Treatment For Osteoarthritis In The Hands
Keeping Your Hands Fully Functional...
The Short Answer
Painful hands? Weakened Grip? Diagnosed With Osteoarthritis? To stop it getting worse and start controlling your symptoms, you need to start some form of dedicated treatment for osteoarthritis in the hands.
Now is the time to form a treatment plan to restrict the pain and stop the progress of osteoarthritis. Our pain specialist reviews the treatment options for osteoarthritis in the hands.
Need help? Helprelievepain has the answers, the question is which ones will work best for you?
Finding The Right Solution For You…
Sadly there is no known cure for osteoarthritis in the hands, so good treatment revolves around 3 key principles
- Reduce the pain
- Increase your hands mobility (if it is restricted yet)
- Strengthen the surrounding ‘joint matrix’ to give your hand joints better support
The key to finding the best treatment for osteoarthritis in the hands, is to be willing to try a number of different approaches.
As we’ve explained at length in other sections on this site, pain is subjective – what works for you won’t necessarily work for someone else and vice versa.
Furthermore, there is very rarely one single, best treatment. In truth, you fill find a number of different treatments will work for you and the key is to use as a single approach.
For example, you may find self hypnosis worked really well for reducing your brain’s transmission of the pain, while your physio therapistist gave you some great exercises to strengthen your hands. Align this a hot wrap for the end of hardworking days and an OTC painkiller tucked away as an emergency and you may have your solution.
I always try to explain it as thinking of a shopping basket of goods. As you try things, you find some you like and some you don’t.
Eventually, you only buy the combination of those that work best (or taste nicest) for you – and those make up your personal treatment plan.
Please Note – Your hands are a different biomechanical structure to your fingers. For this reason, we have dealt with treating them separately. If you wanted treatment for osteoarthritis in the fingers, please see our other articles.
Treatment For Osteoarthritis In The Hands –
Over-The Counter Medications
Acetaminophen (Paracetamol). Various brand names including Tylenol. This is generally considered a safe medication to use for mild painkilling. It is an easy drug to have in the cupboard for use in case the pain of your hand osteoarthritis has a really bad day.
Over-The-Counter NSAIDs. Some ‘non steroidal anti inflammatory drugs’ such as Naproxen or Ibuprofen can provide more intense pain relief and still be purchased over the counter.
However, in more recent years the danger of taking NSAIDs such as ibuprofen has been revealed (LINK TO IBU PAGE), partly due to their inherit ability to thin the blood, which isn’t always a good idea.
Capsaicin Cream. There are a range of topical pain relieving creams on the market today, but I’ve chosen capsaicin cream as one of the most common on the market.
Made from chilli peppers this is a fast and highly localised option for treating the pain of osteoarthritis in the hands. They are generally considered very safe and can be effective, if only for a short period of time.
Prescription Strength NSAIDs. If your family doctor prescribes you a drug as treatment for osteoarthritis in the hands, it is most likely they will choose one of these, if you’ve already tried Naproxen.
They are more effective than a Naproxen or an Ibuprofen, but they come with a much higher side effect profile and their use will need to be monitored by your doctor. They can be broken down into two categories
Cox 2 Inhibitors – The newer class of NSAIDs, they reduce inflammation and in doing so, reduce your pain.
However, although they are supposed to carry fewer stomach problems than a standard NSAID, several have been withdrawn due to safety concerns over the incidence of heart attacks and strokes.
At the current time, (to my knowledge) only Celebrex is still licensed in the US and Celecoxib/ etodolac are the only two in the UK.
Corticosteroids. These are another potential choice and include cortisone and prenisone.
They need to be injected however, so would require a referral to a hand surgeon (depending on the skill of your family doctor).
Opioids. In more advanced cases of osteoarthritis, opioids such as morphine or tramadol are increasingly being prescribed.
These are far from ideal as they come with many side effects (see ‘Severe Pain Medication’), but they do offer extreme pain relief if nothing else will work.
2. Lifestyle Changes
- Exercise Regularly
- Lose Weight
- Try An Anti-Inflammatory Diet
This may seem a strange solution if you still believe that osteoarthritis is purely caused by wear and tear.
However, new medical understanding of the causes of osteoarthritis puts it down to damage of the entire joint matrix – including the muscles, tendons and ligaments.
Specific hand exercises, designed to build up strength in your hands, will strengthen those supporting structures and not only give the joints in your hands better support, but also help to repair the surrounding structure that should slow down the progression of your osteoarthritis.
Stoffer-Marx et al (published in ‘Arthritis Research & Therapy’) found that improving grip strength could saw an increase in patients satisfaction with their treatment.
If money is tight, exercise is also very often the most cost effective treatment for osteoarthritis in the hands.
This is not quite as important with hand osteoarthritis as it is with knee or hip osteoarthritis, but it is still a factor.
It is not the weight-bearing aspect that’s a problem, but the fact that being overweight still leaves you carrying more ‘inflammatory components’ and therefore more predisposed to suffering with inflammation anywhere in your body.
