How to Manage Your Osteoarthritis

Osteoarthritis, also called degenerative joint disease, happens when the cartilage in a joint breaks down. Cartilage allows the bones in a joint to glide over one another. When the cartilage breaks down, the bones rub together. This causes pain, swelling, and loss of motion. Osteoarthritis most often affects the hands, neck, lower back, knees, and hips.

Your healthcare provider can help you find ways to reduce pain, move better, and protect your joints from further injury. Changes in your daily activities can also help. These changes may include weight management, exercise, pain control, joint protection, and medication. If these don’t help, surgery may be an option.

Weight management

Extra weight can put stress on your joints and increase pain. This happens most often in the weight-bearing joints, such as your hips, knees, and ankles.

Weight loss is not easy, but even losing a small amount of weight can help. Talk with your healthcare provider about ways to lose weight. Diet changes and exercise can help. A dietician or nutritionist can help you with eating healthy. In some cases, medication or weight loss surgery may help.

Exercise

Exercise is a key part of arthritis care. Exercise strengthens the muscles that support your joints. It also lessens joint pain and stiffness. And, it helps to improve your overall health. You should try to do a variety of exercises to build strength and improve your lung and heart health. All exercises burn calories and can help you lose weight. It is critical to talk with your healthcare provider prior to starting an exercise routine. Your healthcare provider can help you determine what type of exercise routine and intensity level is best for you. Your healthcare provider may also be able to give you handouts on exercise techniques or refer you to a physical therapist to learn the optimal exercise routine for your needs.

Man using resistance band to strengthen his shoulders and arms
A man uses resistance band to strengthen his shoulders and arms.

The types of exercise are:

  • Strengthening exercises. These can be done with exercise bands or resistance bands (inexpensive exercise aids), or with weights.
  • Aerobic activities. These exercises keep your heart and lungs strong. Moderate aerobic activity for 30 minutes most days of the week is recommended. You can even break it up into three 10-minute increments. Activities such as swimming, walking, cycling are good choices.
  • Range of motion/stretching activities. These can lessen pain and stiffness and help you move better.
  • Balance exercises. These help you maintain balance and improve your daily living. Yoga and tai chi are excellent examples.

Start exercising slowly each time by gently moving your joints. Warm up for at least 5 to 10 minutes before any exercise. Talk with your healthcare provider:

  • Before starting an exercise program or adding new exercises to your daily routine
  • When a joint becomes painful or swollen
  • About taking pain medication or using ice or heat before or after you exercise

Joint protection

To lessen pain and protect your joints from further damage you should:

  • Balance rest with activity. It’s important to be active and to exercise every day. But, you should rest in between periods of activity.
  • Take care of your joints. There are things you do every day that can make your joint symptoms worse. And, there are better ways of doing those same things. For example:
    • Store heavy kitchen items at waist-height so that you can easily get to them.
    • Use aids like long-handled graspers and jar-openers.
  • Recognize pain. If your joints hurt more than usual, you may have done too much.
  • Sleep. It’s important to get enough sleep each night. Sleep gives your energy to be active during the day. It also helps you to feel better overall. If you are having trouble sleeping, or don’t feel rested when you wake up, talk with your healthcare provider.

Medication

Over-the-counter and prescription medications can help reduce the pain and stiffness from osteoarthritis. They include:

  • Pills, topical medication (rubbed on the skin), and injections into the joint
  • Pain relievers, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen

It’s very important that you talk with your healthcare provider before taking any medication for arthritis. Even medications that are available without prescription can cause serious side effects. Some can make other medical problems worse and interfere with other medications.

Each person reacts differently to these medications. If one medication doesn’t work for you, your provider may prescribe a different one.

Pain control

Although medications can help control most arthritis pain, you can also try:

  • Relaxation techniques. Deep breathing, yoga, or easy stretching can help.
  • Cold and heat. Applying ice packs, moist heat, or hot showers and baths can help lessen pain and stiffness. Ask your healthcare provider what he or she suggests.
  • Other methods. Massage, acupuncture, transcutaneous electrical nerve stimulation or TENS (a small device that delivers light impulses to the nerves) can also help.

Surgery

If other treatments don’t work for your arthritis, you may need surgery.

  • Arthroscopic surgery. During arthroscopic surgery, the healthcare provider uses a special tool called an arthroscope to see and work inside your joint. It may be done to remove loose or damaged cartilage and bone. It can also be used to smooth or reposition bones.
  • Joint replacement surgery. Joint replacement surgery is when the damaged joint is replaced with new man-made joints. The knee and hip joints are replaced most often.

Talk with your healthcare provider about the benefits and risks of these procedures.

There are many ways to handle the pain of osteoarthritis. Work with your healthcare provider to figure out what’s best for you.

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Hand Pain and Problems

Anatomy of the hand

The hand is composed of many different bones, muscles, and ligaments that allow for a large amount of movement and dexterity. There are 3 major types of bones in the hand itself, including:

Anatomy of the hand
Click Image to Enlarge
  • Phalanges. The 14 bones that are found in the fingers of each hand and also in the toes of each foot. Each finger has 3 phalanges (the distal, middle, and proximal); the thumb only has 2.
  • Metacarpal bones. The 5 bones that compose the middle part of the hand.
  • Carpal bones. The 8 bones that create the wrist. The carpal bones are connected to 2 bones of the arm, the ulnar bone and the radius bone.

