MSK self-management workbook Osteoarthritis (oa) of the wrist, hand and thumb DeQuervain’s Tenosynovitis July 2020 MSK Wrist and Hand Disclaimer This workbook provides general advice which may not be specific to you. It is important that if you are in pain that you see a health care professional for an assessment to rule out serious, albeit rare, pathology. Please talk to a health care provider if you have not seen one before. This workbook can be used on your own, however, we recommend that you do so alongside a health professional. Health and safety This workbook is designed to help you manage your condition. It is recommended that the workbook is used alongside advice from a health professional. Together you can work to help with your recovery. You may progress more rapidly or slowly through this workbook depending on your symptoms and other factors related to your condition. It is important that if you are experiencing pain during the activities in this workbook then you should discuss your symptoms with a health professional. Purpose of workbook This workbook provides a general overview of the management of your condition. The workbook is split into different sections with the main focus being education, self-management advice and exercise. We recommend reading all the sections over time, however, you may find that not all of this information is relevant to you. The exercise section gives you a choice of exercises, varying in difficulty. Begin with the level you feel is appropriate, based on your pain and confidence. You then have the option over time to make these exercises more challenging or reduce to a more basic level as required. The self-management section provides education on other management options that can be used in conjunction with exercise to improve your condition. Finally, the workbook also includes a range of additional resources available that may be of benefit, such as leaflets, videos and contact details for other services. 1 MSK Wrist and Hand Contents Page Page 4 Introduction to hand and wrist anatomy and the workbook in general Page 6 Understanding pain Pages 7-9 What is Osteoarthritis? - Why does it occur? - What is the natural history? - How is it diagnosed? Page 10 OA myths v facts Pages 11-12 DeQuervain’s Tenosynovitis Pages 13-15 What can I do to help my wrist/hand or thumb OA? Page 16-17 Operations for wrist/hand and thumb OA Page 18-20 General Information on Having a Hand/Wrist Operation Page 21-26 Joint Protection and Activity Advice and Modifications Page 27 Goal Setting Page 28-37 Exercises Page 38 Useful Links 2 MSK Wrist and Hand Page 40 Multi-Language Page 40 Acknowledgements 3 MSK Wrist and Hand Introduction to the wrist, hand and thumb The wrist is a complex joint that bridges the hand with the forearm. It is made up of a collection of bones: two long bones called the radius and the ulna, eight carpal bones and the base of the metacarpal bones. Below the metacarpal bones are the phalange bones, of which there are 19 in total. As well as the bones in your wrists there are also many muscles, tendons, ligaments and nerves that help you move your hand and wrist and give it stability and feeling. Some problems with the wrist and hand occur due to injury. Other problems occur as a result of the normal ageing process, or “wear and tear”. Wear and tear can occur in soft tissue and joints; the wrist joint, the joint at the base of the thumb, the small joints of the hand and fingers and even in the tendons in the hand. Wear and tear is normal and can be considered as the ‘grey hair’ of joints and tendons. Whilst your joints may have wear and tear, this does not necessarily mean you will have pain. However, when pain is an issue it can make day to day activities more difficult. The Radius Base of thumb The Ulna (CMC joint) The Carpal Bones The Phalanges The Metacarpals The Wrist joint (made up of the radius, ulna, carpal bones and base of the metacarpal) 4 MSK Wrist and Hand How to use this workbook You have been asked to look through this workbook because you have symptoms which could be due to Osteoarthritis (OA) or DeQuervains tenosynovitis. If your health care professional thinks you may have Osteoarthritis of the wrist, hand or thumb then please read the sections on Osteoarthritis (OA). DeQuervains tenosynovitis is another condition which can give pain in and around the thumb. Some of the advice and management given for this is similar to that for OA, therefore, it has been included in this booklet. Please read the appropriate section if your health care professional has given you this diagnosis. Additionally, this booklet provides information to promote a better understanding of pain in general; a variety of exercises to manage your condition; advice for hand posture and positioning; information on activity modification and general management advice and looking after splints that you may have been given, advised to buy or already have. The ultimate aim is to give you as much advice and help as possible to help you improve and manage your symptoms. Please look at the table of contents and use this when working through the book. 5 MSK Wrist and Hand Understanding pain Before getting into the specifics of painful wrist and hand conditions, it is important to gain an understanding of how pain works in general. A good understanding of pain has been shown to improve people’s ability to manage their symptoms more effectively. How is this relevant to you? It is important to note that pain does not necessarily mean harm. We can experience pain as a result of tissue damage, however, it’s also possible to feel no pain at all, even with damage to our body. Similarly, we can experience significant amounts of pain with no damage to our bodies. We know that pain is far more complex than solely what is going on in our bodies and can be influenced by other areas of your life. These include: Mood and emotions Beliefs about pain Avoidance of meaningful activities/social contact. Lifestyle choices This is often referred to as “The Bio - Psycho - Social model of pain” which means that all areas of your life can influence pain. It is important therefore to look at your life as a whole when dealing with hand or wrist pain/dysfunction to identify potential contributing factors. Further information can be found on understanding pain on the link below: https://www.nhsaaa.net/pain-management-service/ The following pages provide information and detail about the specific OA and tendon conditions which can affect the hand and wrist. These are designed to support you with exercise and help you care for your wrist and hand. We hope you find it useful. 6 MSK Wrist and Hand What is Osteoarthritis of the hand and thumb? The term ‘arthritis’ is used to describe pain and swelling in a joint(s). There are many different types of arthritis, osteoarthritis being the most common; it is also known as ‘wear and tear’ arthritis as a result of the normal ageing process. Osteoarthritis can also be genetic or occur as a result of injury to a joint; this is known as ‘secondary osteoarthritis’. The following section will give you information on OA of the hand. The section after that focuses on OA of the base of thumb. Osteoarthritis of the wrist, hand and thumb Normal joints are constantly undergoing repair due to the daily wear and tear that is placed on them. In osteoarthritis this process does not seem to occur correctly and changes occur. The cartilage that covers the end of the bone becomes damaged and bony growths can form around the joint edges. These are called osteophytes and the tissues surrounding the joint can become inflamed which may lead to stiffness (See diagram one). Diagram one: Changes that occur in the hand with osteoarthritis. 7 MSK Wrist and Hand Why does it occur? It isn’t always clear but there are a number of factors that can play a role in developing OA of the hand, wrist and/or thumb, including: Age: OA is more common with increasing age. This is due to the natural wear and tear process and a reduction in the body’s ability to repair as you get older. Genetics: There is thought to be a link to inheriting OA. Gender: Women are more likely to develop OA than men. Previous injury: If you have had previous trauma or injury to your wrist thumb or a small joint in your hand this may contribute to OA. Care of the joint: Without periods of rest or looking after your joint(s) this can contribute to a flare up of your pain. What is the natural history? The term natural history is used to describe what happens when nature runs its own course. With osteoarthritis in the hand, it is often possible to see what is likely to happen with time by looking at the hands of parents, since this is often a hereditary condition. Most people will find that although their parents may have quite stiff and misshapen hands, their hands still work fairly normally and there is not much that they are unable to do because of the arthritis. The majority of people develop osteoarthritic changes with time. For most the condition is not painful, although individual joints can occasionally become sore. This is as a result of inflammation of the joint which then produces pain.