Synovial joints contain a layer of cartilage that acts as a shock absorber during movement and activity. Over time, the process of “Osteoarthritis”, commonly referred to as "OA" causes this cartilage to progressively disintegrate, compromising its ability to dissipate stress. (1,2) Progressive degeneration causes pain, stiffness, and impairment in the ability to perform manual tasks, resulting in diminished quality of life. (3,4)
On the whole, osteoarthritis (OA) is the most common musculoskeletal disorder. (1,5) In fact, people over age 65 universally demonstrate evidence of cartilage damage. (6) Symptomatic hand osteoarthritis is thought to affect 10- 25% of the population. (7) The joints closest to your finger nails are the most frequently affected sites in the hand. (8)
The prevalence of osteoarthritis increases with age, and the incidence for developing hand osteoarthritis peaks between the ages of 50 and 60. Hand OA is up to 2.6 times more common in females. (7,10) Like other types of osteoarthritis, hand OA is thought to have a genetic link. (10)
What causes OA?
Repetitive use is often implicated as a cause of osteoarthritis; however, some authors question whether the stress associated with routine activities of daily living is enough to cause degeneration in a healthy joint. (11) Joints that have been previously injured and those that are lax, misaligned or deformed are at higher risk for developing OA. (7,11) Osteoarthritis is more common in occupations that require repetitive movement of the hands, particularly labor and manufacturing jobs. (10) Contrary to popular opinion, knuckle cracking is not associated with osteoarthritis, regardless of duration or frequency. (13)
Smoking may increase one’s risk for developing osteoarthritis in other parts of the body, but it does not seem to be a contributor to hand osteoarthritis (14,49). Obesity (BMI greater than 30) is a risk factor for both weight bearing and non-weight bearing joints. (15,16) Obesity’s influence on osteoarthritis of non-weight bearing joints, including the hand, is thought to result from a systemic inflammatory process related to excess adipose tissue. (5,10) Osteoarthritis was one thought to be a purely mechanical, non-inflammatory form of arthritis, but newer studies demonstrate a biochemical upregulation of several inflammatory pathways. (17)
Treatment goals for hand osteoarthritis include reducing pain while improving strength and range of motion. (29,30)
Pain relief is the primary goal because of its direct correlation with improved function. (31)
The American College of Rheumatology recommends the use of non-drug treatments for hand osteoarthritis. (3)
Interventions may include modalities, soft tissue manipulation, exercise, splints, and ADL advice. (7,30) The long-term use of a nighttime splint for the thumb is a well-recognized and effective treatment for thumb OA. (35-37)
Joint mobilization has been shown to decrease pain
Massage/manual therapy has been shown to help reduce pain in patients with hand osteoarthritis (39)
Topical counterirritant cream, including capsaicin, is recommended for symptomatic hand OA (3,24) Exercise to improve range of motion and strength is a mainstay in the treatment of hand osteoarthritis (40-42)
Surprisingly, ROM exercises demonstrate the most significant gains in strength, while strengthening exercises tend to improve ROM (40-42)
Aerobic, aquatic and resistance exercises may provide benefit. (24)
The benefit of Glucosamine Sulfate or Chondroitin Sulfate is debatable but its use has been advocated for patients with hand osteoarthritis (48).
Supplements and medications, including analgesics and NSAIDs, have not been shown to retard cartilage loss. (4,7)
Topical NSAIDS may be a safer alternative to oral medications for older patients (32)
Analgesic and/or cortisone injections are sometimes used for pain management.
Surgical joint replacement is an alternative for patients with significant pain and loss of function, who are recalcitrant to conservative management.
At Creekside Performance Center, we are highly trained to treat this condition. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves.
Evidence Based-Patient Centered-Outcome Focused
1. Loughlin J. The genetic epidemiology of human primary osteoarthritis: current status. Expert Rev Mol Med. May 24 2005;7(9):1-12.
2. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteo- arthritis. Lancet 2005; 365: 965–973.
3. Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 1990; 33: 1601–10.
4. Lozada CJ, Altman RD. Management of osteoarthritis. In: McCartyDJ, KoopmanWJ, editors. Arthritis and allied conditions: a textbook of rheumatology. 14th ed. Philadelphia: Lippincott; 2001. p. 2246–63.
