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Osteoarthritis of the hand

What is it?  

Osteoarthritis is a wear and repair process and a commonly affected joint is the thumb. It can cause joint pain with limitation of movement, which may affect daily activities. Osteoarthritis is the most common type of arthritis, affecting approximately 9 million people in the UK.

Versus Arthritis have produced a summary of ‘What is Osteoarthritis?’ please click on the video below to watch:

Causes of hand osteoarthritis

Osteoarthritis of the hand is a common joint problem. OA in the carpometacarpal joint (CMC joint) at the base of the thumb and in the small joints of the fingers are the most common causes of pain in this area.

OA in the hand can be related to repetitive precision loading (pinch-type activities) and strong grip, as well as other factors such as obesity and hormone changes. 

Symptoms of hand osteoarthritis

Pain is the primary symptom associated with hand osteoarthritis. Initially, pain is present with movement or activity (e.g. turning a key, opening a door, lifting a cup). In some cases of osteoarthritis pain may be present even during inactivity or rest. Other symptoms of hand osteoarthritis include:

  • Difficulty gripping objects
  • Swelling, stiffness, or tenderness of the small joints of the hand
  • Enlarged appearance and altered posture of the CMC joint
  • Nodular (bumpy) formations on the joints of the fingers
  • Limited range of motion

Treatment of hand osteoarthritis

Early osteoarthritis of the hand can be effectively managed using non-surgical treatment options. These treatments aim to reduce the pain caused by wear and tear of the joint:

  • Some medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP.
  • Exercise
  • Splinting
  • Joint protection

How to manage Osteoarthritis of the hand

Simple painkillers  

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Topical (applied directly on the affected body area) anti-inflammatories are recommended initially. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice or heat therapy

Heat may be helpful for stiff and painful joints by resting your hand on a covered hot water bottle or microwaved wheat pack, or moving your hand in a bowl of warm water.

Do not use heat therapy on a joint that is hot and swollen as this will make it worse. Instead consider ice therapy to ease pain and swelling

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day. 

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling

Do not put ice directly on to the skin as this may cause a burn.

Exercises

National guidance states that simple exercise to strengthen muscles is helpful in the early stages. The following exercises target those muscles. Repeat just once a day

These exercises are aimed at improving hand pain, function and stiffness. The exercises should be performed at least 3 times per week

Try and perform 10 repetitions of each exercise for the first 2 weeks, increasing to 12 repetitions over the next 2 weeks and 15 repetitions thereafter.

Warm up

1.

Before starting these exercises, warm up your hands by rubbing them with hand cream or soaking them in warm water.

2. Make an “O” sign

In this exercise the outer 2 joints of the thumb should always be slightly bent.

Start by opening your hand as if you are trying to grab a bottle. Then put your index finger against the thumb, bending the joints of the finger and thumb.

Open the hand again before repeating this with the middle, ring and little fingers.

3. Finger Hook

Rest elbow on a table.

Starting with fingers straight, curl the tips of your fingers down into a hook.

Return the fingers to a straight position.

4. Big Knuckle rise

Start with your forearm supported on a table with palm facing down and the finger straight.

Bend your big knuckles keeping the fingers straight. Straighten your big knuckles back to a flat hand.

5. Roll into a fist

Put your forearm on a table.

First bend your fingertips, then the next joint followed by the fist.

Hold this position for a few seconds before straightening the finger joints in the reverse order.

6. Finger stretch

One hand is placed on a flat surface with the fingers spread, while the other hand stabilises the wrist.

Spread all the fingers, including the thumb, holding for 5 seconds. Bring the fingers back together again.

7. Thumb abduction/extension

Place your hand on a table with palm down and fingers straight.

Pull the thumb away from the index finger. Keep the tip of your thumb slightly bent.

Hold this position for 5 seconds.

It may help to rest a pencil against the outside of your thumb to help guide the movement.

Note: This can be made into a strengthening exercise by adding a small elastic band. (as shown)

8. Grip strength

Support your forearm on a table and hold a sponge or soft ball.

