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Osteoarthritis Of Hand



Synonyms: Osteoarthrosis, hand: physical and occupational therapy; degenerative joint disease, hand: physical and occupational therapy; arthritis, osteo, hand: physical and occupational therapy; hypertrophic arthritis, hand: physical and occupational therapy; degenerative arthritis, hand: physical and occupational therapy; hand osteoarthritis: physical and occupational therapy; physical and occupational therapy: handosteoarthritis; occupational and physical therapy: hand osteoarthritis; osteoarthrosis, hand: physical and occupational therapy; degenerative joint disease, hand: physical and occupational therapy; arthritis, osteo, hand: physical and occupational therapy

  • Anatomical location/body part affected: Musculoskeletal system; the hand, including the wrist, fingers, and thumb; for information on osteoarthritis (OA) in other joints of the body, see the series of Clinical Reviews on these topics
  • Area(s) of specialty: Orthopedic Rehabilitation, Geriatric Rehabilitation, Hand Therapy
  • Description: OA is the most common joint disease.  Degenerative in nature, OA is characterized by the progressive loss of articular cartilage as well as reactive changes in the joint margins and the subchondral bone. When the hand is affected by OA, any or all of following joints can be involved:
    • Trapezio-metacarpal (basilar) joint/carpometacarpal (CMC) joint of the thumb: located at the base of the thumb, where the thumb and wrist come together
    • Distal interphalangeal (DIP) joint: the end joint closest to the finger tip
    • Proximal interphalangeal (PIP) joint: the middle joint of the finger
    • The wrist (less frequently involved)
    • American College of Rheumatology criteria for the classification of OA of the hand
      • Hand pain, aching, or stiffness and at least three of the following:
        • Hard tissue enlargement of 2 or more of 10 selected joints
        • Hard tissue enlargement of 2 or more DIP joints
        • Fewer than 3 swollen metacarpophalangeal (MCP) joints
        • Deformity of at least 1 of 10 selected joints
  • Presentation/signs and symptoms: Signs and symptoms of OA of the hand will vary according to patient but can include:
    • Signs
      • Joint bony enlargements
        • Heberden’s nodules can occur in the DIP joints
        • Bouchard’s nodules can occur in the PIP joints
      • Decreased range of motion (ROM) with pain at the end of the range
      • Weakness and wasting of the muscles acting on the joint
      • Crepitus can occur as a late sign
      • Joint swelling and tenderness are not always present in OA; however, they can occur along the joint margin if synovitis is present
    • Symptoms
      • History of slowly developing joint pain
      • Pain that occurs after the use of a joint and progresses over the course of the day
      • Stiffness of less than 30 minutes duration (especially after prolonged disuse or in the morning)
      • Most individuals with OA of the hand experience exacerbation and remission of symptoms
    • Systemic signs and symptoms are absent in OA of the hand

Causes, Pathogenesis, & Risk Factors

  • Causes: There are two forms of OA, primary and secondary
    • Primary
      • Primary OA is idiopathic in nature and is classified according to its clinical features (i.e., localized, generalized, erosive)
      • Usually associated with aging and overuse
    • Secondary (as the result of another condition)
      • Secondary OA can be caused by the following:
        • Trauma
        • Childhood anatomic abnormalities
        • Inheritable metabolic disorders (e.g., Wilson’s disease, alkaptonuria, hemochromatosis)
        • Neuropathic arthropathy
        • Hemophilic arthropathy
        • Endocrine disorders (e.g., hyperparathyroidism, hypothyroidism)
        • Paget’s disease
        • Noninfectious inflammatory arthritis (e.g., rheumatoid arthritis [RA], spondyloarthropathies)
          • For additional information on RA, see the series of Clinical Reviews on this topic
        • Gout or pseudogout
        • Septic or tuberculous arthritis
        • History of surgery on the joint
        • Calcium deposition
  • Pathogenesis: In OA, the cartilage of the joint loses elasticity and breaks down, causing the bones of the joint to rub together, resulting in pain and stiffness. The subchondral bone that lies beneath the cartilage changes as a result of lost cartilage; the bone may thicken and/or form cysts or osteophytes (bone spurs). Sometimes small pieces of the bone or cartilage detach from the joint itself and float loosely in the joint space. Although previously thought to be a noninflammatory disease, the lining of the joint (synovium) can become inflamed in OA and create cytokines (inflammatory proteins), which further damage cartilage. Inflammation is present in most patients with symptomatic OA.(7) Joint involvement in OA is typically asymmetrical
    • Pathological findings of the bone in OA
      • Patchy cartilage damage and bony hypertrophy seen macroscopically
      • Edema of the extracellular matrix and cartilage microcracks
      • Fissuring and pitting of the subchondral bone
      • Erosion and osteocartilaginous loose bodies
      • Subchondral bone trabecular microfractures and sclerosis with osteophyte formation
      • Degradation response produced by release of proteolytic enzymes, collagenolytic enzymes, prostaglandins, and immune response(1)
    • Erosive OA (EOA) of the hand is a subset of OA of the hand; diagnosis is made based on presence of central erosions and collapse of the subchondral bone plate on radiographs of the interphalangeal joints; individuals with EOA of the hand often experience greater pain, increased functional limitations, and worse hand mobility than those with OA of the hand
  • Risk factors
    • Age (increased risk after age 50)
    • Obesity
    • Prolonged occupational or sports joint stress
    • Injury to a joint due to trauma, surgery, infection, or inflammatory arthritis
    • Gender (female gender associated with increased risk of OA of the hand)
    • Genetic predisposition
    • Inherited bone abnormalities or inherited traits (e.g., dysplasia, misalignment)
    • High bone density
    • Vitamin D deficiency
    • Geographic location/climate (specifically altitude, latitude, annual precipitation, mean temperature in the summer, and mean day duration in the winter)

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