Hand Osteoarthritis (OA)
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on August 11, 2024
Hand osteoarthritis (OA) is a degenerative joint disease marked by cartilage breakdown in the hand joints, leading to pain, stiffness, and reduced function. It is particularly prevalent among older adults, with increased incidence as age advances. The condition significantly affects daily activities, such as gripping and writing. This article covers the definition of hand osteoarthritis, hand joint anatomy, types of hand OA, and its comparison with rheumatoid arthritis.
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What is hand osteoarthritis?
Hand osteoarthritis (OA) is a chronic condition characterized by cartilage degeneration in the hand joints, causing pain, swelling, stiffness, and functional loss.
Hand joint anatomy
Finger joints: Distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints.
Thumb base joint: Carpometacarpal (CMC) joint.
Types of hand osteoarthritis
Nodal osteoarthritis: Bony nodes at the PIP and DIP joints.
Erosive osteoarthritis: Involves inflammation and erosion at the DIP joints.
Thumb base osteoarthritis: Affects the CMC joint, causing pain and grip difficulties.
Comparison with rheumatoid arthritis
Unlike OA, which is degenerative, rheumatoid arthritis (RA) is autoimmune, causing joint inflammation and affecting multiple joints symmetrically.
Causes and risk factors of hand osteoarthritis
Hand osteoarthritis (OA) results from various factors that contribute to the degeneration of joint cartilage and surrounding structures. Understanding these causes and risk factors is crucial for early identification and management.
Age-related changes
Cartilage wear and tear: Gradual deterioration of joint cartilage.
Changes in synovial fluid: Reduced lubrication in joints.
Genetic predisposition
Family history: Increased risk if relatives have OA.
Specific genes: Certain genes linked to hand OA.
Previous hand injuries
Fractures: Past fractures can lead to OA.
Ligament injuries: Damage to ligaments may increase risk.
Occupational factors
Repetitive hand movements: Jobs or tasks involving repetitive motions.
High-impact activities: Activities putting stress on hand joints.
Gender and hormonal influences
Higher prevalence in postmenopausal women: Hormonal changes increase risk.
Other risk factors
Obesity: Excess weight adds stress to joints.
Certain medical conditions: Conditions like diabetes may elevate risk.
Signs and symptoms of hand osteoarthritis
The symptoms of hand osteoarthritis can vary in severity and may significantly impact daily life.
Pain
Characteristics: Pain associated with hand OA is often described as aching or burning.
Patterns: Pain may be more pronounced in the morning or after periods of inactivity and can worsen with activity.
Stiffness
Duration and timing: Stiffness is typically most severe upon waking and can last for several minutes to hours.
Impact on movement: Stiff joints can limit the range of motion and make hand movements difficult.
Swelling and inflammation
Visible signs: Swelling around the affected joints is common and can be accompanied by tenderness.
Warmth in affected joints: Inflammation can cause the joints to feel warm to the touch.
Changes in hand appearance
Heberden's nodes: Bony enlargements at the DIP joints.
Bouchard's nodes: Bony enlargements at the PIP joints.
Squaring of the thumb base: A characteristic change in the shape of the thumb joint.
Reduced grip strength and dexterity
Difficulty with fine motor tasks: Activities such as writing, typing, and buttoning clothes can become challenging.
Weakened pinch strength: Gripping and pinching objects can be difficult due to reduced strength.
Impact on daily activities
Daily tasks: Hand OA can make everyday tasks like opening jars, writing, and using tools painful and difficult, significantly affecting the quality of life.
Diagnosis of hand osteoarthritis
Diagnosing hand osteoarthritis (OA) involves a combination of clinical evaluations, imaging studies, and laboratory tests to ensure an accurate assessment and to rule out other conditions.
Physical Examination Techniques
Visual inspection: Doctors look for visible signs such as swelling, deformities, and the presence of Heberden's or Bouchard's nodes.
Palpation of joints: By feeling the joints, doctors can detect tenderness, warmth, and the presence of bony enlargements.
Range of motion tests: Assessing how well the joints can move helps determine the extent of stiffness and functional limitation.
Grip and pinch strength measurements: Evaluating the strength of the hand and fingers helps in understanding the impact of OA on hand function.
Imaging Studies
X-rays: Commonly used to identify joint space narrowing, the presence of osteophytes (bone spurs), and other structural changes in the joints.
MRI: Provides detailed images of both soft tissues and bones, helping to assess the extent of cartilage damage and inflammation.
Ultrasound: Useful for visualizing inflammation and other soft tissue abnormalities in the joints.
Laboratory Tests
To rule out other conditions: Tests such as rheumatoid factor or anti-CCP antibodies can help differentiate hand OA from other conditions like rheumatoid arthritis.