Starting at your big knuckles and finishing with your finger tips, curl your fingers to squeeze the sponge/ball as hard as is comfortable. Maintain this hold for 5 seconds.

Splinting

The goals of splinting are to increase stability, reduce pain, decrease inflammation, improve function, and reduce the mechanical stress that may be causing the instability. Splinting generally will not prevent or correct abnormal joint posture, but can provide rest and support.

Compression gloves (as pictured) are widely available online and can add warmth and support to the hand joints. Note the seams are worn on the outside of the glove. These may be hand-washed or machine-washed in an ‘easy care’ load (40 ℃).

Joint protection

Joint protection strategies are also shown to help reduce pain in this condition. The link below will take you to the Versus Arthritis patient information on this subject.

Joint care and protection strategies from Versus Arthritis.

How to manage and prevent future flare ups of Osteoarthritis of the thumb?

There is little you can do to avoid this condition as it is mostly genetic. It can however be aggravated by trauma, e.g. a fall onto the hand. There are a number of ways to manage it and help protect your joint while still remaining active.

Joint protection top tips

General

Use two hands and modify tasks

Spread the load. Adapt objects to create a larger surface area to grip.

Extra grip can be added to pens, cutlery, brushes or hand rails by using tape. Cycle tape is a good option which can be found in a range of colours in cycle shops such as Halfords.

Pace yourself

Take breaks, don’t try to do too much and intersperse heavier jobs with lighter ones. You can achieve more over three days of moderate activity than in one day of doing too much, followed by two days of exhaustion.

Slide, don’t lift

Particularly in the kitchen, try rearranging the locations of items so that you can slide things along sides and work surfaces instead of carrying them.

Warm up before starting the day

If hands are stiff and sore first thing when you wake up, fill a sink with warm and soapy water or apply baby oil and gently exercise and massage your hands in the water.

In the bathroom

Transfer shower gels and shampoo into pump bottles

Pressing down on a dispenser can be an easier motion to perform than squeezing a bottle.

Towelling bathrobes

Since towels can be heavy, try wearing a towelling robe while using a hand towel, rather than relying on a single large towel, or use a micro towel or a tea towel for light quick absorption.

Long handled aids

If you have difficulties reaching underarms to wash, use a long-handled sponge or create something similar by taking a long-handled washing up mop and putting a flannel over it.

A fly swot can be used in a similar way by attaching a flannel over the end piece creating a device to wash your feet and between the toes.

Electric tooth brush

Electric tooth brushes require less repetitive movement from the wrist and hand but teeth are still properly cleaned.

Lever taps

If you have difficulties gripping and twisting yours taps, have lever taps fitted, these can be purchased from a DIY store. You may also be eligible to have them fitted by social services.

In the kitchen

Wringing cloths

Wring a dishcloth by winding it round the tap and then crossing the two ends over each other and twisting.

Cooking vegetables or rice

Vegetables can be bought pre-chopped and kept in the freezer for when you need them. They can be microwaved or steamed alternatively to being boiled, meaning there is no need to lift heavy pans to drain.

Boil in the bag rice or microwavable rice makes cooking it much easier as there is no need to drain the rice.

To cook potatoes, place a metal colander inside the saucepan so that you only need to pick up the colander and potatoes once they are ready. Once the pan is cooled, you can safely pick it up with two hands to dispose of the water.

Opening bottle tops and jars

Use nut-crackers (the type with inside serrations) to unscrew small bottle tops.

Silicon grips can be purchased to help you open jars. Alternatively wear a rubber glove or use a rubber non-slip matt.

Larger grips

Kitchen utensils can be purchased which have large rubber handles making them easier to grip. Alternatively you can wrap tape round the handles or fit on some tubing.

Kitchen knives with saw like handles can also be purchased making cutting much easier.

Thermal mugs

These are insulated so they don’t get hot on the outside – holding a thermal mug by wrapping both hands around it can be more comfortable than holding a standard mug by its handle.

