Arthrosis of the hand and its treatment, causes and symptoms of the disease

Arthrosis of the hands is called a progressive degenerative-dystrophic pathology, which is characterized by primary damage to the cartilage with subsequent deformation of the bone structures. Clinically, it is manifested by episodic or constant pain in the joints of the fingers, swelling, limitation of range of motion. At the initial stages of development, systemic and local preparations, physiotherapeutic and massage procedures, exercise therapy are used to treat arthrosis. With severe damage to the joints, endoprosthetics are performed.

Stage description

Features of the clinical and radiological picture are the basis of the classification of arthrosis of the hands. In total, 3 stages of pathology are distinguished, each of which is characterized by certain symptoms and radiological signs. Classification of arthrosis Kellgren and Lawrence is also generally accepted. These authors distinguish stage 0 of the disease in which there are no radiological signs of damage to the bones and cartilage, and clinical manifestations are weak.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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1 stage

With arthrosis of the hands in the first stage, the composition of the synovial fluid changes. It contains insufficient amount of nutrients for the normal functioning of cartilage. On the obtained x-ray images, there is a fuzzy narrowing of the joint space, the formation of initial osteophytes at the edges of bone structures.

2 stage

Bone formations (Heberden nodules) are formed in places of localization of edema, which are usually located symmetrically on the left and right hand. Small joints of the fingers noticeably deform, which becomes the reason for the restriction of mobility. Arthrosis is manifested by a violation of the functions of the periarticular muscles, their moderate atrophy.

Multiple osteophytes, subchondral osteosclerosis in bone tissues, and a marked narrowing of the joint space are clearly visualized on radiographic images.

3 stage

When conducting an X-ray examination, extensive osteophytes, full or partial fusion of the joint space, subchondral cysts, “articular mice” (freely moving solid particles) are detected. The articular site is severely deformed, which leads to a violation of the relationship between the anatomical structures. Ligaments and tendons are involved in the degenerative process – they shorten and become less durable.

Causes

Quite rarely, patients are diagnosed with primary, or idiopathic, arthrosis of the hands. This term refers to a pathology that has developed without any reason. During the examination, no prerequisites or provoking factors that served as a “trigger” for the destructive-degenerative process were found.

But in most cases, secondary arthrosis is detected, the causes of which are numerous and varied:

  • previous injuries of the hands – dislocations, subluxations, fractures, damage to muscles and (or) ligament-tendon apparatus;
  • congenital and acquired abnormalities in the structure of the joints of the hand, including dysplasia;
  • metabolic disorders, blood circulation or circulatory disorders;
  • endocrine diseases, for example, diabetes mellitus, hypothyro >

Provoking factors include old age, a sedentary lifestyle, excessive physical exertion, frequent hypothermia. The risk group includes people whose diets lack foods with a high content of trace elements, water- and fat-soluble vitamins.

Symptoms of hand arthrosis depending on the degree

Arthrosis of the hands of a certain stage is distinguished by its specific clinical manifestations. This allows the orthopedist to make an initial diagnosis during an external examination of the patient. With arthrosis of the hands, several types of pain syndrome are distinguished. Mechanical pain appears during stress on the joints. Its main causes are micro-fractures of trabecular bone tissue, venous congestion and intraarticular hypertension. The “starting” pain is short-term, it is felt only at the beginning of the movement. Periodic “blockade” pain provokes particles of destroyed cartilage that are affected by the articular surfaces.

Degrees of arthrosis of the handsCharacteristic clinical manifestations
First

At the initial stage of development, pathology manifests itself with weak discomfort, disappearing after a short rest. Specific clicks, crunching, cracking occur when performing rotational movements, flexion or extension of the wrist joint. Pain at rest is absent, appear only after physical exertion. Their intensity increases with hypothermia, changing weather, flu, SARS. The pain is pulling, pressing, aching, clearly localized.