5. Anderson JJ, Felson DT: Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol 1988, 128:179–189.
6. Kraus VB. Pathogenesis and treatment of osteoarthritis. Med Clin North Am 1997; 81: 85–112.
7. Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW, Dincer F, Dziedzic K, Hauselmann HJ, Kaklamanis P, Kloppenburg M, Lohmander LS, Maheu E, Martin-Mola E, Pavelka K, Punzi L, Reiter S, Smolen J, Verbruggen G, Watt I, Zimmermann-Gorska I, Escisit : EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT. Ann Rheum Dis 2009, 68:8-17.
8. Wilder FV, Barrett JP, Farina EJ. Joint-specific prevalence of osteoarthritis of the hand. Osteoarthritis and Cartilage Volume 14, Issue 9 , Pages 953-957, September 2006
9. Penny Murata, MD New Guidelines Issued to Diagnose Hand Osteoarthritis Medscape Medical News accessed 06/30/2014. http://www.medscape.org/viewar...
10. Garvin J. Leung, K. D. Rainsford and Walter F. Kean Osteoarthritis of the hand I: aetiology and pathogenesis, risk factors, investigation and diagnosis JournalofPharmacyandPharmacology,66, pp. 339–346
i11. Dr Steele Provides
13. Kevin deWeber, MD, FAAFP, Mariusz Olszewski, MD, Rebecca Ortolano, MD Knuckle Cracking and Hand Osteoarthritis J Am Board Fam Med. 2011;24(2):169-174.
14. Hart DJ, Spector TD. Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study. Ann Rheum Dis. 1993 Feb;52(2):93-6.
15. Yusuf E, Nelissen RG, Ioan-Facsinay A, Stojanovic-Susulic V, DeGroot J, van OG, Middeldorp S, Huizinga TW, Kloppenburg M: Association between weight or body mass index and hand osteoarthritis: a systematic review. Ann Rheum Dis 2010, 69:761–765.
16. Teichtahl AJ, Wang Y, Wluka AE, Cicuttini FM: Obesity and knee osteoarthritis: new insights provided by body composition studies. Obesity (Silver Spring) 2008, 16:232–240.
17. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteo- arthritis. Lancet 2005; 365: 965–973.
18. Beaton D, Davis AM, Hudak P, McConnell S. The DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure: what do we know about it now? Br J Hand Ther 2001;6:109-18.
19. MacDermid J, Humphrey R, Richards R. Validation of scales used to assess outcome of CMC arthroplasty. J Bone Joint Surg Br 2008;90-B(Supp I):121
20. Penny Murata, MD New Guidelines Issued to Diagnose Hand Osteoarthritis Medscape Medical News accessed 06/30/2014. http://www.medscape.org/viewar... Accessed 7/8/14
21. Salaffi F, Carotti M, Stancati A, Grassi W. Radiographic assessment of osteoarthritis: analysis of disease progression. Aging Clin Exp Res 2003;15:391-404
22. Buckland-Wright C, Verbruggen G, Haraoui PB. Imaging: radiological assessment of hand osteoarthritis. In: Osteoarthritis Cartilage. 2000: 55-6.
23. Jewell FM, Watt I, Doherty M. Plain radiographic features of osteoarthritis. In: Brandt KD, Doherty M, Lohmander LS, eds. Osteoarthritis. New York, NY: Oxford University Press;. 1998: 217-37.
24. Osteoarthritis | University of Maryland Medical Center http://umm.edu/health/medical/... Accessed 7/8/2014 University of Maryland Medical Center Web Site
25. Bagis S, Sahin G, Yapici Y, Cimen OB, Erdogan C: The effect of hand osteoarthritis on grip and pinch strength and hand function in postmenopausal women. Clinical rheumatology 2003, 22:420-424
26. Villafañe JH et. al, Combined Thumb Abduction and Finger Extension Strenth: A Comparision of Older Adults with and without Carpometacarpal Osteoarthritis J Manipulative Physiol Ther 2013;36:238-244
27. Stacy GS. Primary Osteoarthritis Imaging. Medscape http://emedicine.medscape.com/article/392096-overview. accessed 7/1/14
28. Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am
2004; 42: 1–9.
