist when applying pressure or gripping something
- The hand and wrist feels stiff, especially in the mornings and evenings
- Difficulty holding something in your hand or twisting doorknobs because of the pain and weakening of the hand muscles
- Fine motor tasks like tying shoelaces or buttoning a shirt becoming more difficult
- In the advanced stages of osteoarthritis, the pain feels like a constant ache
How Hand and Wrist Arthritis is Diagnosed
Diagnosis of hand and wrist osteoarthritis is often difficult for a skilled physiotherapist until the late stages. This is due to the broad spectrum of severity, but a simple radiograph can tell a lot.
A plain X-Ray of the hand and wrist will show the classic signs of joint space narrowing (through loss of cartilage), formation of bony spurs and cysts and hardening of the subchondral bone (that lies underneath cartilage) due to the increased friction from bone to bone contact.
A X-Ray showing wrist osteoarthritis (author: James Heilman, MD; source: WikiMedia Commons)
The clinical hallmarks for late stage hand osteoarthritis are:
- Swelling of the knuckles, and joints of the fingers appears over time
- Bony enlargements called Heberden and Bouchard nodes which develop on the finger joints
Here are some key differences between Osteoarthritis (OA) and Rheumatoid Arthritis (RA):
- Joint stiffness in the morning typically lasts less than 1 hour with OA and greater than 1 hour with RA
- Only specific joints are affected with OA whereas RA is more widespread and can affect other organs
- Movements cause pain in OA whereas gentle movements may relieve pain with RA
- RA also affects structures such as tendons outside the joint, leading to the classic deformities of the hand
Causes of Hand and Wrist Arthritis
The causes of osteoarthritis in the hand and wrist are the same in all other joints of the body. It starts with the breakdown of cartilage and underlying bone, resulting in a chronically inflamed joint that is painful and stiff.
Age is a major causal factor, however there are many predisposing risk factors, some of which are modifiable (i.e. able to be reduced). Some are listed below:
- Genetics and family history of osteoarthritis
- Women are more likely to be affected than men
- Menopausal status
- Joint hypermobility
- Overweight and obesity
- Lack of exercise
- Previous joint injury (such as a dislocation)
- Occupations or sports that overuse the hands or prone to hand injury (e.g. gymnastics, boxing)
Treatment of Hand and Wrist Arthritis
There is good evidence for physiotherapy management of hand and wrist osteoarthritis. While physiotherapy does not cure osteoarthritis, it has been proven to reduce pain and inflammation associated with the condition and improve hand function.
Your skilled physiotherapist will work with you and your goals and prescribe you with appropriate hand exercises, joint protection exercises, heat treatments and orthotics to improve grip strength, improve range of motion, reduce pain, and thus improving hand function.
(Bugera, Fahrner, Lowe, Johnson, & Burns, n.d.) (American Academy of Orthopaedic Surgeons, 2013; Valdes & Marik, 2010)
American Academy of Orthopaedic Surgeons. (2013, December, 2013). Arthritis of the Hand Retrieved December 06, 2016, from http://orthoinfo.aaos.org/topic.cfm?topic=a00224
Bugera, Y., Fahrner, J., Lowe, R., Johnson, K., & Burns, S. A. (n.d.). Wrist and Hand Osteoarthritis Retrieved December 06, 2016, from http://www.physio-pedia.com/Wrist_and_Hand_Osteoarthritis
Valdes, K., & Marik, T. (2010). A systematic review of conservative interventions for osteoarthritis of the hand. J Hand Ther, 23(4), 334-350; quiz 351. doi: 10.1016/j.jht.2010.05.001