Given that one element of hand osteoarthritis is the inflammation, losing weight can still have a surprising effect (just not as much as if the benefit was reduced weight bearing plus reduced inflammation).
Qin et al in ‘Arthritis & Rheumatology’ calculated that the lifetime risk of hand osteoarthritis was 11% higher in obese individuals (47% vs 36%).
Try An Anti-Inflammatory Diet.
Even if you are normal weight, there are still some changes you can try to impact your hand osteoarthritis. Anti-inflammatory diets do not work for everyone and some people see such marginal gains, that they decide the sacrifice is not worth it.
However, some patients also swear by an anti-inflammatory diet to reduce the swelling and help control the pain. I have covered the benefits of an anti-inflammatory diet in much more detail here ‘Following An Anti-Inflammatory Diet’
3. Self-Administered Treatments
Hot And Cold Therapy
Heat therapy is a great to soothe sore hands, particularly at the end of a long, hard day. Unlike your hips for example, your hands are easy to increase in temperature either by soaking them in hot water or using a hot wrap.
The effect of the heat increases blood flow to your hands, theoretically improving healing at least in your surrounding tendons, ligaments and muscles.
For extra benefits, start with 20 minutes of cold therapy which will help to reduce any painful inflammation and swelling, then follow it with 20 minutes of warm therapy – a real tonic for painful hands.
Perhaps one of the most under-rated pain relievers of all. The power of hypnosis can make people believe amazing things.
Self hypnosis is about learning to describe your pain in ways that tell your brain it’s not as painful after all.
The placebo effect and the Feldenkrais method are both successful examples of pain relief achieved through mental repositioning.
The placebo effect in particular is recognised across the world as interference from the pain, whereby taking an empty tablet actually convinces the brain to reproduce the effects it was expecting to get from it.
This is so common, that it has to be factored in to clinical trials by running a control group with the same regime/ tablets but not containing anything. This is so the ‘placebo effect’ can be taken out of trial results and we can assess the ACTUAL benefit of the drugs ingredients.
The point is the brain turns the bodies’ messages into literal pain.
If the brain chooses to, it can literally switch off these messages and hugely turn down your pain.
Aromatherapy is probably the oldest medicine of all time, using numerous essential oils – similar to humanities’ very first efforts at medicine and an ingredient in some of todays’ blockbuster drugs.
Various oils such as lavender oil and peppermint oil have clinically proven analgesic effects and lavender oil has even proved very successful at treating osteoarthritis LINK???
Furthermore, aromatherapy isn’t just about inhaling the essential oils, there re plenty of topical creams containing the oils that can be rubbed in to painful hands to provide a high level of pain relief.
Please see ‘lavender oil for arthritis’ for more details.
Cognitive Behavioural Therapy
CBT as it is commonly referred to, is basically about taking a big problem that seems impossible and turning it in to bitesize tasks that are fully achievable.
It helps be giving you much greater direction and a plan, rather than giving up because a problem seems just to big to overcome.
In the case of treating hand osteoarthritis, it may be that it has stopped you playing golf because you cant hold a golf club properly.
Rather than giving up, the CBT approach would be to write the big problem (cant hold a golf club) and write down why you cant (pain, lack of strength, locking hand).
Next you write down potential solutions against each – for pain maybe you try 4 different solutions (painkillers/ aromatherapy creams/ physiotherapy and hot/cold therapy).
Then you put together a strength building exercise program for your hands and allow yourself 16 weeks to do it. Every 4 weeks, you chart your progress in terms of exercise and reps you’re now able to complete and assess the effect of a different pain control regime.
By the end of 16 weeks, you should have the best 2 pain relief treatments to start using together and much stronger hands. You could then try to swing a club again.
If this still causes a problem, your 3rd option could be to consult a professional golf coach about changing your grip on the club.
Basically, CBT is putting a plan together to break one big problem into small tasks. Seems simple maybe, but it does work!
There is limited evidence about whether acupuncture really works, but if we assume that it could, then it should be worth a try.
Acupuncture involves placing needles in nerves to either dull the pain or stimulate healing. It is likely to be more effective in your hands than some other areas, due to the slim nature of the hand, ensuring the target nerves are available close to the skin.
Keep A Diary
Stress is well known for increasing pain. Even in the hands, poor sleep and stress are likely to heighten your brain’s perception of the pain you feel.
A lot of stress comes from daily activities getting out of our control or not being able to achieve what we used to (pre osteoarthritis). By keeping a diary you can plan ahead much better, avoiding potentially stressful events and planning your activities so you achieve small steps everyday and don’t get frustrated.
There is substantive evidence that fish oil can help with a range of types of arthritis. The same is also true for osteoarthritis.
The theory is that the oil can help to lubricate the joints and, if nothing else, fish oil supplements will still improve your general health.
Splinting can add much needed stabilisation to a weakened hand. This could be by stabilising your knuckles or by stabilising your hand to your wrist or even your arms.
Many people find braces or supports at night to be essential in getting a better nights’ sleep.
If you keep a diary as mentioned above, you should also plan in to have regular, periodic rest periods.
Osteoarthritis is well known for getting worse during the day, principally because your weakened hands get tired.
