OSTEOARTHRITIS and your HANDS - VCH



INFLAMMATORY ARTHRITIS

and your HANDS

MNEMONICS FOR JOINT PROTECTION PRINCIPLES

Hot & cold Your own pace

Exercise Others to help you

Larger joints Use both hands

Plan ahead Rest

Splints

Enlarge grips

Listen to your pain

Friction and leverage

INFLAMMATORY ARTHRITIS and your HANDS

WHAT IS INFLAMMATORY ARTHRITIS?

• It is a term used to describe many different types of arthritis, which cause inflammation in the lining of a joint. Inflammation in other body parts (e.g. lung, heart, and eyes etc.) may also occur. The most common type of inflammatory arthritis is Rheumatoid Arthritis.

• The cause of most types of inflammatory arthritis is unknown.

• There are many proven treatments that help minimise and control the symptoms.

WHAT HAPPENS WHEN THE JOINT BECOMES INFLAMED?

• Due to a disorder of the body’s immune defence system, an inflammatory reaction occurs in the lining of joints. Inflammation of the joint lining causes it to thicken and produce extra fluid. This causes the joint to be HOT, SWOLLEN, PAINFUL, and possibly RED.

• If inflammation in the joint lining persists, it can damage other structures within and around the joint. For instance, the joint capsule, which encloses and stabilises the joint can become stretched due to extra fluid within the joint. Also the smooth covering on the ends of the bone called cartilage may become damaged.

Symptoms:

1. Pain

• Joint pain occurs when using the joints and sometimes at rest

2. Stiffness

• Joint stiffness is often worse in the morning or after periods of inactivity

3. Difficulty using your hands

• Pain and stiffness in your hands makes activities requiring strength or dexterity difficult

4. Fatigue

• When your arthritis is more active, fatigue often increases and you may tire more easily

Flare – an increase in disease activity:

As the nature and course of inflammatory arthritis is variable, your symptoms can change frequently (i.e. on a day-to-day and month-to-month basis). Other factors may also trigger a flare-up or worsening of your symptoms. Some of these factors include:

❖ Too little rest

❖ Overactivity

❖ A change in medication

❖ Stress

❖ Weather etc.

Treatments:

How to manage your flare:

The type of treatments you use will depend on your arthritis and what you have found works most effectively for you. Usually the best approach is a combination of the following along with taking your medication as prescribed:

➢ Use physical modalities like ice, contrast baths, heat

➢ Get more rest

➢ Use splints to provide local rest and support to involved joints; some splints are designed to be worn while resting; while some splints can be worn when your are using your hands.

Types of Physical Modalities:

❖ Ice

• Decreases circulation which helps to decrease joint pain and swelling

• It is preferable to use ice if the joint is acutely inflamed (i.e. hot and swollen).

• Ice should not be applied to your hands if you have circulation problems in your hands (e.g. Raynaud’s).

• Examples included: using cold water, ice packs, bag of frozen peas, etc

• Ice packs can be easily made at home and wrapped in a cold wet towel.

• Ice therapy can be applied about 10 to 15 minutes & frequently throughout the day (i.e. 4 to 5 times per day)

❖ Contrast baths

• Useful for decreasing pain, swelling and stiffness in the joints.

• Alternating the use of hot and cold on the hands

• For example, soak your hands in cold water for 10 seconds, then in hot water for 5 seconds. This is repeated for 10 minutes and can be used several times a day.

• Caution with decreased sensation or Raynaud’s phenomenon

❖ Heat

• Heat increases circulation to your hands, which relaxes muscles and helps to decrease pain and stiffness in the joint. It will help decrease inflammation, however, ice is much preferred if the joint is acutely inflamed

• Heat should not be applied if sensation in the hands is impaired

• Heat therapy can be applied about 10 to 15 minutes & frequently throughout the day (i.e. 4 to 5 times per day)

• Examples included: using hot bath, hot packs or wax bath, hot water bottles.

• Wrap a towel around the pack to protect your skin from excessive heat

JOINT PROTECTION

The aim of joint protection is to reduce the stress on your joints. By reducing stress on the involved joints, you can reduce your pain. Joint Protection techniques can be used at rest and during activity. At rest, it is done by supporting the joint in a comfortable and well-aligned position. During activity, it may be done by using adaptive equipment or alternative methods.

