Transcription:
Painful Arthritic Hands? Hand Therapy Can Help!

Melanie Cole (Host): According to Arthritis.org, more than 50 million adults have doctor-diagnosed arthritis. That’s 1 in 5 people over the age of 18. My guest today is Timothy Burkhart. He’s an occupational therapist with Meritus Health. Welcome to the show, Timothy. Arthritis can affect any number of joints in our body -- it can be rheumatoid or osteoarthritis -- but a lot of people get it in their hands. Tell us a little bit about what you see as hand arthritis and what are the debilitation effects that people experience?

Timothy Burkhart (Guest): We see it very frequently, and the most common report we have is pain. Obviously, that impacts your life, and your occupations you engage with day-to-day including things from daily activities like dressing to occupations like your job if it includes the use of your hands.

Melanie: People always think right away to start with NSAIDs, but that’s not necessarily the best thing you can do for your hands. Name some other things that people can try right off the bat if they have painful, stiff hands that don’t seem to move or grab things the way they’d like.

Timothy: Well, if you’re having significant issues, one of the first things you can do is discuss it with your physician. There are some basic exercises that can be done to keep tendon health and joint health going. There are some different types of bracing or orthotic fabrications that can be put into place to protect joints, allow them to rest, and decrease inflammation that would be present over time. There are some exercises present to improve the strength and stability of joints to help the joint from damaging itself further, as well.

Melanie: Let’s start with some of the topical anti-inflammatory creams. People use Voltaren – they try all these things on their hands. Do those work?

Timothy: There is some research showing that it helps and I think you see a range of how helpful it is in the real world. Some people have reported it helps. Some people report that it has not helped, so I think that’s on a case-by-case basis.

Melanie: And what about ice? Is that something they can use for their arthritic hands?

Timothy: When people are experiencing pain in your arthritic hands, I think there’s two things to consider. The first is if you’ve really done something to inflame your hands and they’re swollen or irritated, sometimes ice is a good thing. It helps decrease that inflammation like an acute injury. Other times when you’re dealing with a more chronic inflammatory process a heating process with some type of moist heat tends to be a little more effective due to the effects of increasing blood flow to the area. Ultimately, the increased blood flow to the area picks up the pooled edema, which is the swelling, causing inflammation and ultimately pain at a joint site.

Melanie: And what about hand braces? There’s a lot of those on the market that people see and ones for their wrists if they have arthritic wrists. Do any of these help, and should they be using braces?

Timothy: I think there’s a couple considerations when talking about braces for the arthritic hand. There’s probably two different areas to consider. The first, and foremost, is joint protection, and that would be like we just talked about with heat. You get inflammation at an injured joint site, and you need to get the inflammation out. A brace that you would see on the shelf that could potentially hold your hand or wrist in a neutral, resting position prevents further damage of the bone-to-bone -- which is a lot of arthritis, which causes inflammation. It protects it to let it rest and calm down. That’s the first type for joint protection.

The second type is also for some joint support that allows you to actually move and function. A lot of people have pain in their thumb – the base of their thumb. There’s some custom braces and even some off-the-shelf braces that give you support at the inflamed and painful joint that still allow you to move your hand and do some functional tasks, as well. That’s the most common. We also get into some other applications where there are some bracings that can be placed on painful, inflamed nodules that people get in their finger joints, and that can help reduce the inflammation, and ultimately, decrease the pain, as well.

Melanie: Let’s talk about hand therapy and the role of an occupational therapist in arthritic hands. What can you do, and give us some exercises, and stretches, and things people can try for their hands?

Timothy: Occupational therapy’s roles in the arthritic hand always starts with an evaluation, and that’s considering the whole person. Our industry has a background that originated in psychology. If someone comes in with just a painful hand, we have to consider the person as a whole, looking at maybe what are some of their daily routines that they engage in that could be adding to the problem.

Some of the actual treatment revolves around modifying activities that could be adding to the deficits at hand. If someone writes a lot and they’re using a very small-gripped pen, adding a little build-up to the grip on the pen, which puts less stress on the joints in the hand. Up to modifying maybe somebody’s computer workstation, ergonomically looking at the alignment of -- even going to the spine, the neck, the shoulder, elbow, the wrist position. It all actually adds to the position of the hands and the activity, so modifying just ergonomically alignments at the shoulder, elbow, wrist, and so on.

Specific exercises that we do – the most common one for painful hands and arthritis is called the tendon glide. It’s a series of movements where your fingers are straight; then they’re bent to 90 degrees, then you bend it down to touch the palm of your hand, then you pull your fingertips up, and then roll it into a fist. This ultimately moves your tendons and joints through a pain-free excursion of motion to pump some of the swelling out of the joints, as well. That’s the most basic exercise for the issue at hand

Melanie: So then, give us your best advice. What would you tell people that come in and they’ve got these painful hands, and how can they really seek help? Who do they go to first?

Timothy: If you’re having a significant issue and pain in your hand I think the first, and foremost place is with your primary care physician and having an open discussion about what’s going on. And then, if you have not been tested, there may be some tests that go on and maybe a referral to a rheumatologist. Ultimately, if you know you’re having pain in your hands because you have arthritis -- and some of the things you may hear about and we’ve talked about you think could be helpful – you could ask for a referral to therapy and start with a basic evaluation and go from there. Usually, it always starts with the primary care physician these days.

Melanie: And now, give your best advice to people suffering from hand pain from arthritis, and what would you like to tell them?

Timothy: I think the best advice that I can give from seeing people on a daily basis in the clinic dealing with hand pain related arthritis is the root cause being the inflammatory process and damage to joints. Ultimately, if you’re doing an activity on a regular basis that’s part of your daily routine and it hurts, you need to find a way to make it not hurt. Every time that joint is impinging and damaging itself further causing more swelling and inflammation that’s going to be a revolving door in a cycle that’s just going to continue and continue. Ultimately, you need to stop the cycle and modify the activity so that it’s not painful or seek medical treatment and therapy to end the pain, but ultimately, if it hurts don’t do it or find a different way to do it.

Melanie: And Timothy, as long as we’re talking about some activities – people are texting so much, and they’re at computers typing – does this contribute to arthritis in the hands?

Timothy: It definitely can add to your symptoms that you’re having with hand pain. To answer your question, does it directly cause arthritis? I’m not sure about that, but anytime you’re repetitively moving your joints and moving your hands -- and especially if you already have damage to the joints and it does hurt to type or text for prolonged periods of time -- yes, it can add to the problems that you’re having, especially if you’re using the thumb, which – one of the most common issues we have is pain at the base of the thumb, the CMC joint, that would be specific to texting. Our hands get so strong – our thumbs get so strong with bending inwards like if you’re touching your pinky, that’s where the damage occurs is on the inside of the joint. There are exercises people can do to strengthen the extensors or the muscles that keep the thumb up, that yes, completing a task on a high-repetition – like texting, could add to the inflammation and pain related to an arthritic thumb.

Melanie: Thank you, so much, for being with us today Timothy. That’s great information. You’re listening to Your Health Matters with Meritus Health, and for more information, you can go to MeritusHealth.com, that’s MeritusHealth.com. This is Melanie Cole. Thanks, so much, for listening.