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WILDERMAN MEDICAL CLINIC
Anatomy of the hand and wrist
The wrist joint is formed by the two bones of the forearm, the radius and ulna, meeting the eight small carpal bones, collectively referred to as the carpus.
While it is referred to as the wrist joint, it is actually composed of multiple joints which allow for a wide range of motion in this joint.
Hand, an Equally Complex Structure
The hand is an equally complex structure, consisting of five bones that make up the middle (palm) part of the hand, called the metacarpals, and the fourteen bones of the fingers called the phalanges. Joints in the wrist and hand are formed in any place where two or more bones meet.
Fingers
In the fingers, these joints are called the metacarpophalangeal joints (MCP), which are at the base of the finger, the proximal interphalangeal joint (PIP), which is the middle joint of the finger, and the distal interphalangeal joint (DIP), which is the last joint of the finger closest to the fingernail.
The bony ends of each joint are covered in a thin, smooth layer of cartilage, which protects the bones and allows for smooth movements in the joints.
Wrist
The wrist and hand also consist of multiple ligaments, tendons, and muscles that provide structural support and the ability to manipulate the wrist, hand, and fingers in complex and controlled movements.
How does osteoarthritis develop in the hand and wrist joints?
Osteoarthritis in the hand and wrist is often a result of wear and tear in the joints.
Frequent or heavy use of the wrist and hand joints can result in the gradual breakdown of the cartilage that covers and protects the bones; as the cartilage wears away, movement in these joints results in friction which then causes inflammation, pain, and further breakdown of the protective cartilage.
Ongoing friction and inflammation in the joints can then result in damage to the bones themselves, which develop bony growths, called bone spurs, that in turn cause further friction, pain, and inflammation in the joints.
According to the Cleveland Clinic, osteoarthritis of the hand and wrist is most commonly seen at the base of the thumb, where it meets the wrist, and in the middle and last (closest to the fingernail) joints of the fingers.
What are the symptoms?
Symptoms of osteoarthritis of the wrist and hand include:
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Aches and pains in the wrist and hand, particularly following increased hand/wrist use
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Stiffness or pain in the wrist and hand upon waking in the morning
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Swelling or reduced range of motion in the hand and wrist joints
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Cracking or popping noises with hand or wrist movements
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Enlarged or deformed finger joints
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Tenderness in the joints to touch or pressure
How common is osteoarthritis of the hand and wrist?
Osteoarthritis of the wrist and hand is a common occurrence, particularly in those over the age of 50.
A journal article published in 2017, titled Lifetime risk of symptomatic hand osteoarthritis: the Johnston County osteoarthritis project found that “nearly one in two women will develop SHOA (symptomatic hand osteoarthritis) by age 85 compared with one in four men…Lifetime risk among individuals with obesity is 11 percentage points higher than those without obesity” (Qin et al. 2017).
In another article, titled Assessing health-related quality of life in hand osteoarthritis: a literature review, the authors reviewed the findings of 33 journal articles (taken from 167 articles that were screened to determine if they met the necessary criteria); they noted that “hand osteoarthritis (HOA) is a common disease that affects up to 40% of adults and may severely impair their health-related quality of life (HRQL)” (Michon et al. 2011).
What are the risk factors associated with osteoarthritis of the hand and wrist joints?
Common risk factors for osteoarthritis of the hand and wrist include:
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Age (typically seen after age 50)
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Heavy or repetitive hand and wrist use
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Obesity
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Previous injuries to the hand or wrist
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Family history of arthritis
How is the condition diagnosed?
Diagnosis of osteoarthritis of the hand or wrist involves three components:
1. A medical history –
Your physician will discuss your medical history with you in detail. This is an essential step to help determine what type of symptoms you are experiencing, how these symptoms affect your day-to-day functioning, when and how these symptoms first began, and what aggravates them.
You will also be asked what medications you are taking, what other medical conditions you have, and what type of lifestyle habits you practice (such as exercise, diet, smoking, alcohol consumption, and more).
2. A physical examination –
After discussing your medical history, your physician will examine the affected areas, assessing for pain or tenderness with palpation and movements. They will also check for limitations in your range of motion in the affected joints.
3. Diagnostic imaging/testing –
You may be instructed to get bloodwork done in order to rule out other conditions, such as rheumatoid arthritis, as the source of your pain. X-rays are used to visualize the joints of the wrist and hand, assessing for loss of cartilage or the formation of bone spurs.
How is the condition treated?
The approach to your treatment for osteoarthritis of the hand and wrist will be dependent on several factors, including the severity of arthritis, how old you are, your level of activity, and your overall health.
The treatments will focus on reducing pain, increasing mobility and function, and slowing the progression of the disease.
Your physician will work with you to determine which treatment, or combination of treatments, is best suited to your specific needs.
Some of these treatment options include:
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Acetaminophen to reduce pain
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NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation
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Other oral medications specific to treating arthritis and inflammation
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Topical creams, such as Lidocaine, Menthol, Traumeel, and Tiger Balm
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Physiotherapy
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Resting the hand and wrist
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Hot/cold therapy, using heat and ice to reduce pain and swelling
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Acupuncture and Acupressure
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Massage therapy
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Occupational therapy (including improving the ergonomics of your workstation, learning to use assistive devices, or altering how movements are performed to minimize the aggravation of the affected joint)
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Exercise to strengthen the muscles of the hand and wrist and improve functional ability
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Dietary changes to reduce weight and inflammation
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Smoking cessation
What do we do at WMC?
At the Wilderman Medical Clinic, we offer numerous interventional and non-interventional treatment options for hand and wrist osteoarthritis, including:
Interventional pain management for osteoarthritis of the hand and wrist joints:
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Cortisone injections for hand and wrist joint osteoarthritis
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Dextrose (prolotherapy) injections for hand and wrist joint osteoarthritis
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PRP (plasma-rich protein) injections for hand and wrist joint osteoarthritis
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nStride injections for hand and wrist joint osteoarthritis
Non-interventional pain management for osteoarthritis of the hand and wrist joints:
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Psychotherapy
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Kinesiology education sessions
When is surgery required?
Surgery may be considered if all other alternatives fail to provide adequate pain relief.
Some surgical options include fusion of the affected joints to provide stability and reduce pain or replacement of the joint with an artificial joint. Surgery may also be required to repair or replace tendons that are damaged due to ongoing inflammation in the area.
While surgical intervention may reduce pain in the affected area, these options do result in a significantly reduced range of motion; therefore, it is essential to exhaust all other options before opting for surgery, if possible.
Works cited
Arthritis of the hand. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/7082-arthritis-of-the-wrist-and-hand#:~:text=Osteoarthritis%20most%20commonly%20affects%20your,the%20joints%20of%20your%20finger.
Michon M, Maheu E, Berenbaum F. Assessing health-related quality of life in hand osteoarthritis: a literature review. Annals of the Rheumatic Diseases 2011;70:921-928.
Qin J, Barbour KE, Murphy LB, Nelson AE, Schwartz TA, Helmick CG, Allen KD, Renner JB, Baker NA, Jordan JM. Lifetime Risk of Symptomatic Hand Osteoarthritis: The Johnston County Osteoarthritis Project. Arthritis Rheumatol. 2017 Jun;69(6):1204-1212. doi: 10.1002/art.40097. Epub 2017 May 8. PMID: 28470947; PMCID: PMC5449255.
