II. Epidemiology
- Hand less commonly affected in Osteoarthritis
- Hand Osteoarthritis is most common in postmenopausal women (esp. age over 70 years)
- Hand most disabling of joints to be involved
III. Signs
- Trapeziometacarpal joint (first carpometacarpal joint at base of thumb, Thumb Base Osteoarthritis)
- Most common site for Hand Osteoarthritis
- Pain, swelling, weakness and decreased thumb base range of motion
- Provoked by repeated gripping, pinching and forceful thumb use
- Treated with NSAIDs (oral, topical), occupational therapy, Thumb Spica Splint
- First Carpometacarpal Joint Steroid Injection in refractory or severe cases
- Heberden's Nodes
- Distal interphalangeal joint (ITP) nodular swelling
- Bouchard's Nodes
- Proximal interphalangeal joint (PIP) nodular swelling
- Mucous cysts may develop at interphalangeal joints
-
First Metacarpal-phalangeal joint (MCP) involvement
- Other MCP joints are generally spared
-
Wrist spared
- Contrast with Rheumatoid Arthritis
IV. Diagnosis: Hand Osteoarthritis Diagnostic Criteria (American College Rheumatology)
- Hand pain, aching or stiffness and
- Two DIP or PIP joints with hard tissue enlargement and
- Less than 3 swollen MCP joints
- One of the following
- Two DIP joints with hard tissue enlargement or
- Deformity of two DIP, PIP, or MCP joints
- References
V. Imaging
- See Hand XRay in Osteoarthritis
- May demonstrate Osteoarthritis severity (osteophytes, joint space narrowing)
VI. Management
- See Osteoarthritis
-
NSAIDs
- Oral NSAIDs (caution in older patients, renal disease, Peptic Ulcer Disease)
- Topical NSAID (e.g. Diclofenac Gel)
- Intermittent Splinting
- Thumb Spica Splint for Thumb Osteoarthritis
- Moist heat
- Occupational therapy
- Local Corticosteroid Injection
- Contrast Baths
- Surgery for resistant cases
- Arthroplasty
- Arthrodesis