Arthritis

Wrist and Hand Arthritis

Do you have pain in your hands typing on the keyboard at work?

Do you have pain in your hand or wrist when opening and closing jars?

 Do you feel you have less strength in your hands when performing everyday manual tasks?

Hand and wrist arthritis may be the cause of your problem.

What is arthritis?? I hear you ask…

Arthritis is a very common degenerative condition that can form in the joints of your body as you get older.

It causes wearing away of the cartilage in the joint, which is the shock absorbing material between the bones. This can result in inflammation of the synovial lining in the joint. This is significant as this lining is responsible for producing synovial fluid, which helps protect and lubricate the joint.

 

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What are the common signs and symptoms of hand and wrist arthritis?

If you have arthritis in the wrist and hands you may experience some of the following signs and symptoms:

  • Loss of movement in the joints of the wrist and hand.
  • You might notice grinding or cracking noises with joint movement.
  • Pain in the joint may come and go. It can become worse with gripping objects or repetitive wrist and finger movement. As the arthritis progresses it may develop into a constant ache, even at rest.
  • The joints may swell and can become tender to touch.
  • The joints may appear to be misshaped or deformed.

 

How can we solve the problem?

Mild symptoms associated with arthritis can be treated effectively by oral anti-inflammatories and physiotherapy. Physiotherapy would involve soft tissue massage to relieve muscle tightness around arthritic joints. Specific exercises can be prescribed for the joints to help improve and maintain range of motion and strength. Additionally, a physiotherapist could provide a splint or support to help protect the joints whilst performing everyday tasks.

In more severe cases of wrist and hand cortisone injections or surgery may be indicated. Surgery is considered when conservative management, no longer eases the pain, or when deformity prevents normal use of the hand. Surgery is also recommended in some patients with inflammatory arthritis. In these patients, the surgery stabilizes joints and prevents tendon damage. Deformity, loss of motion and pain that is not adequately controlled are the main reasons for surgery.

 

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Smart Phones – Pain Triggers

According to recent survey’s, 81% of Australians use a smartphone. This jumps to 96% in 18-34 year olds, with 79% of them checking their phone as soon as they wake up. In fact, 23% of people spend more time on their smartphone or tablet than talking to their partner or friends. The average person will spend between 2-4hrs a day on their mobile device, checking it over 200 times a day and adding up to almost 1000hrs of smartphone usage in a year.

With smartphones playing such a large role in our lives, it is unsurprising that many people can experience episodes of pain following their use. One of the most common injuries is texting thumb, or De Quervain syndrome as discussed in one of the earlier blogs. This is caused by the repetitive strain placed on the tendons around your thumb while texting, leading to areas of irritation and inflammation.

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Common symptoms can include:

  • pain at the thumb or wrist
  • reduced grip strength
  • reduced movement

So how can you manage your pain? Regular stretches and icing the thumb and wrist can help reduce post-texting pain. You can also try using other fingers to text, scroll or email. If this fails, a review by your physio may be necessary as in severe cases a splint or taping to support the joint may be necessary.

However, the most effective treatment is to spend less time on your smartphone and talking to your friends or partner. Even checking your phone only 100 times a day can reduce the time spent on your device by 500hrs over the course of the year. Imagine what you could do with all that free time!

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Knee Braces

Do knee braces cause muscle wasting?

It’s often stated that knee braces can cause muscle wasting, if used for too long. However there has been very little research into this. A study this year (2016) by Callaghan et al. (reference below) assessed 108 patients using braces for OA of the patella-femoral joint. They found that the maximum voluntary contraction of the quadricep (thigh) muscles did not reduce with brace use.

So it’s fine to use a knee brace?

All studies have limitations. This study only assessed a flexible knee support, so we can’t apply the findings across all knee braces – these will need to be assessed separately.

Any other limitations?

Yes- the study was only over 18 weeks. We do not know what would happen in people who wear braces longer than this.

In summary?

Using a flexible brace appears not to have a detrimental effect on the quadricep muscles in the short term. Anyone wishing to wear a knee brace longer than this period should discuss this with their physiotherapist.

Reference: Callaghan M, Parkes M, and Felson D  2016 The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis

Journal of Orthopaedic and Sports Physical Therapy

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Hip Pain – What’s the Cause?

Top 5 reasons

Hip pain is common in people who play sport. A lot of sports related hip pain is simply a sign of overuse- and will respond well to a few days rest. If it persists, it’s worth getting it assessed. Here are 5 common reasons for hip pain-:

Hip Pain - 2

Clue- its’ all about Location, location, location

Exactly where the pain is in the hip can be a strong clue as to the source of the pain. For example, pain that is deep, and more towards the groin is more likely to be related to the hip joint itself.clue-clipart-dT87enn6c

Pain on the outside of the hip is more likely to be tendon or bursa pain.

 Use the location of pain as a guide.

1. Adductor tendinopathy

The painbrian_kicking1web is usually towards the groin, and is worse with activities where you are on a single leg, or kicking. A very common injury in sports players where lots of kicking or running is involved.

Adductor injuries are common in kicking sports

2. Gluteus Medius tendinopathy / bursitis

hipPainDiagThis is the tendon of on of the gluteal muscles, and just like the tendons at the ankle (achilles) and the knee (patella) can become problematic. The pain tends to be on the outside of the hip (lateral hip pain), and can be painful to touch. The nearby bursa can also be inflamed and a source of pain.

3. Femoral-acetabular impingement (FAI)

faisThis is the funky, trendy diagnosis at present. The pain with FAI is usually deep and in towards the groin. The hypothesis is that people with a difference within the bony contours of the bone, in either the femoral head (the ball) or the the acetabulum (socket) will be more prone to pain from impingement. These are called either CAM or PINCER (see diagram). There is much controversy over how to diagnose this, and how to treat it. However, many patients can be successfully managed conservatively.

The funky and trendy diagnosis of the moment- FAI.

4. Referred pain from the lower back

hip-pain

Injuries in the lower back can refer pain to the hip. The pain is usually deep, or radiating across an area around the hip or upper leg. This is easily diagnosed by a physiotherapist, and treatment for the lumbar spine usually resolves this injury

The lower back can refer pain to the hip

5. Labral / cartilage tear 

This is an unusual injury but can be a cause of hip pain.The location of the pain is often deep, and towards the groin. If pain is associated with painful clicking at the hip then this diagnosis may be a possibility. Read more about Labral Tears here.