ARTHRITIS

There are many types of arthritic processes that can cause joint changes, pain and loss of motion and strength in the hands.  Many excellent and detailed resources are available and will be listed under "resources".  Here is a brief overview.

Osteoarthritis (OA)

Osteoarthritis is caused by wear-and-tear on the joints.  Anyone over the age of 40 has some degree of arthritic changes in their joints.  The level of impairment may be impacted by our genetic predisposition toward joint changes, the types of use our hands have seen over the years, and any trauma to the hand (for example, previous fractures) that has occurred.  With hand overuse, the cartilage (the cover on the end of the bones that provides a nice smooth surface on which bones in contact with each other glide) deteriorates.

The most common osteoarthritic joint changes in the hand occur at the tips of the fingers by the finger nails (Heberden's nodes) and in the middle joints of the fingers (Bouchard's nodes).  The joints may initially feel painful, hot, and swollen; then typically the pain may decrease but nodules of calcification remain.  The bones may begin to deviate to different angles or become "floppy";  or the tip of the fingers may droop and become painful and unstable.

Arthritis at the base of the thumb (basal joint or CMC (carpometacarpal) joint) is also very common.  Pinch activity places stress on this joint and eventually it becomes quite painful to perform any type of hand activity.  The Comfort Cool neoprene thumb splint was designed specifically for CMC arthritis.  It is comfortable, easy to apply, and provides support to the thumb joint while allowing some flexibility during activity.

Once a joint has changed it's appearance, it will not change back.  It is necessary to provide an unstable joint with stability through splinting or through surgery, depending upon the severity.  The goals of therapy are to prevent or slow down further joint changes and to control the swelling and pain that is currently present.

Rheumatoid Arthritis (RA)

Rheumatoid Arthritis is caused by an immune disorder in which the body begins to attack it's own joints.  Multiple joints become hot, tender, swollen and painful.  It becomes quite difficult to perform all activity.  Joint changes that occur in the hand tend to follow a typical pattern.  The large knuckles of the hand tend to drift toward the small finger or droop.  The middle joint of the fingers  tend to hyperextend (swan neck deformity) or become contracted in a bent position (boutonnière deformity).  The back of the wrist often becomes swollen with a thick, viscous fluid (synovitis).

Once again, the goals of therapy are to prevent further joint instability through the use of splinting, joint protection and energy conservation methods.  Therapy modalities may be used to reduce swelling and pain.

Arthritis Tips

• Use heat to loosen up tight or stiff joints.
• Use cold packs to control swelling or the pain of "hot joints".
• Use splints at rest to hold joints in the best anatomical position possible.
• Use splints during hand use that allow some flexibility but support the most affected joints.
• Use joint protection and energy conservation techniques.
• Use adaptive devices ("gadgets") to ease the stress on joints.
• Keep all unaffected joints as loose as possible.
• Begin exercising the affected joints as soon as pain and swelling allow.