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LETS TALK ABOUT HAND OSTEOARTHRITIS (OA)!

28/4/2023

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Can it be predicted, does Rock Climbing or cracking your knuckles cause hand OA? And what can we do to manage OA once we have it? Read on to discover more….

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 How handy would it be if you could actually predict your likelihood of developing hand Arthritis


​​Well now you actually can predict the future using a prediction tool to get an estimation of your likelihood of developing hand OA over the coming 12 years. This tool is still being validated for females, but is thought to be reliable for use by males aged 35-70 years old who don’t currently have OA in their hands. The tool uses your age, weight, height, education, work level, sleep quality, weekly physical activity and general health to determine your probability of developing hand OA in 12 years time.
 
What risk factors did they identify?

As you would expect, greater age as well as heavier work, were found to increase your risk for both sexes. But interestingly this study also found that in men increased BMI (Body mass Index) and poor sleep quality also have a negative effect. Whilst in women the relevant risk factors were increased BMI, and a sedentary lifestyle. To minimise your risk, your doctor could refer males to a sleep specialist or recommend obese clients see a nutritionist. 

The lifestyle factors give us yet another good reason to follow the WHO (World Health Organisation) 2020 guidelines for Physical activity: For adults aged 18-64: WHO recommends at least 150 -300 minutes of moderate activity or 75-150 minutes of vigorous intensity exercise per week. For older adults they recommend at least 3 sessions per week of moderate intensity exercise including strength and balance training.

Is there a link between hand OA and rock climbing?

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It is generally accepted that rock climbers have thicker pulleys, collateral ligaments and capsules in their finger joints as well as bone adaptations. A 2022 study followed an elite rock climber over 10 years and found that bone thickness and osteophyte size did increase over time. As a result, the climber presented with morning stiffness but no pain.
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Previous research has indicated that 84% of rock climbers present with signs of OA particularly in the middle finger. It is thought that the crimp position used by 90% of climbers contributes to the issue. Although is important to note that findings on Xray do not always correlate with symptoms
So would I recommend to my clients that they avoid rock climbing to prevent osteoarthritis? Probably not. Especially given that their participation is likely to assist them meeting their WHO guidelines for physical activity.


So can cracking your knuckles cause OA?

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​Researchers in 1990 reviewed 300 participants over the age of 45. This included 74 regular knuckle crackers and 226 who didn’t. The researchers found no significant difference in rates of OA between the two groups. So that’s good news for the knuckle crackers but not such good news for those of us who have to listen to them cracking their fingers. Ewww!

But I already have hand arthritis?  What can I do to manage it?

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Conservative treatments for hand OA include:
  • education regarding how to protect your joints -modifying activity, aids and equipment,
  •  learning how heat and compression can assist with your symptoms,
  • how and when to exercise your hands, as well as
  • prescription and fitting of custom splints and braces
  • warm paraffin wax bath and hand massage
 
Other interventions your GP may recommend:
  • Medications to manage the joint inflammation and pain,
  • Injections of steroids into the affected joint
  • Refer you to a hand surgeon
 
Please get in touch if you would like a customised management plan for your arthritis.

Many thanks to handyevidence.com for the informative research updates and inspiration
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DON’T WORRY IT’S JUST FRACTURED……

1/11/2022

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​So what is the difference between a fracture and a break anyway?

Essentially there is no difference and the terms can be used interchangeably. Both terms mean that there has been a loss of integrity to the bone, varying from a slight crack, to a bone that has been broken into many, many pieces.
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Of course, some bone injuries are more serious than others. The below pictures are 15 examples of different types of fractures/ breaks. Every single upper limb fracture needs to be individually assessed, managed and protected to permit healing including small finger fractures.
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​HOW CAN I TELL IF I HAVE A FRACTURE?


​Common signs of a broken bone are:
  • bruising,
  • swelling, pain,
  • loss of motion and
  • tenderness to touch.

However, as AMAZING as we are, your doctor or hand therapist does not have XRAY vision! ​It is impossible to know if a fracture is present without doing an Xray, or CT or MRI scan.