During relapses, mild swelling of the interphalangeal joints is observed. They swell, and the skin above them is smoothed. Edema is accompanied by a slight restriction of movement, but within 1-2 hours these symptoms disappear

The secondAt stage 2, crunching and clicks become familiar, they are heard even with incomplete flexion of the wrist joint or fingers. The pains in the joints of the hands also become constant. They arise at rest, including at night, amplified by any movement of the hands. A specific sign of cartilage damage appears – morning swelling and stiffness of movements, which lasts until noon, and then disappears due to the production of hormone-like substances in the body
The thirdThis stage of arthrosis is characterized by severe deformation of the joints of the hands, partial or complete limitation of mobility. Due to the stiffness resulting from the fusion of the surfaces of the joint, the severity of the pain syndrome is reduced. During relapses, severe dull pains appear, spreading above the wrist. At the stage of remission, the discomfort is less intense, pulling, aching.

Diagnosis of pathology

The initial diagnosis is made on the basis of patient complaints, medical history and the results of a series of tests. The latter allow us to evaluate the functional usefulness of the joints of the hands, the condition of the muscles and ligament-tendon apparatus. Of the instrumental studies, radiography is the most informative, helping to identify not only specific signs of arthrosis, but also complications that have arisen. As an additional diagnosis, MRI or CT is performed to detect destructive and degenerative changes in cartilage, muscle tissue, ligaments and tendons.

If synovitis is suspected, joint puncture is performed. Synovial fluid is taken to assess its composition. Joint arthroscopy is often combined with sampling of the synovial membrane and cartilage for histological examination.

Therapies

Osteoarthritis of the hand of 1-2 severity is treated with conservative – pharmacological drugs, physiotherapy, daily exercise therapy and gymnastics. The fusion of bone articular surfaces and the destruction of hyaline cartilage cannot be eliminated medically. Therefore, when diagnosing a pathology at 3 stages of the course, patients are usually immediately offered surgical intervention.

Medication Therapy

For relief of acute pain, patients are prescribed intraarticular blockade of anesthetics (Lidocaine, Novocaine) and glucocorticosteroids (Diprospan, Dexamethasone, Triamcinolone). The analgesic effect of treatment procedures is noted for several days. But hormones are toxic to cartilage and bone tissue, so they can often not be used.

  • injection solutions Ortophen, Meloxicam, Xefocam;

  • Nise, Ketorol, Diclofenac, Celecoxib, Etoricoxib tablets;

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  • ointments and gels Voltaren, Fastum, Arthrosilen, Dolgit, Finalgel.

Local application of ointments with a warming and locally irritating effect allows to improve blood circulation and microcirculation, to eliminate painful sensations. These are Viprosal, Finalgon, Nayatoks, Kapsikam, Apizartron.

With arthrosis 1, less than 2 degrees, chondroprotectors Alflutop, Structum, Arthra, Teraflex, Don are included in therapeutic regimens. Their long term use contributes to the partial regeneration of damaged cartilage tissue.

Physiotherapy

Physiotherapy measures also help get rid of pain. At the remission stage, electrophoresis, ultraphonophoresis with analgesics, anesthetics, NSAIDs, glucocorticosteroids, B vitamins, chondroprotectors are performed. After stopping the aseptic inflammatory process that occurs due to trauma to the soft tissues by osteophytes, patients are assigned 5-10 sessions of the following physiotherapy:

Balneotherapy is practiced – sulfide, radon and sea baths. To improve the blood supply to cartilage and bone tissue, paraffin or ozokerite applications are used.

Therapeutic gymnastics and physical therapy

From the first days of treatment, patients are shown daily physical therapy classes. A set of exercises is developed by a physical therapy doctor, previously studying the results of a patient’s diagnosis. It shows how to properly perform movements and dose loads. Regular exercises help strengthen the muscles of the wrist, stabilize its structure, improve blood circulation and microcirculation. The most therapeutically effective exercises are:

  • warm-up – squeezing the brush for a minute with subsequent relaxation;
  • circular rotation of the brush, first in one, then in the other direction;
  • imitation of playing the piano;
  • abduction of the thumb to the s >

For training, you can use special expanders of varying degrees of rigidity. Recently, in pharmacies and medical equipment stores balls are sold on the surface of which there are many soft cylindrical villi. Their use (rolling between the palms, squeezing) improves fine motor skills.

