What are some effective treatments for osteoarthritis?

DEAR DOCTOR K:

I have osteoarthritis of my hands. Are any treatments particularly effective for this condition?

DEAR READER:

Osteoarthritis causes stiffness and pain in the joints. It develops when cartilage — the tissue that covers the ends of bones — deteriorates. In the hand, osteoarthritis usually strikes the joint at the base of the thumb and the last joints before the tip of the fingers.

Here are some of the best ways to manage pain and improve function in your hands:

SPLINTING. The first line of action is to immobilize the painful joint with a splint. This gives the joint a chance to rest so the pain can subside.

ADAPT DAILY TASKS. Specialized products and assistive devices allow you to perform daily tasks without putting additional strain on your hands. For example, use an electric can opener or an electric toothbrush instead of the manual versions. Or wear slip-on shoes to avoid the hassle of tying shoelaces.

HEAT OR COLD THERAPY. Taking a warm bath or shower or soaking your hands in warm water can ease pain and stiffness. After exercise or exertion, cold therapy may work better. Place a bag of ice or frozen vegetables wrapped in a towel on the painful joint, or use a freezer gel pack.

EXERCISE. Therapeutic exercises, especially range-of-motion exercises for the thumb and wrist, help keep hand joints working as well as possible. (I’ve put examples of range-of-motion hand exercises below.) A hand physical therapist can recommend gentle, pain-free strengthening exercises once inflammation and pain have subsided.

TOPICAL MEDICATIONS. Topical medications are creams, ointments or gels that are applied directly on the painful joint. One prescription gel, diclofenac (Voltaren), offers modest relief for hand arthritis. Other gels and creams are available over the counter and by prescription. They haven’t been studied as thoroughly, but some people find them helpful for mild to moderate pain.

ORAL MEDICATIONS. For more severe pain, drugs taken by mouth are typically more effective. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin) and naproxen (Aleve), relieve pain and inflammation.

CORTICOSTEROID SHOTS. For short-term relief, your doctor can inject corticosteroids directly into a joint to relieve pain and inflammation. Overuse of injections can increase damage within the joint.

ALTERNATIVE THERAPIES. These therapies include yoga, acupuncture and dietary supplements. Some people find that they work well, while others experience little or no benefit. Particularly if these therapies have helped you with other types of pain, they would be worth considering for osteoarthritis of your hands.

Our hands are remarkable. Compared to other animals — particularly the various types of monkeys to which we are most closely related — we can do more with our hands. You don’t realize how important your hands are until you have a medical condition that affects how they function.

Osteoarthritis of the hands doesn’t cause major deformity of the hands like rheumatoid arthritis can. But it can make the things you love to do — cooking, gardening, playing a musical instrument — harder to do. Fortunately, you should be able to get considerable relief.

Range-of-motion exercises

Your muscles and tendons move the joints through arcs of motion, as when you bend and straighten your fingers. If your normal range of motion is impaired—if you can’t bend your thumb without pain, for example—you may have trouble doing ordinary things like opening a jar. These exercises move your wrist and fingers through their normal ranges of motion and require all the hand’s tendons to perform their specific functions. Hold each position for five to 10 seconds. Do one set of 10 repetitions, three times a day.

wrist-extension

Wrist extension and flexion

  • Place your forearm on a table on a rolled-up towel for padding with your hand hanging off the edge of the table, palm down.
  • Move the hand upward until you feel a gentle stretch.
  • Return to the starting position.
  • Repeat the same motions with the elbow bent at your side, palm facing up.

wrist supination

Wrist supination/pronation

  • Stand or sit with your arm at your side with the elbow bent to 90 degrees, palm facing down.
  • Rotate your forearm, so that your palm faces up and then down.

wrist-ulnar-radial

Wrist ulnar/radial deviation

  • Support your forearm on a table on a rolled-up towel for padding or on your knee, thumb upward.
  • Move the hand straight up and down.

thumb-flexion

Thumb flexion/extension

  • Begin with your thumb positioned outward.
  • Move the thumb across the palm and back to the starting position.

hand-finger

Hand/finger tendon glide

  • Start with the fingers extended straight out.
  • Make a hook fist; return to a straight hand.
  • Make a full fist; return to a straight hand.