Why Does My Hand Hurt?

Arthritis is a serious chronic disease affecting the health of Canadians. In BC it is estimated that more than 547, 000 people have arthritis, of which more than 85,000 are severely limited in their daily activities. By 2026 the number of people estimated to have arthritis was 874,000, of which 122,000 will be severely limited in their daily activities. Osteoarthritis (OA), also known as degenerative arthritis or degenerative joint disease, is the most common type of arthritis affecting 10 percent of Canadians.

In its more serious forms, osteoarthritis leads to the destruction of joints, such as hips and knees, which may require expensive joint replacement surgery. OA is often referred to as a ‘wear and tear’ disease, because over time cartilage can weaken and break down, sometimes developing cracks and holes. Pieces of damaged cartilage then can break off and irritate the joints or tissues nearby. The joint pain and swelling associated with OA can make it painful and difficult to move.

The most common site for osteoarthritis is at the Carpometacarpal (CMC) joint of the thumb – that is, the joint at the base of the thumb and the bone the wrist. The ends of these bones are covered with cartilage, which acts as a cushion and allows them to move freely. OA destroys the cartilage surrounding the joint, causing joints to become inflamed, resulting in pain and restricting movement of the thumb across the palm.

The actual degenerative process of CMC osteoarthritis is not completely understood. While it is primarily a “wear and tear” process, there are other factors that play a role in degenerative arthritis. These include previous trauma or injury, repetitive stress over long periods of time, laxity or looseness of the joint secondary to hormones or just the aging process. Muscle imbalance in the thumb may also be a contributing factor to CMC osteoarthritis. An imbalance can lead to poor control over the joint causing it to move at a slightly incorrect angle or rotation. If the joint is not stabilized properly it can rub or glide the wrong way causing the surrounding tissue to become inflamed and activate the degenerative process.

People developing osteoarthritis at the base of the thumb usually first notice pain associated with pinching activities such as turning keys or opening car doors. Simple activities such as holding eating utensils or a glass of water can be too pain to perform. Tenderness in the fleshy thumb muscle or over the joint may also be experienced and there may be an aching discomfort at the base of the thumb following heavy use or with weather changes.

As the disease progresses and more joint cartilage is lost, less stress on the thumb is necessary to produce pain. People will often avoid using the thumb for those activities that produce pain and over time this disuse can to lead weakness, muscle loss and a tendency to drop things. The pain can be so unbearable that it interferes with one’s quality of life at times indicating surgical intervention.

Fortunately, therapy has been an effective treatment for the relief of symptoms for CMC joint pain. Treatment initially begins with splinting the thumb in a comfortable position in order to put the thumb at rest and prevent the arthritic joint from moving. Splint treatment usually at night is often quite effective at decreasing the pain associated with CMC osteoarthritis. It is important that the splints used for this condition extend well up on the thumb as most commercially available, “drug-store” wrist splints leave the thumb free and may actually worsen the discomfort at the base joint. For this reason it is considered beneficial to have a custom made splint prepared by a trained health professional such as an occupational therapist or certified hand therapist.

Other conservative treatments include modalities such as ultrasound to reduce inflammation and pain, educating the patient on joint protection techniques, and work simplification. Anti-inflammatory medications may be also helpful, while a cortisone injection into the arthritic joint has been proven to be an effective non-surgical treatment in relieving pain.

When these conservative methods of treatment are no longer beneficial to the patient, surgery may be necessary. The most important goal of surgery is to eliminate the pain at the base of the joint of the thumb. Surgery may be performed in several ways according to the personal preference of the surgeon. In some instances, surgery is necessary to improve the position of the thumb, range of motion, and to improve strength for pinching and grasping.

Following surgery, patients are often referred to hand therapy for rehabilitation. Exercises designed to stretch and strengthen structures stabilizing the thumb is considered to be the best approach to treating post surgical pain, swelling, and movement limitations. As these restrictions gradually resolve within three to six months most patients experience complete, or near-complete pain relief along with recovery of range of motion.

For more information or to book an appointment with a Certified Hand Therapist, visit us at www.handtherapycentres.com or cal 604-941-3055.

Thank You Trevor & Monica

Thank you for giving me the opportunity to work here at Guildford Hand Therapy.  I appreciate the patience & advice you've granted me.  The challenges from working here have made this experience very rewarding.  Good luck with everything and the New West centre!

Liz