Hand osteoarthritis is a degenerative disease of the joints located in the hand, which is associated with accelerated wear of the articular cartilage. Due to the general increase in joint degeneration after the age of 50, the risk for joint arthritis increases with this age.
What is hand osteoarthritis?
Schematic diagram difference between healthy joint, arthritis and osteoarthritis. Click to enlarge. Hand osteoarthritis is a degenerative disease of the cartilaginous structures of the wrists characterized by an accelerated process of wear or attrition. In particular, the middle and end joints of the fingers, the thumb saddle joint, and the wrist joint (especially between the radius and ulna and the radius and scaphoid) are frequently affected by hand arthrosis. Damage to the cartilaginous joint structures leads to roughening and cracks, so that they lose thickness and can no longer fulfill their shock– or pressure-reducing function and relieve the joint. As the affected cartilage structures and adjacent bones are subjected to increasingly greater loads, the bones thicken (subchondral sclerosis) and form attachments (osteophytes). As the disease progresses, secondary inflammation of the synovium (arthritis) and joint effusions may manifest, leading to pain in addition to the joint stiffness characteristic of hand osteoarthritis.
Causes
Osteoarthritic wear is generally caused by damage to the articular cartilage layer, although in most cases the underlying cause of this damage cannot be determined (primary hand osteoarthritis). In addition to genetic factors (familial accumulation), hormonal causes are suspected, since women in particular are affected by finger joint arthrosis after the menopause. In addition, crystallopathies (crystal deposits such as gout), metabolic diseases, rheumatoid arthritis, osteoporosis (bone loss), osteonecrosis (death of a bone section) as well as genetic or accident-related joint malpositions can cause damage to the cartilage structures in the joints and thus hand arthrosis (secondary hand arthrosis). The wear process is additionally favored by a permanent overload of the corresponding joints (overweight, joint-straining activities) as well as lack of exercise.
Symptoms, complaints and signs
Hand osteoarthritis does not initially cause any complaints. As the disease progresses, various symptoms and complaints may develop. Typically, a slight stiffening of the fingers occurs first, which is noticed by the affected person mainly in the morning and after longer periods of rest. Later, the fingers swell, making it increasingly difficult to form a fist. Eventually, the pain also occurs at rest and leads to further movement restrictions. Often, the joints swell and become red or very warm. If the finger end joints are involved, thickenings sometimes develop that may fill with jelly or pus and empty out after a few days to weeks. Subsequently, new thickenings form. In later stages, these thickenings develop into bony skin lesions that first appear on the right and left sides of the joints and eventually spread to the entire hand. Hand arthrosis at the thumb saddle joint causes pain and movement restrictions. There is severe pressure pain during everyday movements, which only subsides slowly. Accompanying these symptoms, hand arthrosis can cause circulatory disturbances, [[paralysis9]s and sensory disturbances in the affected hand. In a severe course, the affected hand or finger can no longer be moved or can only be moved to a limited extent.
Diagnosis and course
Hand osteoarthritis is diagnosed on the basis of characteristic symptoms (pain, swelling, redness, hyperthermia, joint stiffness). The diagnosis is confirmed by an X-ray examination, which reveals the typical joint changes caused by osteoarthritis, such as narrowed joint space, compression of the bones near the joint, and bone attachments (osteophytes). In addition, an X-ray image allows statements to be made about the stage of hand arthrosis. Underlying metabolic diseases or osteopathies can be detected in the course of a computer tomography, magnetic resonance imaging or blood tests.Joint punctures and urography (X-ray contrast imaging of the kidney and urinary tract) are used to diagnose crystallopathies such as gout. Unlike other endogenous structures such as skin, nails or hair, cartilaginous structures lose the ability to regenerate after puberty, so that damage cannot be compensated or can only be compensated to a very limited extent. With early prevention or diagnosis and initiation of therapy, degenerative changes and progression of hand osteoarthritis can be slowed.
Complications
Hand osteoarthritis causes rapid wear and tear of the wrists, resulting in relatively severe pain. This pain can occur either in the form of movement pain or as rest pain and thus negatively affect the quality of life in any case. The pain also leads to considerable restrictions in movement, so that normal activities with the hands can usually no longer be carried out without further ado. The pain often spreads to the entire hand. Pain at rest can lead to sleep problems at night. It is not uncommon for swelling of the joints to occur. Due to the pain and the impairments in everyday life caused by the hand arthrosis, psychological complaints or other moods can also arise. Patients often withdraw from active life and thereby no longer participate in social interactions. The treatment of hand arthrosis is carried out with the help of medication, therapies or by means of a surgical intervention. No other complications occur in the process. However, it cannot be predicted whether the fingers and the entire hand will regain full use after treatment. Life expectancy is not affected by hand osteoarthritis.
When should you see a doctor?
As soon as there is unexplained discomfort in the wrist or hand, a visit to the doctor is highly recommended. This is especially true if wrist movement is restricted. In this case, the orthopedist should clarify whether hand arthritis is present or where the cause of the symptoms lies. Often, the symptoms develop rather gradually over months or even years. In this case, those affected should ask a doctor for advice as soon as they become aware of the symptoms in everyday life. A visit to the doctor is particularly unavoidable if the hand is only able to function to a reduced extent or if the strength in the fingers increasingly decreases. Circulatory disorders in the area of the hand must also be examined and treated in good time. The same applies if the affected person cannot hold objects or can do so only with great difficulty, or if the hand trembles frequently when at rest. Many patients develop so-called avoidance behavior in order to spare the hand. However, this tends to be counterproductive. Instead, a physician should be consulted so that he or she can perform the necessary examinations and initiate appropriate therapeutic measures. Particular urgency is required if the symptoms are already spreading to other areas or the pain is so severe that regular medication is required.