Differential Diagnosis
Rheumatoid arthritis: An autoimmune condition that causes joint inflammation and may present similarly to OA.
Psoriatic arthritis: Associated with psoriasis, this condition also causes joint pain and swelling.
Gout: Characterized by sudden, severe attacks of pain and swelling in the joints due to uric acid crystal accumulation.
Prevention strategies for hand osteoarthritis
Preventing or slowing hand osteoarthritis (OA) involves lifestyle adjustments and protective measures.
Joint protection techniques
Proper body mechanics: Use correct techniques to reduce joint stress during activities.
Use of larger joints: Shift heavy tasks to larger joints to minimize hand joint strain.
Maintaining a healthy weight
Impact of weight: Excess weight increases joint stress and can worsen OA symptoms.
Nutritional considerations: A balanced diet with anti-inflammatory foods supports joint health.
Regular hand exercises
Range of motion exercises: Maintain joint flexibility to reduce stiffness.
Strengthening exercises: Build muscle strength to support and stabilize joints.
Ergonomic considerations
Workplace adaptations: Adjust your work environment to reduce hand joint strain.
Ergonomic tools: Use tools like ergonomic keyboards and cushioned handles to protect joints.
Treatment options for hand osteoarthritis
Effective management of hand osteoarthritis (OA) includes both non-surgical and, if necessary, surgical treatments.
Non-surgical treatments
Pain management medications
Over-the-counter: NSAIDs like ibuprofen and acetaminophen for pain and inflammation.
Prescription: Stronger NSAIDs and Cox-2 inhibitors for severe pain.
Topical treatments
Anti-inflammatory gels/creams: Provide localized relief.
Capsaicin cream: Reduces pain by depleting pain neurotransmitter substance P.
Splinting and bracing
Thumb spica and ring splints: Stabilize joints and reduce pain.
Custom vs. over-the-counter: Custom splints offer a better fit and more effective support.
Lifestyle modifications
Activity pacing: Balance activity with rest to prevent joint overload.
Joint protection: Use assistive devices and modify techniques.
Ergonomic adaptations: Adjust workspaces and use ergonomic tools.
Injections
Corticosteroid injections: Provide pain relief and reduce inflammation.
Hyaluronic acid injections: Improve joint lubrication and reduce pain.
Surgical interventions
Joint replacement
Finger joint and thumb CMC joint arthroplasty: Replacing the damaged joints with artificial implants to restore function and reduce pain.
Joint fusion (Arthrodesis)
For end-stage osteoarthritis: This procedure fuses the bones in a joint together, providing pain relief at the cost of some mobility.
Newer surgical techniques
Minimally invasive options: These techniques aim to reduce recovery time and complications associated with traditional surgery.
Emerging technologies: Innovations such as 3D-printed implants offer personalized solutions and potentially better outcomes.
Physiotherapy for hand osteoarthritis
Physiotherapy plays a crucial role in managing hand osteoarthritis (OA), offering various benefits and specific techniques to improve patient outcomes.
Benefits of physiotherapy
Pain reduction: Through targeted exercises and treatments, physiotherapy can help alleviate pain associated with hand OA.
Improved function: Physiotherapy can enhance the range of motion, strength, and dexterity, allowing for better performance of daily activities.
Delayed disease progression: Regular physiotherapy can slow the progression of OA by maintaining joint health and preventing further degeneration.
Specific techniques and exercises
Manual therapy
Joint mobilisation: Gentle techniques to improve joint movement and reduce stiffness.
Strengthening exercises
Exercises: Targeting the muscles around the hand and wrist to support and stabilize the joints.
Flexibility and range of motion exercises
Exercises: Designed to maintain or improve the flexibility of the hand joints, reducing stiffness and enhancing mobility.
Pain management strategies
Heat and cold therapy: Applying heat can relax muscles and reduce stiffness, while cold therapy can decrease inflammation and numb pain.
TENS (Transcutaneous electrical nerve stimulation): A non-invasive method that uses electrical currents to relieve pain.
Improving hand function and strength
Grip and pinch exercises: Exercises to strengthen the muscles involved in gripping and pinching, which are often weakened by OA.
Fine motor skill activities: Tasks that improve the coordination and dexterity of the fingers, aiding in the performance of daily activities.
Assistive devices and adaptations
Recommending appropriate tools: Suggesting tools and devices designed to reduce strain on the hand joints, such as ergonomic kitchen utensils or writing aids.
Teaching proper use of devices: Educating patients on how to use assistive devices effectively to protect their joints and maintain independence.
Self-management techniques
Self-management techniques empower individuals with hand osteoarthritis (OA) to take an active role in managing their condition and improving their quality of life.
