Osteoarthritis of the hands and wrist can be a painful and restrictive condition to live with. It affects around nine million people in the UK, more commonly women and those aged over 40. Symptoms range from almost none to those that can significantly reduce your quality of life. Pain, reduced grip strength and difficulty with fine manipulation are common consequences of symptomatic hand and wrist osteoarthritis. So what causes these symptoms and what treatment options are there?
Osteoarthritis is often called nodal osteoarthritis. This is because painful and inflamed joints can eventually settle and give rise to bony swellings called nodes in your joints.
The main symptoms of osteoarthritis, pain and inflammation, are caused by the cartilage that covers the bones in your joint degrading, which results in bone rubbing against bone. This, in turn, can trigger more joint fluid to be produced, which causes swelling.
As your bones rub against each other, they can wear away, which is why osteoarthritis can also cause joint deformities.
Although osteoarthritis is usually caused by wear and tear as you age, your risk is higher if it runs in your family, you have gout or rheumatoid arthritis, or you’re obese. It can also be caused by an injury, such as a bad sprain or fracture.
Hand and wrist osteoarthritis, specifically, is more common in people with occupations that involve repetitive movements of the hands and wrist eg hairdressers, clothing makers and bakers. The joints most commonly affected are in the fingertips and the base of the thumb joint, although other finger joints can also be affected.
There are a range of treatment options, including self-help measures, splints, physiotherapy, medication and in more severe cases, surgery.
Simple self-help techniques can ease your pain and save you time. Try to avoid clothing and shoes with fiddly buttons and fastenings. Instead opt for Velcro or popper buttons and with zips, attach small keyrings to make them easier to grip.
In the kitchen, you can invest in an electric tin opener, lightweight two-handled pans and easy-grip cutlery. All of these small changes will put less strain on your affected joints.
Physiotherapy and physical activity
Be mindful not to overdo things. If your fingers are painful and swollen, rest your hands. However, keep in mind that underuse can also worsen your symptoms as your joints will become stiff and your muscles will weaken. This is where a specialist hand therapist, who may be a physiotherapist or an occupational therapist, can help by providing exercises that will help protect the range of movement in your hands and wrists without straining them.
Wrist splints are a good way to rest your wrist joints and ensure they are positioned correctly. You can wear your wrist splints at night, as well as during the day when performing tasks that involve your hands and wrists.
There are different types of splints, which are designed to provide different kinds of support. It is therefore important to speak to your GP, physiotherapist or occupational therapist to find out which type of splint is appropriate for your needs.
Over-the-counter medication can help relieve joint pain and stiffness, such as paracetamol, non-steroidal anti-inflammatory drugs (eg ibuprofen), as well as creams or gels containing painkillers and anti-inflammatory drugs.
Steroid injections can also be useful in reducing symptoms. However, it’s hard to predict how much they will help you and for how long as this varies from person to person. It is generally recommended that you have no more than three steroid injections in the same area per year.
If self-help measures, physiotherapy and medication aren’t successful in relieving your symptoms, your doctor may recommend surgery, especially if more than one joint is affected. There are several different types of surgery available.
If the base of your thumb is affected by osteoarthritis, your doctor may recommend a trapeziectomy. This is the removal of the trapezium bone at the base of your thumb. It usually offers good, lifelong pain relief and is performed as a day case under general anaesthesia or using an arm block where you remain awake but your whole arm is numb so you can’t feel any pain.
However, recovery from a trapeziectomy is often long and sometimes painful. Your doctor may therefore explore other options with you, such as a tiny joint replacement, which also comes with risks and benefits that they will discuss with you.
If you have finger osteoarthritis, your doctor may recommend surgery to fuse the joint in the tip of your finger (distal interphalangeal joint). Although this will prevent movement of that joint, it can correct deformity, reduce swelling and relieve pain. Finger surgery is performed under local anaesthesia as a day case and involves fusing the joint by inserting a tiny screw across it. For the two larger finger joints, joint replacement is sometimes possible, which can relieve pain while still allowing some level of movement.
If you’re concerned that you may have hand and wrist osteoarthritis, see your GP to discuss your symptoms and treatment options. Self-help measures, splints, medication and/or physiotherapy may be enough to resolve your symptoms and improve your quality of life. However, if these treatments are not successful, you can speak to a consultant orthopaedic surgeon to explore your surgical options.
Mr Adrian Chojnowski is a Consultant Orthopaedic Surgeon at Spire Norwich Hospital and at Norfolk and Norwich University Hospital NHS Trust, specialising in the hand and wrist. He is also an active member of the research community, focusing on carpal tunnel syndrome and Dupuytren's contracture. He qualified from Cambridge University, trained largely in East Anglia and also was a fellow at the University of Toronto Hand Programme.