Joint protection principles for your hand includes:

1. Respect “Pain”

• Pain can occur due to inflammation, damage or overuse of your hands

• Pain that occurs with or after an activity is an important warning sign. If the pain persists after stop the activity, then you should reduce the time and/or effort you spend on the activity

• Remember you are the best judge of your pain, so let your feelings guide your activity level

• Be aware of your pain-free time and work within that time

• Ignoring pain can lead to increase of pain

2. Pace your activities

• Take short and frequent rest breaks rather than waiting until you are finished the task to take a rest and stop before you are tired

• Use a timer to help you take regular rest breaks

3. Avoid tight grasps – tight grasps put excessive stress on the knuckle joints

• Use padded handles on items (e.g. toothbrush, hammer, mixing spoons etc.) so less force is required to grip object

Joint Protection (cont’d)

4. Avoid pressure on the small joints of the hand – The joints in the hand are small and less structurally strong. Use large joints when possible

• For example, do not carry plastic grocery bags or purses with your fingers but rather hook the handle over your forearm or hold the parcel with your arms against your trunk

5. Avoid pressure against the backs of your fingers

• For example, do not push yourself up from a chair using the backs of your fingers, but rather choose higher chairs and push on the palm of your hand if necessary

6. Avoid side pinch – Pressure from the thumb on the thumb side of the

index finger contributes to drifting of the fingers

• Use of adapted pen grips and key extensions help to avoid side pinch.

Joint Protection (cont’d)

7. Use adapted equipment to minimise stress and improve your ability to use your hand.

• Use leverage – less force is required to turn or lift an object if the lever arm is long. Use tap turners, key extensions, etc.

• Use padded handles – large diameter handle permits a firm hold to be maintained without extra stresses produced by tight grasp.

• Use traction – a non-slippery surface will improve grip with less pressure. Use pen grips, non-skid mats under objects, etc.

8. Use splints – To protect and support your joints in a well aligned position

Exercises

• Hand exercises will maintain your hand mobility and strength, which in turn will help to decrease the pain and stiffness in your hands

• It is important to perform the exercises correctly and to relax between each exercise. Be aware of your body posture and continue to breathe.

• Try to incorporate your hand exercises into your daily routine. They

can easily be done while watching TV, listening to music etc.

Hand exercises

• Do exercises at least once or twice a day with each exercise repeated about 5 to 10 times

• Apply heat (e.g. heat pack) or cold (ice pack) to your hands for 5 -10 minutes before & after you perform these exercises. This will help decrease the pain and stiffness in your hands so you can exercise more easily

1) TUCK

Curl the tips of your fingers down

to touch the base of each finger.

Uncurl to the straight position.

2) FIST

Make a gentle fist curling all your

Fingers. Slowly open your hand

wide.

3) TIP TO TIP

Touch the tip of your thumb

to the tip of each finger, making a circle.

Open your hand completely after each

touch.

THUMB ABDUCTION

With your hands resting on table,

palms up, move your thumb

directly towards the ceiling.

Always keep the thumb in line

with the index finger.

5) FINGER WALKING

With palm flat on table,

lift or slide your fingers

one by one towards thumb.

Do not walk your fingers

back.

6) FINGER HOLDING

Place your palm flat on a table

with fingers straight, place a

pencil on the outer edge of

each finger (on the thumb side).

Press finger gently against the

Pencil. Hold for 6 seconds.

7) THUMB EXTENSION

Place the palm of your hand on

a table. Bring your thumb away

from the index finger and then

back again.

8) PALMS UP & DOWN

Place palm of hands and forearms

flat on table. Tuck elbows snugly

into your sides. Turn hands over to

‘palms up’ position, bringing thumb

as close as possible to table, then

return to original position.

9) WRIST EXTENSION / FLEXION

With your hands resting on the border

of your little finger and your forearms

supported on a table, bend wrists in

and tend out.

Exercise Balls – The use of exercise putty or squeezing exercise balls is not recommended as it can put excessive stress on the joints of the hand

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OTIVA-16

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Mary Pack Arthritis Program

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