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Overcoming Inflammation

Exercises to help hand osteoarthritis

November 21, 2017
Exercises to help hand osteoarthritis

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

Distal phalanges, intermediate phalanges, proximal phalanges, metacarpals, carpals

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

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

DIP, PIP, MCP, IP, and CMC 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.

Arches of the hand

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

Self-rated health

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.

Self-Injection Videos

How to inject methotrexate

September 12, 2017
How to inject methotrexate

Methotrexate is commonly prescribed to treat rheumatoid arthritis, psoriatic arthritis, psoriasis, as well as many other autoimmune diseases. It comes as a pill but in certain situations the medication may be more effective if it’s injected.  That being said, injectable methotrexate comes as a auto-injector pen but due to cost, often times we need to rely on the good old-fashioned method: needle, syringe, and a vial of methotrexate.  First, Dr. Farrell is going to teach us how to inject a vial of methotrexate.  In the second video, she will teach us how to inject with an auto-injector pen.

Preparing for your injection

  • Keep your medication stored in the refrigerator until use
    • Before injecting medication, take the vial out of the refrigerator.
    • Allow it to warm up to room temperature.
  • Pick a place in your house that is clean and has room for your materials (such as the kitchen table).
  • Wash your hands thoroughly with either:
    • Soap & water
    • Hand sanitizer
  • Chose an area to inject – Thigh or Stomach.
    • Chose an area that is intact and clear.
    • It should not have any of the following:
      • Cuts
      • Scrapes
      • Bruises
      • Psoriasis patches
      • If you have extensive psoriasis, inject between patches
      • Moles
      • Scars
    • Please rotate area each time you inject (shown in picture below).

Areas to inject subcutaneous medication

  • Cleanse chosen area
    • Cleanse chosen area with either of the following:
      • Alcohol swab
      • Alcohol and a cotton ball
    • Use the chosen alcohol material to “swipe” area
      • Can either use a circular motion or wipe in “strips”
      • Allow the area to dry

Injecting a methotrexate vial

Drawing the medication

  • If it is your first time using the vial, you will have to remove the plastic cap from the vial
  • Clean the top of the vial with an alcohol swab
  • Open syringe packaging and take syringe out
    • Be careful while doing this – the needle may come apart, so make sure the needle is securely on the syringe before moving on
  • Double check the dosage on your prescription.  Does your doctor want you to inject 0.5 mL? 0.6 mL?
  • Pull plunger to get air into the syringe
    • The amount of air should be half the amount of the dose that you are going to draw up (Example: if you need a dose that is 1 mL of methotrexate, draw up 0.5 mL of air)
  • Press the needle into the vial
    • Should be right into the center of the top of the vial at a 90-degree angle
  • Push the plunger to transfer the air into the vial
  • Flip the vial upside down with the needle still in
  • Pull back on the plunger to draw liquid into the syringe
    • If an air bubble appears into the syringe, push the plunger back up and try pulling out again
    • This may take a few tries before you get only medication into the syringe
  • Once you have withdrawn the dose of the medication that you need, flip the vial and take the needle out

Injecting the medicine

  • Pinch cleansed skin
  • Insert needle into the chosen area at a 45-degree angle
    • You may keep the skin pinched or let go of the skin
  • Push the plunger slowly to inject the medication
  • Once you have injected all of the medication, take the needle out of your skin

After the injection

  • Properly dispose of the entire syringe
    • NEVER recap the needle
    • Sharps Container
      • Can be purchased at your local pharmacy
      • Disposal
        • Hospitals may take full sharps containers, ask first.
        • Pharmacies and Doctors’ offices are not allowed to take used syringes or needles
  • Discard remaining materials in the trash (cap, alcohol swabs, etc.)

Injecting methotrexate with an auto-injector pen

Injecting Otrexup®

  • There will be a number “1” labeled on the auto-injector
    • Twist cap off
  • There will be a number “2” labeled on the auto-injector
    • Press with thumb to flip cap off
  • Place tip of the auto-injector on the skin at a 90-degree angle
  • Press button to release medication
    • Hold for 10 seconds
    • May feel a slight pinch and tingling as the medication goes in

Injecting Rasuvo®

  • There will be a yellow cap at the end that you will pull straight off
  • Place tip of the auto-injector on the skin at a 90-degree angle
  • Press button to release medication
    • Hold for 10 seconds
    • May feel a slight pinch and tingling as the medication goes in

After the injection

  • Properly dispose of the auto-injector.
    • Sharps Container
      • May be provided by the drug company (depending on the medication)
      • Can be purchased at your local pharmacy
      • You may use a coffee can if you are unable to attain a sharps container
      • Disposal
        • Hospitals may take sharps
        • Pharmacies and Doctors’ offices are not allowed to take used syringes or needles
  • Discard remaining materials in the trash (cap, alcohol swabs, etc.)

Credits

Jessica Farrell, PharmD.  Clinical Pharmacist, The Center for Rheumatology/Associate Professor, Albany College of Pharmacy and Health Sciences

With the help of Autumn Koniowka. Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences, and Megan Phillips. Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences.

A special thanks to Tammy Garren, PhD. Instructional Designer, Center for Innovative Learning, Albany College of Pharmacy and Health Sciences.

Methotrexate vial image: By Li Wa/Shutterstock

Injection site image: By British Columbia Institute of Technology (BCIT). Download this book for free at http://open.bccampus.ca [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

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.

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