Occasionally your fracture may not appear on an initial Xray for a variety of reasons, so if your symptoms persist please follow up again with your health professional for further assessment
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​FRACTURE TREATMENT OF THE UPPER LIMB


​The seriousness of any broken bone and the way your health professional decides to manage it is determined by several factors:
  1. the type of fracture you have,
  2. whether it is in a good position and
  3. whether it is likely to move position

Options for protecting and keeping your fracture still include:
  • slings
  • off the shelf splints
  • custom thermoplastic splints
  • plaster or fibreglass casting
  • buddy tape
  • displaced fractures may require manipulation of the bone position
  • unstable fractures may require surgery to hold the broken segments in place with wires, screws or plates.

The length of immobilisation will depend on the bone involved (legs tend to take roughly double the time of arm bones), as well as the type of fracture and the age of the patient.
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Children tend to heal faster, whilst scaphoid fractures (a bone in your hand) can take an especially long time to heal if the bone’s blood flow is affected. Most upperlimb (arm) fractures will be protected / immobilised for about 6 weeks.

​TYPES OF FRACTURES


The above picture gives you some idea of the many types of fractures that can occur. Just to complicate things, sometimes real life fractures can fit more than one of the above categories.
 
Open fracture
An open fracture is when the skin and tissues between the bone and the skin have been damaged and there is a risk of infection. These fractures will require washing out, manipulation back into place, antibiotics and immobilisation with a plaster.
 
Displaced fracture
If the bones have moved out of position you are more likely to need the bone to be manipulated or to require surgery and a plate, screw or wires to keep the bones in position.
 
Comminuted fracture
A comminuted fracture is a more complex break with more than 3 fragments. These can sometimes require surgery but that is not always possible due to the number of bony fragments, and a plaster can still sometimes be the best option.
 
Avulsion fracture
An avulsion fracture is often sustained when a joint is hyperextended or dislocated. When this happens the ligament or tendon is over stretched and instead of breaking, the ligaments detach a small fragment of bone from where it attaches to the bone.
 
Breaks affecting the joint line
Doctors look very closely when a break crosses through the smooth surface of a joint. If the surface of the joint becomes irregular (due to a piece of bone being out of position) people are more likely to have stiffness, pain and longer term risk of joint arthritis.
 
Growth plate fractures
Children’s bones grow from sections called growth plates. These are made of softer cartilage which hardens into bone at around 13-15 years old for girls and 15-17 for boys. It is important to identify growth plate fractures because damage could cause the bone to stop growing early or to grow unevenly
 
Stress fractures
These are tiny cracks in the bone caused by repetitive force and overuse. The most common ones that we hear about are in the feet of long distance runners, but they can also occur in people who have a condition called osteoporosis whose bones are weaker than usual.

Our bones normally adapt to increased load through a process called remodelling. This is a process of continual bone reabsorption and creation but if we increase our training too quickly our bodies cannot keep up and the bones become weakened and develop micro fractures.
 
Greenstick & buckle fractures
A greenstick fracture is when a bone bends and cracks instead of breaking into separate pieces and is most common in the flexible bones of children under 10 years old.

A buckle fracture is an incomplete fracture where the pressure causes a bulging of the bone at the site of injury. This is also very common in younger children who’s bones are more flexible.

Because the children are younger and heal more quickly immobilisation time is often shorter and more like 3 weeks (instead of 6).
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SO WHAT’S MY ADVISE IF YOU SUSPECT A FRACTURE?


  1. Get an Xray - we do not have superpowers
  2. take all finger, hand and wrist fractures seriously & see a professional who is familiar with managing these injuries such as a hand therapist
  3. remember even if your Xray is negative, that only excludes a bone injury.

Many soft tissues such as ligaments and tendons can be damaged during trauma. They also require expert care to ensure a full and timely recovery. Your hand therapist can help you achieve the fastest recovery and can frequently diagnose your soft tissue injury without further imaging being required.
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Looking forward to helping you in your recovery 
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HAVE YOU HEARD OF GYMNAST'S WRIST?

3/9/2022

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What is 'Gymnasts wrist'?

Gymnasts wrist is irritation and inflammation of the growth plate at the end of the forearm bone where it connects to the wrist. In children the bones grow from areas called growth plates which are made of softer and more vulnerable cartilage than mature bone.

What causes gymnast's wrist?

