Osteoarthritis is the most common joint disease.  Unlike rheumatoid arthritis, osteoarthritis is not an autoimmune disease.  Osteoarthritis mainly affects the fingers, knees, hips, as well as the spine.  Today, I would like to talk about hand osteoarthritis, which is much more common in women and particularly women above the age of 50.

We like to think of osteoarthritis as a wear-and-tear arthritis, however, this is somewhat adopting a limited view.  Osteoarthritis certainly has to do with wear-and-tear, however, there are several biochemical and genetic factors that play a crucial role in the pathogenesis of the condition.

Because osteoarthritis is not an autoimmune disease, medications that we use for rheumatoid arthritis that deal with the immune system like methotrexate, are generally not effective in either alleviating pain or stop progression.  Currently there are no disease modifying medications that significantly alter the progress of the disease.  Typically, treatment relies on analgesic medications, both topical and oral, splinting, steroid injections, and surgery.

Although there are no medications that alter the progress of osteoarthritis, hand exercises play a major role in improving function and alleviating pain.  The aim is to strengthen the muscle surrounding the joints to act as cushion to reduce the pressure on the joints.  This will have the effect of improving grip strength, range of motion, and help with pain.

Here’s some evidence.

Hand anatomy

First let’s refresh our anatomy.

First of all, here we have a picture that illustrates the various bones that make up your hand.

• Carpals
• Metacarpals
• Proximal phalanges
• Intermediate phalanges
• Distal phalanges

And then we have the joints that make up your hand.

• Midcarpal joint
• 1^st carpometacarpal (CMC) joint
• 1^st interphalangeal (IP) joint
• Metacarpophalangeal (MCP) joints
• Proximal interphalangeal (PIP) joints
• Distal interphalangeal (DIP) joints

Finally, your hand needs to adapt to do everyday tasks.  Below you will find a picture that demonstrates the arches of the hands.  Basically, these are the different ways your hand can move – range of motion.

Improved hand function, self-rated health and decreased activity limitations – results after two month hand osteoarthritis group intervention

A recent study aimed to study the effect of exercise and paraffin wax therapy on osteoarthritis.  They wanted to see if their intervention would improve hand function, activity limitation, and self-rated health in people suffering from hand osteoarthritis.[1]

This was a prospective cohort study which consecutively recruited people in a primary care clinic in Sweden.  They included people who were symptomatic or had radiographically verified and osteoarthritis.  Finally, they excluded people who had other types of hand diseases, like rheumatoid arthritis or had undergone hand surgery.

Intervention

The intervention consisted of both an educational and exercise component.  People received two group sessions lasting an 1 ½ each.  During the educational piece, they discussed osteoarthritis in general, as well as guides to treatment.  They also discussed why exercise is important for rehabilitation and how to perform exercise as well as how to modify exercise due to pain.

The exercise component started after two educational sessions.  They were held twice weekly over a six-week period.  These were spearheaded by occupational therapists.  Each session started with 20 minutes of paraffin wax therapy followed by 25 minutes of hand exercises.  Typically these included 14 different types of exercises performed at least five times during the 25 minute.

Assessment

Everyone who participated in the study saw one of three occupational therapists at baseline, after three months (after the end of the intervention), and after 12 months (long-term follow-up).  During each visit, the occupational therapist measured hand function, activity limitation, as well as self-rated health.

Hand function

• Range of motion
• Grip force
• Hand pain
• Grip ability

Activity limitations

• The Patient Specific Functional Scale (PSFS), – people were asked to define three limiting activities caused by osteoarthritis
• The Quick Disability of the Arm, Shoulder and Hand (Quick DASH)

Self-rated health

• EuroQol VAS

Results

A total of 49 people participated in the study: 5 were men and 44 were women.  There weren’t any significant differences between the participants who completed study versus those who dropped out, except that the people who dropped out were more likely to be working and the people who completed the study were more likely to be retired.

Hand function

• Grip ability improved significantly from baseline to three months, p<0.001. There was no difference between three months and at 12 months.
• Range of motion improved significantly from baseline to three months, p= 0.011. There was no difference between the results at three months and 12 months.
• Grip force improved significantly from baseline to three months, p<0.001 in the right-hand as well as in the left-hand, p=0.008. The left-hand continued to improve between three months and 12 months but not the right hand.
• Hand pain at rest also significantly reduced after 3 months, p<0.001. There was no difference between the results at three months versus 12 months.

Activity Limitations

• Activity limitations in all three activities improved significantly from baseline to three months, p=0.008, p=0.001, p=0.004. There was no change between three months and 12 months.
• Activity limitations using the Quick-Dash improved significantly from baseline to three months, p=0.001.

Self-rated health

• Self-rated health also improved significantly between baseline and three months, p=0.039, and the results remained stable at long-term follow-up.

Limitations

The study had multiple limitations:

• Small sample size
• Based on the study design, it was impossible to tell whether the improvement in activity and self-rated health leads to improve hand function or vice versa.
• This was not a randomized control trial.
• Unable to distinguish the results of the separate parts of the intervention.

Conclusion

People who suffer from osteoarthritis appeared to improve when it comes to hand function, activity limitations, as well as overall self-rated health when they combine education as well hand exercises.  The improvements were also sustained at 12 months!

In this study, the participants also started their exercise program with a paraffin wax bath.  The European league against rheumatism (EULAR) recommends local application of heat, light, paraffin wax therapy, for the treatment of osteoarthritis as a short-term treatment option to decrease pain and to support muscle strength.  There is ample evidence supporting that hand exercises independently improve pain and function in osteoarthritis.  That being said, it’s safe to say that the improvement seen during the course of this study were not solely caused by paraffin wax therapy.  Although, who would ever say no to a nice relaxing paraffin wax bath?

Hand osteoarthritis program

Now that we have evidence that exercise supporting the role of exercises to improve hand osteoarthritis, it’s time to start the healing process.  Now not all of us either has resources or the time to see an occupational therapist twice a week, but here are a few interventions that you can do in the comfort of your home.

Remember, hand exercises for osteoarthritis should include flexion and extension of the DIP, PIP, and MCP joints, opposition of the index and middle fingers, and well as an opening grip movement – like opening up a door handle.

Please leave your comments below!

References

[1] Bjurehed L, Brodin N, Nordenskiold U, Bjork M. Improved hand function, self-rated health and decreased activity limitations – results after a two month hand osteoarthritis group intervention. Arthritis Care Res (Hoboken). 2017 Oct 3. doi: 10.1002/acr.23431. [Epub ahead of print]

Scheme human hand bones, Mariana Ruiz Villarreal (LadyofHats); retouches by Nyks

Human-Hands-Front-Back, by Evan-Amos

Hand-arches, Drawn freely (OK, crappy) from Physiology of the Joints, I.A. Kapandij 1982, p. 169. Made in Inkscape. |Source={{own}} |Date=January 2013 |Author= [[User:Fama Clamosa|Fama Cl…

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.