Patients with arthritis of any severity are recommended general massage and the effect directly on the hands. To increase therapeutic effectiveness, it is advisable to combine it with physical education classes. Usually used classic, acupressure, vacuum massage.

Arthrosis diet

Therapeutic nutrition and diet for damage to cartilage and bone tissue is to reduce the use of salt, spices, and spices. This avoids fluid retention in the body and the formation of edema. Nutritionists recommend that patients with arthrosis exclude smoked foods, convenience foods, pastries and puff pastries, rich soups, coffee, alcohol from the diet. You should give preference to food, steamed or stewed in a small amount of water.

Several times a week you need to eat fish of fatty varieties (salmon, herring, sardines), which contain fat-soluble vitamins and healthy polyunsaturated fatty acids. Fresh vegetables, fruits, berries must be present in the diet.

Folk remedies

Remedies made according to traditional medicine are used as an auxiliary treatment. It is advisable to apply them after the main conservative therapy or surgery during the rehabilitation period.

Broths

Decoctions and infusions from medicinal plants (elecampane, wild rose, chamomile) are recommended for brush arthrosis to strengthen the body’s defenses, accelerate metabolic and regeneration processes. Their use also stimulates the elimination of mineral salts accumulated in the joints of the hands, which provoke inflammation and stiffness. To prepare the broth, a tablespoon of dried plant material is poured with 2 cups of hot water, brought to a boil and simmered over low heat for 10 minutes. Cool, filter, drink 100 ml 2-3 times a day after meals.

Grinding

Grindings from fresh leaves of burdock, nettle, plantain, dandelion flowers, chopped horseradish roots are especially popular. A container of dark glass is filled with vegetable raw materials, but not tamped. Pour vodka or ethyl alcohol diluted with an equal volume of water along the wall to the top, leave for a couple of months in a warm place. Rubbed into the brush affected by arthrosis with the appearance of painful sensations.

Compresses

With arthrosis, the use of fresh leaves of cabbage, dandelion, horseradish, burdock in the form of compresses is practiced. They are well kneaded until juice and lubricated with honey. A thin layer of any vegetable oil (sunflower, olive, linseed) is applied to the area of ​​the wrist joint, a sheet, a plastic film and a dense fabric are applied on top. The duration of the procedure is 1-2 hours.

Other folk methods

As a means with a mild analgesic, locally irritating, distracting effect, ointments made at home are used. In a mortar, rub a teaspoon of lanolin and tinctures of red hot pepper, add a couple of drops of essential oils of juniper, thyme, eucalyptus, 20 ml of cosmetic almond oil. In parts, 100 g of medical vaseline are injected, stirred. Rubbed into the hands with pulling, aching pain.

Possible complications

Resizing, reducing contractility of the muscles provokes frequent subluxations, contractures. The person is particularly worried about pain at night, adversely affecting the quality of sleep, the patient’s psycho-emotional state.

With prolonged progression of arthrosis of the hands, secondary reactive synovitis often develops – an inflammatory process in the synovial membrane, accompanied by an accumulation of fluid in the joint cavity. The course of the disease can also be complicated by spontaneous hemarthrosis, ankylosis.

Prophylaxis and prognosis

Arthrosis of any localization is not yet amenable to final cure. But subject to all medical recommendations, the prognosis is favorable. Pathology is transferred to the stage of stable remission, at which the risk of painful relapse is minimal.

To avoid the development of arthrosis of the hands, excessive physical exertion on the joints, frequent hypothermia should be avoided. The best prevention of cartilage damage is daily exercise therapy.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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