Polk doctors: Hand pain, stiffness from osteoarthritis can be treated

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May 6, 2020 at 11:11 AM

People often deal with the discomfort of osteoarthritis by taking over-the-counter nonsteroidal anti-inflammatory drugs. Over time, if the pain worsens, they may find themselves taking those drugs in regular, increasing doses. That isn’t good for older people, Polk experts say.

Your fingers feel stiff.

Parts of your hands often hurt.

Simple acts like opening a jar become more difficult or painful.

It’s highly possible these problems stem from osteoarthritis of the hands.

Half of women and one-fourth of men experience osteoarthritis hand stiffness and pain by the time they reach 85, according to the Arthritis Foundation.

"Hand arthritis is extremely common in women," said Dr. Stuart Patterson, an orthopaedic surgeon in South Lakeland who specializes in disorders of the hand and other parts of the upper limb.

"We see it in men, but it typically occurs earlier in women."

People often deal with the discomfort initially by taking over-the-counter nonsteroidal anti-inflammatory drugs. Over time, if the pain worsens, they may find themselves taking those drugs in regular, increasing doses.

That isn’t good for older people, local hand experts said.

"Once you get into your 60s, they’re not a safe drug," Patterson said.

"There are many interactions between these meds and supplements, as well as blood thinners (prescription as well as aspirin)," Dr. Ann Licht said in an email response to a question about whether it’s OK to rely on NSAIDS.

"People with high blood pressure and kidney problems may have more severe reactions to NSAIDS," added Licht, a Watson Clinic surgeon specializing in hand surgery.

Osteoarthritis is most common in the small joints of the fingers, closest to the nails and the base of the thumb, Licht said. It can occur on one side and spread to the other.

Gnarly fingers, bumps, finger deformities, joint stiffness and bone formations, often called bone spurs, are some physical signs that occur in advanced osteoarthritis of the hand, Patterson said.

Osteoarthritis causes protective cartilage at the end of bones to break down and wear away. Pain occurs as the bones rub together.

Surgery isn’t all these surgeons and other hand specialists have to offer when that happens.

"Surgery is when you’re disabled, either disabling pain or impairing your ability to do things," Patterson said, "when you’re miserable and you’ve exhausted your non-surgical options."

It’s helpful to see a hand surgeon before that stage to rule out other causes of pain, such as rheumatoid arthritis or carpal tunnel syndrome, he said.

Licht recommends seeing a hand specialist when medicines don’t work, aren’t indicated or when deformities are starting.

"Steroid injections to the joints can be a lifesaver for patients who are either not ready for surgery … can’t take arthritis meds or the meds aren’t working," Licht said.

Occupational therapists have an important role in treating osteoarthritis of the hand. They work with patients on hand exercises, devices like splints or braces and pain relief such as warm paraffin.

Some therapists, mostly occupational but also some physical therapists, take extra training to become certified hand therapists.

"Our main goal in hand therapy is to preserve the hand," said Jennifer Castelli, occupational and certified hand specialist. "We focus on what they need and adapt it from there."

If a joint is overworked, it causes tension in the tissue around it, affecting the amount of pain. Joint damage also occurs.

Splints can keep the joint from moving so it has time to rest, Castelli said.

She and her husband, John, founded The Hand Rehabilitation Center of Florida. It has clinics in Winter Haven, Lakeland and Sebring.

Their Lakeland clinic has connecting space with Patterson’s Central Florida Orthopaedic Surgery Associates. Patterson collaborates with Judie Johnson, another of the rehabilitation center’s occupational therapists/certified hand specialists.

"Getting people in here early, before they develop horrible stiffness and horrible pain can help them learn helpful management skills," Johnson said.

Hand therapists can offer a variety of alternatives, including exercises to increase the hand’s range of motion and ways to do everyday activities that put less stress on the joints. Examples would be avoiding doing heavy pinching with the thumb and lifting pots with two hands instead of one, Johnson said.

Assistive devices can make it easier to open jars or hold a spoon.

"It doesn’t fix the arthritis but it makes it so you hopefully can live with it," said Johnson, who has dealt with hand osteoarthritis of her own for 20 years.

Hand specialists can help "cut through the confusion" of the volume of devices and tools to find the ones most effective for individual patients, Patterson said.

"Even if two people have the same type of arthritis, their needs and medical history/conditions may make treatment very different," Licht said.

"Evaluation by a qualified hand surgeon can offer options and treatment solutions tailored to the individual."

When surgery is needed, patients and their surgeons decide between fusion or joint replacement. Which works best depends on the location of the damaged joint and, to some extent, what patients need to do with their hands.

Patterson said joint replacement doesn’t do well in the small joints at the end of the fingers. He prefers fusion for them.

But fusion typically doesn’t do as well at the base of the thumb, he said, or in the middle joint of the long and ring fingers. Those middle joints, he said, need to be able to bend and fusion prevents that.

Overall, joints are best fused if they aren’t "vital motion" joints, Licht said, while some need to be replaced to preserve or improve motion.

"Fusions are most reliable and require minimal rehab," she said. "Joint replacements require a compliant/committed patient as (they) usually require several months of rehab."

Robin Williams Adams can be reached at robinwadams99@yahoo.com