The most common forms of arthritis to affect the wrist and hand are osteoarthritis and rheumatoid arthritis.
Osteoarthritis (OA) is a condition characterized by degeneration of the cartilage that forms joints. It most commonly occurs in people over the age of 60yrs. When OA occurs in the hands can produce bone spurs that may give the follow sign and symptoms:
- Joint stiffness
- Difficulty grasping objects
- Grinding and grating sensation with movement (crepitus)
- Bumps at the end of the fingers (Heberden’s nodes) and bumps on the middle joint of the fingers (Bouchard’s nodes)
- Mis-aligned and deformed finger joints
Joint mobilization and soft tissue techniques to the hands may be useful in reducing pain. Finger and hand exercise to improve nourishment to the joints are helpful. Supplements such as glucosamine, chondroitin, rosehip and omega 3 fatty acids may be of benefit to some people.
Rheumatoid arthritis (RA) is seen most frequently in women of middle age and is characterized by periods of flare-ups and remission.
Chiropractic care to effected joints is best applied during the remission periods. This is also the time to be more active with exercises to improve joint function. Using ‘hand putty’ to improve wrist and hand strength can be helpful.
During flare-ups, on-the-other-hand, it is best to reduce activity in the effected joints and use ice packs often.
As always, if a natural approach is effective, this the preferred option. Omega 3 fatty acids (such as those in fish oil), Vit D and Quercetin (a flavenoid and antioxidant that is found in many fruits, berries, and vegetables) may be helpful.
In more advanced cases, medical management under a rheumatologist may be required.
Carpal Tunnel Syndrome
CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome (CTS) is a condition in which the median nerve becomes irritated or compressed as it passes through the wrist (the carpal tunnel).
The symptoms of CTS relate to the functions of the median nerve and include:
- Numbness, pins and needles (parathesia) affecting the thumb side of the hand. This is the most common symptom and classically occurs at night and relieved by shaking the hand
- Wrist and hand pain – not as common as numbness
- Loss of grip strength
- Muscle wasting (atrophy) of the thumb muscles
Possible causes of CTS include:
- Unknown (idiopathic) – in most cases the cause is unknown
- Repetitive hand use – such as typing or using a screw-driver
- Pregnancy – due to fluid retention
The history and physical examination give a lot of information to support the diagnosis. Some physical tests include:
Tinels Sign: Taping on the wrist over the median reproduces numbness in the hand
Phalen’s Maneuver: Forceful flexion of the wrist (pushing palm closer to forearm) reproduces numbness in the hand
The most accurate diagnosis for CTS is a nerve conduction test that measures the speed of nerve conduction either side of the carpal tunnel.
Individuals with CTS may respond well to chiropractic adjustments to the cervical spine (neck). This is thought to be due to double crush syndrome, where irritation of the nerve branches contributing to the median nerve in the neck, increase sensitivity of the nerve to compression at the wrist.
Other useful ways to reduce pressure on the median nerve include:
- Wearing a wrist brace (especially at night) to prevent over flexion compressing the median nerve
- Improved ergonomics at computer and other healthy habits
- Turmeric, omega 3 fatty acids and Vit B6 may be beneficial, though this has not been proven scientifically
Medical approaches include corticosteroid injections and carpal tunnel decompression surgery.
Deputren’s Contracture is a thickening and shortening of the tissues on the palm side of the hand and fingers. It has no known cause and is usually painless. It typically starts as a lump that develops over time into a ropey contracture that makes it difficult to straighten the fingers.
It is more common in men over 40. You have an increased risk of acquiring Deputren’s contracture if you are a smoker, diabetic or a heavy drinker.
Stretching, mobilization and hot baths can help to maintain flexibility and reduce progression. In advanced cases surgery may be required.
A ganglion cyst is a swelling that can occur at the wrist, hand and foot. It is caused by a protrusion outwards of a weakened joint capsule or tendon sheath.
It may vary in size from day to day, often becoming larger with activity.
Although ganglion cysts can be painful, they often produce no pain, and may disappear by themselves over time.
In some cases wrist mobilization and soft tissue techniques are helpful. Firm pressure on the cysts may help disperse the fluid.
It has been referred to as a Bible cyst as treatment in earlier times was to bash the ganglion with a Bible!
Tenosynovitis involves inflammation of the sheath that surrounds tendons. This sheath is found in the hands, wrists and feet.
This produces pain, swelling and stiffness of joint movement. When this affects the tendons of the thumb it is known as De Quervain Syndrome.
It can be caused by repeated use of mechanical tools, inflammatory arthritis or injury.
A diagnosis is usually made based on clinical presentation. X-rays or blood tests may be useful to rule out various forms of arthritis.
Management typically involves reducing stressful hand actions that aggravate the condition, ice and rehabilitative exercise.
Trigger finger is a disorder characterized by the locking or catching of one or more fingers as they close to make a fist. With forced movement or stretching the finger may then suddenly release (like the trigger of a gun). This is often, but not always, associated with pain.
The condition is medically known as stenosing tenosynovitis. The cause is usually unknown, though it has been associated with rheumatoid arthritis.
Mobilization, stretching and massage are often helpful.
A sprain is defined as the over-stretching of ligaments, and the wrist is a common site for this type of injury. This is usually the result of a fall onto an outstretched hand.
As with all sprains the approach to management takes place in two parts:
Acute Phase – focus is on Rest Ice Compression and Elevation (RICE).
Healing Phase – focus is on mobilization and soft techniques and strengthening exercise.