Taking Care of Your Arthritic Hands
The topic of osteoarthritis has been discussed in two previous blog entries. This blog entry will discuss living with arthritis in your hands and also make suggestions concerning caring for your hands to minimize the symptoms.
The term arthritis simply means an inflammation in a joint. There are over 100 forms of arthritis. The most common form in the hand is osteoarthritis which has been described in previous blogs as a type degenerative joint disease in which the cartilage (cushioning) that covers the bone surfaces at joints begins to wear out. Its symptoms include: pain, stiffness, swelling, the loss of full range of motion and bony nodules at the joints. The most common joints in the hand to develop osteoarthritis include: the base of the thumb where the thumb and wrist come together (basilar joint), at the middle joint of a finger (PIP), and in the last joint near the finger tip (DIP).
Another type of arthritis commonly seen in the hand is rheumatoid arthritis. This is a chronic systemic type of arthritis in which the synovial lining of the joint is inflamed. The early symptoms of rheumatoid arthritis include fatigue, joint pain, and stiffness. As it progresses, rheumatoid arthritis symptoms may feel like the flu, with muscle aches, and a loss of appetite. Hand damage and deformity from rheumatoid arthritis can include nodules, swelling, stiffness, ulnar drift (all the fingers drifting toward the little finger) and joint contractures.
Both of these forms of arthritis can lead to changes in the ability to use your hands effectively. The hand has multiple small joints that work together producing the ability to perform a variety of daily activities such as turning a key, opening lids or picking up change. When arthritis is present, daily activities can become increasingly difficult due to pain, limitation in motion and loss of hand strength.
It is important to manage the symptoms of arthritis in your hands so they don’t affect your ability to do the things you need and want to do every day. There are many techniques and tools which can help to protect your joints, ease your pain and maintain your hand strength. The time to start taking a proactive approach to the care of your hands is as soon as you are diagnosed with arthritis by your physician.
Your physician may introduce various medical interventions such as prescribing medication for your symptoms like anti-inflammatory or analgesic drugs, injections of pain reliever/steroid combinations or a prescription for hand therapy. Wearing a splint is another intervention which may be prescribed. Splinting helps rest your joints in a comfortable position thereby decreasing pain and inflammation. Splints are usually worn only when the joint is painful or to protect the joint during certain activities. If your arthritis has progressed to the point where your pain is severe and hand function is limited, your hand surgeon may suggest a joint arthoplasty. This surgery is commonly done for arthritis in the base of the thumb and is very successful in returning pain free function to the hand.
Things you can do to relieve your symptoms include the use of heat or cold or alternating between them to help relieve the swelling and pain and to soothe your joints. I tell my arthritis patients “Heat is your friend”. Heat can help ease pain, decrease joint stiffness and relax tense muscles. Different forms of heat work better for different people. You can experiment with using moist hot packs or electric heating pads on their lowest settings; there are hot mitts which you can place in a microwave that many arthritic patients find effective, soaking your hands and wrists in bowls of warm water or paraffin wax, or simply taking a shower or bath may ease the pain and stiffness.
There are those people who prefer cold therapy. Cold can be effective for reducing pain during flare-ups or after you've had too much physical activity. Applying ice packs or soaking your hands in cool or cold water has a numbing effect that can be effective for dulling hand and wrist pain. It is important when applying heat or cold treatments you limit the amount of time to no more than 15-20 minutes and take care not to burn yourself or get frostbite.
Don’t be afraid to use your hands. Regular exercise is important in reducing stiffness and keeping your joints and muscles working. There are many exercises that can reduce pain and improve mobility in the hands. They include range-of-motion and stretching and strengthening exercises. Before starting any exercise program it is important to discuss it with either the physician treating you for your arthritis or if therapy has been prescribed, your hand therapist will typically design an exercise program for you to follow at home. It is important for arthritis sufferers to always exercise in a pain free range of motion.
One of the most important things you can do to care for your hands is to incorporate joint protection techniques in all daily activities. This may take some effort at first as learning how to do tasks differently can initially sometimes feel inefficient. Here are some simple tips to protect your joints from undo stress:
1. Respect your pain: Consider pain as a warning that your hands are being overworked and the arthritic joints stressed. If you are experiencing pain after an activity, you probably overdid it. Don't disregard the pain, for arthritis patients there is a 2-hour rule that if you have more arthritis pain two hours after you exercise or perform an activity than you did before, consider cutting back the next time. Basically, adjust your activity level (or modify the task) to your pain level.
2. Use the largest and strongest joints and muscles possible. Try and avoid placing excessive pressure on your finger joints when lifting or carrying objects. Instead of hook grasping with your fingers, use your palm instead when lifting heavy objects. Lift grocery bags by slinging them on your forearm. Instead of using the grip handles on your bag, use the shoulder strap. You should always use both arms when lifting or carrying an object. You will have more strength and stability when you use both of your hands.
3. Avoid forceful gripping. Avoid holding the hands in a fist or tight grip for prolonged periods. Avoid making a tight fist around objects such as toothbrushes, pens or pencils. If you use these objects regularly, wrap them in a cushioned material to keep your hand closing around it tightly or purchase items with wider handles to reduce the stress on your hands. Try to avoid pinching materials between your thumb and pointer finger like plates or holding open a book. Using devices such as book holders, jar and can openers, door and faucet handles that are easy to grip and turn all help avoid overusing the hands. Try to hold objects in the palm as opposed to fingers rather than holding a book with your thumbs, hold it between your open palms, one on top and one on the bottom.
4. Take frequents rest breaks. Observe a balance of work and rest. Do not push yourself to the limit as you may suffer the repercussions of increased pain and symptom flare up. When doing tasks that put stress on your hands, such as holding tools or doing repetitive gripping, make sure to give your hands an occasional break and stop to rest or stretch.
5. Do things differently. When you think about it, it’s not that activities are bad for arthritis; it’s how you do them that causes your symptoms to increase. With a little ingenuity almost any activity can be modified or adapted to reduce stress on your hands for example shaking hands can be painful for people with arthritis. You can avoid some of the pain caused by firm gripping by extending both of your hands and grasping the other person at about the wrist. Lifting and carrying heavy food items or pots and pans in the kitchen can be difficult but is easily modified by sliding those heavy objects on kitchen counters instead of lifting them
6. Take the easy way out. Many commonly available household items designed to make life easier will also protect your joints from undo stress. Using electronic appliances or gadgets like a food processor or an electric can opener in the kitchen or an electric toothbrush ease the stress on your hands. Buying precut veggies, easy-open containers, and quick-fix recipes will make cooking much easier on your hands. Consider purchasing other adaptive equipment, such as jar openers, key turners and large zipper pulls. Invest in garden tools, kitchen utensils and writing devices with large handles. Replace traditional door handles, which you must grasp with your thumb, with levers.
7. Invest in adaptive equipment if needed. If your hand arthritis has progressed to a point where you have difficulty performing simple everyday activities like eating bathing dressing or signing your name it would probably benefit you to invest in adaptive equipment. There are many products available designed specifically assist people with arthritic hands Things like elastic shoelaces, a rocker knife, specially designed arthritic pens or a sock aid can make daily tasks much easier. Most medical supply stores stock such items and there are many catalogs available specializing in these tools.