Home exercise programs
Daily exercise routines: Incorporating daily exercises can help maintain joint mobility and muscle strength. Simple routines include hand stretches, grip strengthening, and range of motion exercises.
Progression of exercises: Gradually increasing the intensity and duration of exercises can help build strength and flexibility without overloading the joints.
Heat and cold therapy
When to use heat vs. cold: Heat therapy is beneficial for relaxing muscles and alleviating stiffness, while cold therapy is effective for reducing inflammation and numbing acute pain.
Application techniques:
Heat therapy: Use warm towels, heating pads, or warm water soaks for 15-20 minutes.
Cold therapy: Apply ice packs wrapped in a cloth for 10-15 minutes to reduce swelling and pain.
Stress management
Relaxation techniques: Practicing deep breathing, progressive muscle relaxation, and gentle yoga can help reduce overall stress and muscle tension.
Mindfulness practices: Techniques such as meditation and mindfulness can help manage pain perception and improve mental well-being.
Adaptive tools for daily living
Kitchen aids: Tools like jar openers, ergonomic knives, and non-slip mats can reduce the strain on hand joints during food preparation.
Writing and computer accessories: Ergonomic pens, keyboard pads, and adaptive computer mice can make writing and computer work more comfortable.
Living with hand osteoarthritis
Managing hand osteoarthritis (OA) involves physical treatments, coping strategies, and emotional support.
Coping strategies
Acceptance and adaptation: Embrace the condition and adjust daily routines accordingly.
Setting realistic goals: Establish achievable targets for activities and self-care.
Emotional and psychological aspects
Dealing with chronic pain: Use cognitive-behavioral therapy (CBT), mindfulness, and relaxation techniques.
Maintaining a positive outlook: Focus on manageable tasks and celebrate small achievements.
Support groups and resources
Local support groups: Engage with others for emotional support and practical advice.
Online communities: Connect with people facing similar challenges.
Educational resources: Stay informed about treatments and self-management through books, websites, and seminars.
Research and future treatments
Ongoing research into hand osteoarthritis (OA) is exploring new treatments and innovative technologies to improve patient outcomes.
Current studies
New medications: Exploring drugs targeting specific pain pathways and disease mechanisms.
Regenerative medicine: Investigating techniques to repair cartilage and slow OA progression.
Emerging therapies and technologies
Stem cell treatments: Aiming to regenerate damaged cartilage and reduce inflammation.
Gene therapy: Modifying genes to mitigate OA effects and potentially reverse joint damage.
Advanced bracing technologies: Developing improved braces for better support and comfort.
When to seek professional help
Signs indicating the need for medical evaluation
Persistent pain: Ongoing or worsening pain that does not improve with standard treatments.
Significant loss of function: Notable difficulty in performing daily activities or a decline in hand function.
Rapid progression of symptoms: Quick worsening of symptoms, such as increased pain or reduced mobility.
Choosing between a physiotherapist and other specialists
Role of Different Healthcare Professionals:
Physiotherapists: Focus on managing symptoms through exercises, manual therapy, and lifestyle advice.
Rheumatologists: Specialize in diagnosing and treating autoimmune and inflammatory conditions, including OA.
Hand surgeons: Handle surgical interventions and advanced treatments for severe cases of hand OA.
When to See a Rheumatologist or Hand Surgeon:
Rheumatologist: If there are signs of systemic involvement or if standard treatments do not manage symptoms effectively.
Hand surgeon: If conservative treatments are insufficient and surgical options are being considered.
Conclusion
Hand osteoarthritis (OA) is a common condition that affects joint function and quality of life. Key points to remember include:
Prevalence and impact: OA reduces hand function and impacts quality of life.
Management: Effective strategies include physiotherapy, medications, lifestyle changes, and possibly surgery.
Self-care and professional Help: Early intervention and proactive self-care are vital. Seek professional help if symptoms persist or worsen.
By adopting these strategies and remaining proactive about care, individuals can better manage hand OA and enhance their quality of life.
References:
Kalichman, L., & Hernández-Molina, G. (2010). Hand Osteoarthritis: An Epidemiological Perspective. Seminars in Arthritis and Rheumatism, 39(6), 465–476. https://doi.org/10.1016/j.semarthrit.2009.03.001
Kloppenburg, M., & Kwok, W.-Y. (2011). Hand osteoarthritis—a heterogeneous disorder. Nature Reviews Rheumatology, 8(1), 22–31. https://doi.org/10.1038/nrrheum.2011.170
Zhang, Y., & Jordan, J. M. (2009). Epidemiology of osteoarthritis. Clinics in Geriatric Medicine, 26(3), 355-369.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.