Osteoarthritis (OA) is a chronic disease usually characterised by joint pain, stiffness and swelling. It is the most common form of arthritis in Australia. It mainly affects the hands, knees and hips however other joints can be affected. Guidelines for treatment has mainly focused on the larger joints however these recommendations cannot always be transferred to management of the hand. Read on for all the latest evidence for this specific area! 

Osteoarthritis of the hand can be caused by a number of different factors. Occupations with repetitive motions or heavy loads, obesity, females and older age groups can all increase the risk. Cartilage is like a cushion and prevents the joints from rubbing together. When this cartilage is damaged, moving your fingers causes the joints to grind together. This can cause pain, inflammation and longer term, bony spurs. The whole joint can be affected. It can affect one finger (monoarticular) or many (polyarticular).

Types

Nodal - usually characterised by the presence of hard bony swellings (Bouchard nodes) and underlying interphalangeal OA. 

Thumb-base - is characterised by pain in the deep thenar, radial wrist or thumb based pain that is worse with use. 

Erosive - an aggressive OA whree pain and swelling are more prolonged. 

Treatment Goals

• Manage or reduce acute symptoms such as pain and stiffness
• Optimise hand function
• Management and self management of flare ups 

Treatment Interventions 

• Exercises to improve function and improve muscle tone. These are specific to each affected joint. 
• Custom splint to support joint to minimise inflammation and pain. An ill-fitting brace can make the inflammation worse. 
• Information and training on best grips, activity modification and use of assistive devices. 
• Topical anti-inflammatories as recommended by a health professional. 
• Oral analgesics could be considered in consultation with your doctor. 
• Surgical intervention if structual abnormalities. 

Things to do at home

• Warm hand bath or get yourself some microwavable wax hand gloves. Heating up the hand, followed by gentle movement can help the fluid inside the joints move back into the blood vessels and can also help deliver healthy fluid into the joints. Hand Therapists can advise on the best exercises to also maintain muscle tone. 
• Look at getting some assisstive devices. Is there a particular thing you do that aggrivates your OA? There are many devices that can reduce the pain on the joints. For example - can openers, grip holders, arthritis food utensils, arthritis pens, touch activated light switches, double handed saucepans, soap mits and many more. 
• Use topical anti-inflammatories if painful and if discussed with your healthcare provider. These can by rubbed onto the affected area up to three times a day. 
• Consider warm gloves in winter or a heat pack. 
• Take a break from whatever is worsening the pain - try and think what you can substitute instead. 
• Don't suffer in silence - the more the fingers swell, the more you don't move them, the stiffer they get. When the fingers get stiff and you stop moving them altogether, the joints and surrounding structures can become worse. Chatting to your doctor or Health Professional can also help to view your concerns in a different light. Write down your concerns to chat to your Hand Therapist or GP at the next visit. Self management is a big step to a better long term outcome. 
• Talk to your Hand Therapist or GP about wearing your splint properly, getting a care plan, managing flare ups and any other concerns you may have. 
• Consider getting some home support - anyone say 25 year old pool man? You may be eligible for rebates through your GP. 

Written by Dee Coles