Numerous muscles, ligaments, and sheaths can be found within the hand. The muscles are the structures that can contract, allowing movement of the bones in the hand. The ligaments are fibrous tissues that help bind together the joints in the hand. The sheaths are tubular structures that surround part of the fingers.

What are some common hand problems?

There are many common hand problems that can interfere with activities of daily living (ADLs), including the following:

Arthritis

Arthritis is joint inflammation and can occur in multiple areas of the hand and wrist. Arthritis of the hand can be very painful.

Osteoarthritis

Osteoarthritis is one of the most common forms of arthritis in the hands and may be caused by normal use of the hand or it may develop after an injury. Osteoarthritis usually develops in one of 3 places: the base of the thumb, at the end joint closest to the finger tip, or at the middle joint of a finger.

Signs and symptoms of osteoarthritis include:

  • Stiffness
  • Swelling and pain
  • Bony nodules at the middle or end joints of the finger
  • Pain and possibly swelling at the base of the thumb
  • Loss of strength in the fingers and the grip of the hand

Treatment for osteoarthritis includes:

  • Nonsteroidal anti-inflammatory drugs
  • Resting  the affected hand
  • Wearing splints at night
  • Using heat to soothe the pain
  • Using ice to reduce swelling
  • Possible cortisone injections
  • Possible surgery when no other treatments work

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through the carpal tunnel in the wrist, a narrow confined space. Since the median nerve provides sensory and motor functions to the thumb and 3 middle fingers, many symptoms may result.
The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:

  • Trouble gripping objects with the hand(s)
  • Pain or numbness in the hand(s)
  • “Pins and needles” feeling in the fingers
  • Swollen feeling in the fingers
  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers

The symptoms of carpal tunnel syndrome may look like other conditions such as tendonitis, bursitis, or rheumatoid arthritis. Always see your healthcare provider for a diagnosis.

Treatment may include:

  • Splinting of the hand (to help prevent wrist movement and decrease the compression of the nerves inside the tunnel)
  • Oral or injected (into the carpal tunnel space) anti-inflammatory medicines (to reduce the swelling)
  • Surgery (to relieve compression on the nerves in the carpal tunnel)
  • Changing position of a computer keyboard, or other ergonomic changes

Ganglion cysts

Soft, fluid-filled cysts can develop on the front or back of the hand for no apparent reason. These are called ganglion cysts the most common, benign (noncancerous), soft-tissue tumor of the hand and wrist.

The following are the most common symptoms for ganglion cysts include:

  • Wrist pain that is aggravated with repeated use or irritation
  • A slow growing, localized swelling, with mild aching and weakness in the wrist
  • An apparent cyst that is smooth, firm, rounded, or tender

The symptoms of ganglion cysts may look like other medical conditions or problems. Always see your healthcare provider for a diagnosis.

Initially, when the cyst is small and painless, treatment is usually not needed. Only when the cyst begins to grow and interferes with the functionality of the hand is treatment usually necessary. Treatment may include:

  • Rest
  • Splinting
  • Nonsteroidal anti-inflammatory medicines
  • Aspiration
  • Cortisone injections
  • Surgery

Tendon problems

Two major problems associated with tendons include tendonitis and tenosynovitis. Tendonitis, inflammation of a tendon (the tough cords of tissue that connect muscles to bones) can affect any tendon, but is most commonly seen in the wrist and fingers. When the tendons become irritated, swelling, pain, and discomfort will occur.

Tenosynovitis is the inflammation of the lining of the tendon sheaths which enclose the tendons. The tendon sheath is usually the site which becomes inflamed, but both the sheath and the tendon can become inflamed simultaneously. The cause of tenosynovitis is often unknown, but usually strain, overuse, injury, or excessive exercise may be implicated. Tendonitis may also be related to disease (such as, diabetes or rheumatoid arthritis).

Common tendon disorders include the following:

  • Lateral epicondylitis (commonly known as tennis elbow). A condition characterized by pain in the back side of the elbow and forearm, along the thumb side when the arm is alongside the body with the thumb turned away. The pain is caused by damage to the tendons that bend the wrist backward away from the palm.
  • Medial epicondylitis (commonly known as golfer’s or baseball elbow). A condition characterized by pain from the elbow to the wrist on the palm side of the forearm. The pain is caused by damage to the tendons that bend the wrist toward the palm.
  • Rotator cuff tendonitis. A shoulder disorder characterized by the inflammation of the shoulder capsule and related tendons.
  • DeQuervain’s tenosynovitis. The most common type of tenosynovitis disorder characterized by the tendon sheath swelling in the tendons of the thumb.
  • Trigger finger/trigger thumb. A tenosynovitis condition in which the tendon sheath becomes inflamed and thickened, thus preventing the smooth extension or flexion of the finger/thumb. The finger/thumb may lock or “trigger” suddenly.

Treatment for most tendon problems may include:

  • Activity modification
  • Ice
  • Splinting or immobilization
  • Steroid injections
  • Nonsteroidal anti-inflammatory medicines
  • Surgery
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