Gymnasts wrist is essentially an overuse injury that occurs in up to 40% of young gymnasts. It is most likely to occur during an intense period of activity such as when a gymnast moves to a higher competitive level.

High impact activities like tumbling and vaulting put an especially large amount of compressive force on the growth plate of the wrist.

Does it cause long term problems?

​If not treated properly, gymnasts wrist can cause the growth plate of the affected bone (radius) to close sooner than it should.

When this happens and the other forearm bone continues to grow you can end up with an asymmetry of the forearm bones and long term chronic wrist pain.

Common symptoms of Gymnasts wrist

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Common symptoms include pain with impact activities as well as local stiffness and swelling.
Xrays can confirm diagnosis by showing widening of the growth plate.
​

What should I do to manage my wrist pain?


​It is best managed by a short period of rest from impact activities as well as regular icing. Pushing through the pain will only make the injury worse and sometimes a wrist brace can be helpful to aid rest..

Once the inflammation has settled impact activities should be added back in slowly and gradually as guided by your symptoms and your hand therapist. They may also recommend taping or use of tiger grip (TM) wrist supports to limit impact and hyperextension.

​Exercises to strengthen your forearm and upper body can help the body's ability to absorb impact whilst tumbling and prevent reinjury.
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Can't I just push through it?


As an athlete you are no doubt used to your muscles hurting sometimes from training. But is is really important to note that you shouldn't train with pain in your wrist. 

Unlike muscle soreness after exercise, pain in a gymnasts wrist is a sign of stress and overuse and it requires rest and professional management. Your hand therapist may need to work with your coach to ensure you getting your training levels just right as you resume activity.

If you or someone you know may have gymnast's wrist- be sure to get it checked properly out. 


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Which is better for DeQuervain's : SPLINTING OR INJECTION?

27/8/2022

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​DeQuervain's tenosynovitis


DeQuervains' is a common cause of wrist and thumb pain in the community. Traditionally you may have heard about it occurring in new mothers due to the sudden change in demands associated with caring for young children. But it can affect people of any age, who is involved in repetitive wrist and thumb movements through work,  DIY, new hobbies, sports, or even moving house.
​

​So what is Dequervain's anyway?


Inflammation of the tendons that lift your thumb out and away from the hand occurs when there is a sudden increase in use. Once the tendons are swollen, they rub on the undersurface of the anchor strap around your wrist when you move your wrist and thumb causing the inflammation to be maintained or aggravated.

This could be due to COVID lockdown knitting, a deadline at work or simply breastfeeding your new baby.
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​What treatments can help DeQuervain's?

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The good news is the it can be managed without surgery in the majority of cases. Management typically involves:

1) avoiding aggravation through ergonomic changes,
2) resting the inflamed tendons with splinting
3) restoring flexibility and strength with exercises to ensure the issue does not recur
4) soft tissue massage
5) icing/ oral anti-inflammatory medications can also be helpful

​What exactly does a cortisone injection (CSI) do?

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Cortisone injections use a needle to deliver anti-inflammatory medication directly to the swollen tendon (inside its sheath) to reduce swelling. This is commonly done under the guidance of an ultrasound scan.

In more chronic cases the injection will also help to break down adhesive scar tissue which causes stiffness. However many people notice the 'effects wearing off' after about 6-8 weeks as the medication gets broken down in your body.

​So which treatment should you try first?

​
Studies are ongoing and certainly indicate an improvement through either splinting or cortisone injection. So you can make a good argument for choosing either as an initial management strategy.

Although Physiotherapists can refer for ultrasound scans we cannot give you a referral for the CSI so you would need to discuss this choice with your GP or specialist if you wanted to start with the injection option.

Sadly however I do see many patients commencing  hand therapy after having had only temporary relief from their 1st (or second) cortisone injection. The majority of these cases can still be helped without needing to resort to surgery.

So what do I recommend to my patients?


There are many factors to be considered including the client's level of patience, tolerance to wearing splints and attitude to injections. Some people are very comfortable with injections and others would prefer less invasive management.

Certainly being educated by your local hand therapist to ensure that you address the underlying cause of the inflammation so that the problem does not recur is a good idea no matter which management path you decide to start with. 

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    Author

    Kate Crump- Physio,
    Accredited Hand Therapist, as awarded by the AHTA

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