29. Kloppenburg M: Hand osteoarthritis--an increasing need for treatment and rehabilitation. Curr Opin Rheumatol 2007, 19:179-183.
30. Clark F, Azen SP, Zemke R, Jackson J, Carlson M, Mandel D, et al. Occupational therapy for independent-living older adults. A randomized controlled trial. JAMA 1997; 278: 1321–6.
31. Barthel HR, Peniston J, Clark M, Gold M, Altman R: Correlation of pain relief with physical function in hand osteoarthritis: randomized controlled trial post hoc analysis. Arthritis Res Ther 2010, 12:R7.
34. Bijsterbosch J, Visser W, Kroon HM, Stamm T, Meulenbelt I, Huizinga TWJ, Kloppenburg M: Thumb base involvement in symptomatic hand osteoarthritis is associated with more pain and functional disability. Ann Rheum Dis 2010, 69:585-587.
35. Swigart CR, Eaton RG, Glickel SZ, Johnson C: Splinting in the treatment of arthritis of the first carpometacarpal joint. Journal of Hand Surgery 1999, 24:86-91.
36. Brosseau L, Wells G, Marchand S, Gaboury I, Stokes B, Morin M, Casimiro L, Yonge K, Tugwell P: Randomized controlled trial on low level laser therapy (LLLT) in the treatment of osteoarthritis (OA) of the hand. Lasers in Surgery and Medicine 2005, 36:210-219.
37. Rannou F, Dimet J, Boutron I, Baron G, Fayad F, Mace Y, Beaudreuil J, Richette P, Ravaud P, Revel M, Poiraudeau S: Splint for base-of-thumb osteoarthritis: A randomized trial. Annals of Internal Medicine 2009., 150
38. Villafañe JH et. al, Hypoalgesic and motor effects of Kaltenborm mobilization on elderly patients with secondary thumb metacarpal osteoarthritis: A radomizaed controlled study. J Manipulative Physiol Ther 2011;34:547-556
39. Field T, Diego M, Hernandez-Reif M, Shea J: Hand arthritis pain is reduced by massage therapy. Journal of Bodywork and Movement Therapies 2007, 11:21-24.
40. Lefler C, Armstrong WJ: Exercise in the treatment of osteoarthritis in the hands of the elderly. Clinical Kinesiology 2004, 58:13-17.
41. Rogers MW, Wilder FV: Exercise and Hand Osteoarthritis Symptomatology: A Controlled Crossover Trial. Journal of Hand Therapy 2009, 22:10-18.
42. Stamm TA, Machold KP, Smolen JS, Fischer S, Redlich K, Graninger W, Ebner W, Erlacher L: Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: A randomized controlled trial. Arthritis Care and Research 2002, 47:44-49.
43. Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM: Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010, CD001977
44. Herman JH, Khosla RC: In vitro effects of Nd: YAG laser radiation on cartilage metabolism. The Journal of rheumatology 1988, 15:1818.
45. Schultz RJ, Krishnamurthy S, Thelmo W, Rodriguez JE, Harvey G: Effects of varying intensities of laser energy on articular cartilage: a preliminary study. Lasers Surg Med 1985, 5:577-588.
46. Hegeds B, Viharos L, Gervain M, Galfi M: The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial. Photomedicine and Laser Surgery 2009, 27:577-584
47. Liuzhen Ye, Leonid Kalichman, Alicia Spittle, Fiona Dobson, Kim Bennella. Effects of rehabilitative interventions on pain, function and physical impairments in people with hand osteoarthritis: a systematic review. Arthritis Research & Therapy 2011, 13:R28
48. Melville NA Chondroitin Sulfate Shows Efficacy for Hand Osteoarthritis Medscape Medical News accessed 06/25/2014 http://www.medscape.com/viewar...
49. Wilder FV, Hall BJ, Barrett JP. Smoking and osteoarthritis: is there an association? The Clearwater Osteoarthritis Study. Osteoarthritis Cartilage. 2003 Jan;11(1):29-35.
aaa. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26: 355–369.