It may not strike you as a designated treatment for osteoarthritis in the hands, but you’ll be surprised – especially if you work with your hands (either physically or on a computer).
Having a planned, designated break every or two for 30 minutes, could make a big difference.
4. Arthritis Gloves
I’ve included arthritis gloves as a separate section because I wanted to comment separately on these. While it would be easy to list these as another ‘potential’ treatment and suggest you try a pair, I cannot do so.
There simply is no evidence that these gloves have any benefit for hands suffering with osteoarthritis. The theory is that they are infused with copper and by wearing them, the copper eases your pain.
This may be a nice idea, but as a pain specialist I rely on clinical data to support their use. With many ‘alternative therapies’ such as hypnosis or aromatherapy I can show clear evidence that they work.
With so-called ‘arthritis gloves’ this simply isn’t the case. I can say that they do work for a few people (a placebo effect), but every time a fair trial has been carried out against plain ‘non infused’ gloves, the results have been inconclusive.
In other words, the copper ‘arthritis’ gloves showed no improvement over the non-infused ones.
I see a lot of people/ sites trying to recommend these, but I cant even bring myself to do the same. The integrity of this site is worth more than that. They just don’t work.
Wearing well fitting gloves with no copper in can have some benefits both from a compression perspective and a soothing structural stability one.
But the copper element is more myth than mythical.
Visiting a physiotherapist can help in building up strength in your hands and supporting joints. They can ensure you are performing exercises for your hands that will both increase the mobility and strength of your joint.
Their services range from as simple as massaging your hands to provide pain relief, up to giving you a whole range of specific hand-strengthening exercises to practice daily.
6. Occupational Therapy
An occupational therapist can visit your home to assess your present situation, look at which activities your hand osteoarthritis is causing you to struggle with and try to suggest some ways in which you can achieve the activities you want.
This could be opening doors, that may be much easier to operate with different, easy-to-open handles or advice on using two hands to perform different activities, to relieve the pressure on one.
They may also offer further advice on splinting and a range of supportive devices to make your life easier.
7. Painkilling Injections
This involves injecting hyaluronic acid into the painful joint(s) in your hand. The idea is that the thick fluid re-lubricates your joint replacing lost synovial fluid and helping to prevent your bones rubbing together. This is not that common anymore, but is still available.
This is the most common form of pain relieving injection, involving the injection of a corticosteroid such as hydrocortisone. Such injections can cause immediate short-term pain relief, but are definitely not recommended long-term as they will weaken your tendons and ligaments.
8. Hand Surgery
As mentioned, there are no known cures for hand osteoarthritis and, in truth, the surgical options are also somewhat limited.
Surgery is always a last resort and this is particularly true with hand osteoarthritis.
A dedicated hand surgeon will have basically two options available –
Joint fusion (arthrodesis)
Fusing two bones together, effectively eliminating the joint altogether.
Great for pain relief, but you will not be able to flex your joint anymore.
This involves removes whichever joint is damaged and replacing it with a prosthetic replacement. Typical areas for this in your hand would be your knuckles or the base of your hand.
The Final Word –
It can be very difficult to select the best treatment for osteoarthritis in the hand. Ideally, you want something topical that treats your hand locally, but it’s important to also achieve the 3 goals – pain relief, mobility and strength building.
Sadly, no single treatment can really boast all three. Painkillers are great for pain relief, but come with considerable downsides, as do corticosteroid injections.
Self-hypnosis has delivered great results for pain relief, but warm wraps are better for increasing mobility as is physiotherapy.
Then there are specific exercises that help to build up your strength and if you can throw all of these into a plan then CBT (cognitive behavioural therapy) could give you a plan to keep your lifestyle very similar and stop osteoarthritis from taking fun activities away.
If you struggle with this, an occupational therapist can advise on how to make your home and life much more osteoarthritis- friendly, as will splints and supportive equipment.
Once you’ve tried all of that, you’ve have a good idea of what works for you and what doesn’t and your hand osteoarthritis may finally be under some control.
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References Used –
1. Michaela A. Stoffer-Marx, Meike Klinger, Simone Luschin, Silvia Meriaux-Kratochvila, Monika Zettel-Tomenendal, Valerie Nell-Duxneuner, Jochen Zwerina, Ingvild Kjeken, Marion Hackl, Sylvia Öhlinger, Anthony Woolf, Kurt Redlich, Josef S. Smolen & Tanja A. Stamm. (Nov 2018). Functional consultation and exercises improve grip strength in osteoarthritis of the hand – a randomised controlled trial. Arthritis Research & Therapy
2. Jin Qin ScD, Kamil E. Barbour PhD, Louise B. Murphy PhD, Amanda E. Nelson MD, Todd A. Schwartz DrPH, Charles G. Helmick MD, Kelli D. Allen PhD, Jordan B. Renner MD, Nancy A Baker ScD, and Joanne M. Jordan MD MPH. (May 2017). Lifetime Risk of Symptomatic Hand Osteoarthritis: The Johnston County Osteoarthritis Project. Arthritis & Rheumatology.