Treatment and therapy
In the case of hand osteoarthritis, therapeutic measures are primarily aimed at reducing pain, improving mobility, and slowing joint wear. Initially, conservative therapy consisting of physiotherapy as well as cooling or application of heat and medication with pain-relieving and anti-inflammatory drugs (nonsteroidal anti-inflammatory drugs) is generally used for acute pain. In cases of pronounced pain and inflammation, cortisone or radionuclides (radiosynoviorthesis) are additionally injected locally into the affected joint to reduce pain. If conservative therapy measures do not improve the symptoms, surgical intervention may be necessary. Various surgical therapy procedures are available for this purpose. For example, in the case of primary hand arthrosis, a so-called denervation may be considered, in which the pain-conducting nerves in the wrist are cut and switched off, while the joint itself and its mobility remain intact. In the case of arthritic wear of the finger middle joints or the wrist, a prosthetic joint replacement or a placeholder made of silicone is often surgically inserted to ensure freedom from pain and mobility of the affected joint.Another procedure is joint stiffening, which is recommended in the case of wear and tear of the finger end joints as well as for sufferers who put a lot of strain on these joints at work. If the thumb saddle joint (rhizarthrosis) or the carpus in the area of the thumb saddle joint is affected, a partial joint removal (carpal bone) with simultaneous tendon suspension or plastic from the body’s own structures for joint stabilization is usually used (Epping plastic). In addition, a dietary change in favor of a plant-based diet with supplements supporting cartilage metabolism (including synthetic cartilage building blocks, glucosamine sulfates, collagen hydrolysates) and antioxidants and vitamins is recommended for hand osteoarthritis.
Outlook and prognosis
The outlook for hand osteoarthritis must be viewed in a differentiated manner. Cures are not available, but affected individuals can slow the progression of a disease. A behavior must be adopted that allows people to live pain-free with hand osteoarthritis. With the right individual attitude, a positive prognosis can be formulated. There are occupations that lead to different stresses on the fingers. Patients with hand osteoarthritis should consider changing their occupation if their income is mainly from their hands. Pension insurance often helps in these cases by funding retraining. It has been proven that being overweight increases the typical symptoms of osteoarthritis. The joints have to carry too much mass. The same applies to the hands. Freedom from symptoms and a low body weight usually go hand in hand. Doctors also advise a healthy diet. Fruits and vegetables contain many omega-3 fatty acids, which inhibit inflammatory reactions. Meat, nicotine and alcohol, on the other hand, are harmful and should be avoided. Preventive measures also include preventing joint wear and tear. Regular and varied exercises can also be done with the fingers. Therapists impart the knowledge of suitable training sessions.
Prevention
Arthritic wear processes and, accordingly, hand arthrosis can be prevented by regular sporting activity that is gentle on the joints. This promotes blood flow to the synovium supplying the cartilage and ensures the development of stabilizing muscles. Likewise, the avoidance of one-sided and unfavorable continuous stress on the wrists prevents hand arthrosis.
Aftercare
One goal of follow-up care is to prevent recurrence of disease. This cannot be present in hand osteoarthritis because there is no chance of cure. Therefore, the only goal can be to make everyday life pain-free. The early initiation of therapy has been shown to alleviate the condition. Patients present themselves continuously to their treating physician in order to document the progress of the hand arthrosis and to initiate countermeasures. In addition to a detailed discussion, imaging is particularly suitable as a diagnostic procedure. X-rays, a CT scan and an MRI provide information about changes in the joint. Sometimes a blood test is also ordered. Three components are available for treatment: general measures, medication and physiotherapy. Special aids such as suitable cutlery or thumb splints promise to preserve independence. They can sometimes be prescribed on prescription. Medications that inhibit inflammation and protect the cartilage can be prescribed depending on the stage of the disease. Patients also have access to physiotherapy. Sometimes young people suffer from hand osteoarthritis. For them, the diagnosis is particularly burdensome when they can no longer practice their profession. In this case, the social insurance agencies help with a change of profession.
What you can do yourself
Pain reduction as well as the preservation of mobility are the first priority in the therapy of hand osteoarthritis. In addition, those affected can do a number of things to alleviate their symptoms and improve their quality of life. The first priority is regular exercise, which should be as gentle on the joints as possible. Sports that do not involve the use of the hands, or only to a limited extent, are also suitable. They promote blood circulation and in this way help to ensure that the joint cartilage is optimally supplied with nutrients. In addition, regular, individually adapted exercise strengthens the muscles located in the joint area.This can also have a positive effect on the course of the disease. Furthermore, heat and cold applications are excellent for self-help with hand arthritis. If the finger joints are acutely inflamed, cold packs have proven effective. They relieve the pain, inhibit the inflammatory processes and have a decongestant effect. Hand osteoarthritis is also associated with pain between episodes. In this case, warming compresses and heat packs are suitable methods to relieve the discomfort. The heat promotes blood circulation and effectively contributes to muscle relaxation. In addition, in the case of osteoarthritis it is generally advisable to rethink one’s diet in order to support the therapy. Especially sausage and meat contain the pro-inflammatory arachidonic acid, which can aggravate an already existing hand osteoarthritis.
