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Coping with arthritis in your hands.

Arthritis can affect any joint in the body, but it is often most noticeable when it affects the hands and fingers. While it can be a painful and functionally limiting disorder, many treatments are available to minimize the symptoms, including therapy, medication, and surgery.

"The most common type of arthritis in older adults is osteoarthritis," says Mount Sinai Medical Center orthopedic surgeon Mark. E. Pruzansky, MD, also director of the HandSport Surgery Institute in Manhattan. "It's age-related and tends to run in families to some degree."

The most common locations of arthritis pain in the hands are at the base of the thumb, where the thumb and wrist come together (also known as the basal joint), at the end joint closest to the finger tip (the distal interphalangeal joint), and at the middle joint of a finger (the proximal interphalangeal joint). Rheumatoid arthritis (RA) is a different problem, adds Dr. Pruzansky. "Arthritis in the wrist is typically caused by RA but is not a normal sign of aging. It may also be related to another problem such as a prior injury."

Symptoms and treatment. The most common symptoms of osteoarthritis in the hands are stiffness, swelling, and pain. Bumps may also form around the joints. In addition, arthritis of the hands can affect grip strength and make tasks like opening jars and turning keys difficult. Osteoarthritis of the hands can be diagnosed during a physical examination. Your doctor may also perform an X-ray, or blood work if concerned that you may be suffering from another type of arthritis.

First-line treatment for hand arthritis includes occupational therapy, splinting, and anti-inflammatory medications (if patients can tolerate them). An occupational therapist will prescribe exercises in a manner that will not aggravate the arthritis but will improve stiffness, pain, and flexibility. Plastic splints can be useful at night and are sometimes used during the day if the pain is severe. Splints give the patient the ability to rest the joint at night, therefore making it easier to use during the day.

Therapists may also analyze how people use their hands and give specific instructions on ways to reduce stress on weakened joints. Treating arthritis in the hands involves two approaches: improving stamina and reducing stress on the joints. Treatment should start with acetaminophen. If not effective, anti-inflammatory medications such as ibuprofen or naproxen may be cautiously used to reduce pain and swelling. Sometimes ice is used to help inflamed joints while heat can be administered if the joints are achy, Dr. Pruzansky says.

Other options. If these first-line treatments do not work, cortisone injections can be administered into the joint to provide temporary relief (several months or more). "Cortisone cannot be used too often, however, as it can weaken tissue," says Dr. Pruzansky. "The good news is that cortisone basically stays where it is, meaning that it minimally enters the system and usually doesn't cause other side effects--but this also means that repeated treatment of the same joint should be limited to avoid tissue damage."

According to Dr. Pruzansky, if cortisone doesn't help then surgery is an option. Joints can be surgically cleaned out to remove bone spurs, swollen tissues, and joint debris. Depending on the severity of the arthritis, surgery can be done arthoscopically (using a tiny camera and instruments) or open surgery can be performed using small incisions. If the arthritis is severe enough, or a location doesn't lend itself to minimally-invasive surgery, joint replacement or ligament and joint reconstructions can be done. Ligament and joint reconstructions without a joint replacement are not common in the basal joints, advises Dr. Pruzansky, and procedures to clean out joints are more common in the finger joints. He adds that plastic joint replacements are more often used in both the large and middle knuckles.

Joint fusions (when two bones are fused together) can be done, but these are less appealing to patients because they limit range of motion in the fingers. This type of procedure is most typically performed on the thumb joints. Most surgical procedures for osteoarthritis of the hands are done on an outpatient basis and involve either local or regional (affecting only a large area, like the arm) anesthesia.


RELATED ARTICLE: Exercises to Boost Joint Flexibility

To boost hand strength and flexibility, try these exercises from the Arthritis Foundation Exercise Program. The program is offered through local branches of the Arthritis Foundation (log onto for details).

Finger Os: Open your hand, fingers apart. Touch the tip of your thumb to the tip of your index finger to make an O shape and repeat with each finger, opening your hand wide after each O.


Finger curls: Open your hand, with your fingers straight. Bend each joint slowly to form a loose fist. Hold the fist for three seconds before straightening your fingers out again.


Thumb bends: Open your hand, fingers relaxed. Reach your thumb across your palm towards the base of your little finger and hold for three seconds before stretching your thumb out again.

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Title Annotation:BONES AND JOINTS
Publication:Focus on Healthy Aging
Date:Mar 1, 2010
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