Shopping

Most major supermarkets will deliver to your door if you order online; some will also let you place orders over the phone. Or use a foldable trolley to transport your shopping e.g. www.reisenthel.com

Lightweight appliances

Smaller appliances such as kettles, irons and vacuum cleaners can be purchased in lightweight and compact travel versions.

Making a cuppa

Only fill the kettle with just enough water using a jug; once the kettle has boiled, lift it while keeping one hand on the handle and the other hand on the front with a tea towel to protect against the heat.

Kitchen trolleys

Kitchen trolleys can be used to help transport heavier and larger items between kitchen surfaces or to the table.

Electric gadgets

Let gadgets such as electric razors, toothbrushes and can openers do some of the work for you.

Safety cap bottles

Try using nut crackers on bleach bottles. You can also contact Versus Arthritis or you pharmacist to dispense your medication without safety cap.

Getting Dressed

Fastenings

Replace fiddly buttons with Velcro. You can also do this to your children’s clothing if you dress them.

Zips can be made easier to pull by tying some ribbon on to them.

Putting on coats/jackets  

Jackets/ coats with a silky lining can be helpful as they allow wrists to slip more easily through the arm holes.

Shoes

You can buy coiled shoe laces if you find regular ones difficult.

Long handled shoe horns and elastic laces help to put on footwear.

Examples of helpful gadgets and adapted devices

Pouring Devices

Topster – Milk Carton Pourer

Milk carton pourer from Lakeland

Kitchen and home equipment from Betterware

Adapted Handles

Using pipe lagging or gripoball on handles can increase the surface area of an object making it easier to grip. www.gripoballs.com

Alternatively OXO do a range of utensils with large rubber handles.

www.OXOuk.com

Stockists include: Dunelm Mill, Homesense, Lakeland

Plugs

Easy Pull Plug Removal Aid Amazon

Knitting

Bamboo knitting needles

www.knittingaid.com

Whether you’re right or left handed knit any stitch with complete freedom and support. Use your needles, Ease painful joints, Use one handed.

Dressing

Innovative fastenings make dressing easier for those who may suffer from restricted movement or lack of finger dexterity

www.theablelabel.com

www.peta-uk.com

Etac Butler Buttoner Round. A great helper when buttoning or using a zip

www.etac.com/products/small-aids-for-daily-living

Cutting

The angled handle of these tools keeps your hand and wrist in a natural position, making cutting and grating smooth and simple. Despite being stainless steel they are very lightweight which is ideal for someone who has very weak hands. The “soft-feel” black grip on the handle of the kitchen tools is non-slip making them safer to use with wet or greasy hands. The green “soft-feel” grip on the garden tools has a non-slip waterproof finish making the tools easy to grip even if you have wet hands.

Etac ergonomic knives

Pill cutter

Opening Devices

The JarKey (or JarPop) is a jar opener that opens jars, not by twisting the lid, but by lifting the edge of it, so that the vacuum inside is released. When the vacuum is released, it is easy to unscrew the lid. Jarkey

This One Touch product works as a tin and jar opener.

Multi Opener. Six openers in one. Removes safety seals, metal bottle caps, ring pulls, jar lids, bottle tops and has an enclosed blade for slicing open sealed bags.

Key Grip.

Tap Turner

Wire chip pan basket.

Other information:

More useful tips can be found on the National Rheumatoid Arthritis Society website:

www.nras.org.uk/useful-tips

Wessex DriveAbility – www.wessexdriveability.org.uk  02380554100

Other Stockists examples:

Steamer Trading cook shop- www.steamer.co.uk

Lakeland – www.lakeland.co.uk

Salamander Cookshop Wimborne – http://www.salamandercookshop.com

Poole Mobility – www.poolemobility.co.uk

The Range – www.therange.co.uk

Dunelm Mill- http://www.dunelm.com

Betterware- https://www.betterware.co.uk

Nottingham rehab suppliers- www.nrshealth.co.uk

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