Management of Osteoarthritis: Conservative and Surgical Management for Hand and Wrist

Managing osteoarthritis in the hand and wrist can be very debilitating for patients.

Osteoarthritis in the hand and wrist can be very debilitating for patients, who are often confused and lost with the conflicting opinions between conservative and surgical treatments. Physical therapists carry a lot of influence in helping patients decide on the best course of action, so it’s extremely important for them to understand both the conservative and surgical options for PT management of osteoarthritis.

This article will act as a guide for rehab professionals in understanding osteoarthritis in hands and wrists, conservative and surgical management strategies, assessment, and optimal interventions.

Recommended course: Conservative and Surgical Management of the Osteoarthritic Hand and Wrist

Understanding osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease where tissues within the joint break down over time. It is the most common form of arthritis. The CDC reports 32.5 million Americans suffering from the condition, with the hands being one of the most common places for osteoarthritis.

There’s no clear reason why osteoarthritis happens, but research is consistently developing new findings. These results allow rehab professionals to more effectively treat their patients.

Causes of osteoarthritis

The exact cause of osteoarthritis has proven to be a difficult thing to pinpoint. Its development is likely influenced by a combination of genetic, biomechanical, and environmental factors given its complexity.

A key factor is thought to be defective collagen in the joints, which increases the chance of articular cartilage becoming injured from different forces (like mechanical loading). This injury can cascade into a cycle of progressive deterioration and inflammation, resulting in joint pain, stiffness, and disability.

Osteoarthritis risk factors

There is a wide variability in how different risk factors affect the likelihood of osteoarthritis forming in someone’s hands or wrists. It’s also important to note that there are both risk factors outside a person’s control and within their control. These risk factors include:

• Age: Approximately 70% of people suffering from osteoarthritis are above 55.
• Genetics: Certain genetic variations may influence the structure and integrity of joint tissues, making some people more prone to the development of OA.
• Joint trauma: Overusing or repetitively stressing hands and wrists through occupations and activities can contribute to osteoarthritis. Plus, joint trauma can cause injuries to ligaments and cartilage that lead to osteoarthritis in the future.
• Obesity: Excess weight puts increased stress on your joints, which holds true for the hands and wrists during movements where one holds or pushes themselves up. There may also be metabolic effects that increase the risk of OA associated with obesity.
• Gender: The WHO reports that approximately 60% of those living with OA are women.

Pathophysiology of osteoarthritis

Osteoarthritis is typically progressive and can cause inflammation, damage to bones, and cartilage deterioration. A common series of events include:

• Articular cartilage degeneration: The cartilage in the hands and wrists erodes, with a loss of proteoglycans and collagen fibers. This leads to friction and joint damage.
• Bone changes: With insufficient cartilage to cover them, bones rub together and can form osteophytes.
• Synovial inflammation: This contributes to more pain, swelling, and cartilage breakdown.
• Soft-tissue involvement: Muscles and ligaments around the hands and wrists are also affected, possibly leading to joint instability.

PT management of osteoarthritis: Assessment for hands and wrists

Physical therapists must keep the complex nature of osteoarthritis in mind when assessing patients for hand and wrist osteoarthritis. They should aim to understand the relationship between different risk factors.

Patient history

Rehab professionals must closely examine the patient’s personal situation, and explore:

• Family history: Does the patient’s family have a history of osteoarthritis?
• Occupation: Do factors at work contribute to the development of osteoarthritis?
• Social history: Are there any extracurricular activities (such as sports) that put the patient at risk?
• Symptoms: Is the patient reporting stiffness and pain first thing in the morning? How long does it take to resolve? What eases the pain? Is the pain anywhere else in the body? When is the inflammation at its worst?
• Drug use: Includes recreational drugs, supplements, and medicines.

Pain assessment and physical assessment

Assess the pain levels at baseline (before intervention) and during stress, such as when the patient lifts or grips an object. Using pain scales helps determine the patient’s response to treatment. It can also help them self-manage when doing activities outside the clinic.

A physical assessment needs to look at the following points for the affected joints:

• Appearance: Swelling, Bouchard’s nodes, Heberden’s nodes, etc.
• Palpation: Pain on palpation (POP), stiffness, hardness, etc.
• Range of motion: Establish a baseline, monitor for progress.
• Strength: Through manual testing and/or handheld dynamometer. Note pain upon exertion.
• Provocative tests: Safely apply irritative forces.
• Functional capabilities: Assess hand and wrist function through different activities such as gripping, holding, and small finger movements.

Conservative PT treatment of osteoarthritis in the hand and wrist

The goal of treatment should be to maintain/progress functionality and manage discomfort/pain. Conservative treatment may include a combination of the following:

• Patient education: Effective education empowers hand/wrist OA patients to manage daily activities. It addresses pain, functional limitations, and the use of adaptive equipment in treatment.
• Adaptive equipment: This may include immobilizing orthoses or supportive orthoses, which reduce joint forces.