Radiology Diagnosis of OA of the hands and wrist is determined primarily by clinical presentation. However, radiological tests can confirm a diagnosis in questionable cases, and are helpful in ruling out other conditions. Plain x-rays showing the presence of asymmetric joint space narrowing, increased subchondral density (that appears white on film), new bone cell formation, marginal bony growths (i.e., bone spurs), or joint subluxation can be helpful when there is a diagnostic question (Khorashadi et al.,2012). Laboratory tests No laboratory tests can pinpoint a diagnosis of OA, but joint fluid aspiration can be used to rule out other conditions that
Joint space narrowing and the presence of marginal osteophytes on an x-ray are key diagnostic features in OA. Although imaging might confirm an OA diagnosis or evaluate its severity, a normal radiograph does not rule out OA in its early stages, just as a standard x-ray might not reveal evidence of a suspected fracture until it is reevaluated a week or so later when evidence of fracture healing is observed (Khorashadi et al., 2012). Only one-third of those who have x-ray evidence of decreased joint cartilage exhibit pain or limited range of motion (Khorashadi et al., 2012; O’Neill & Felson, 2018).
create joint pain. When no other disease is present, the synovial fluid of an osteoarthritic joint is clear (Khorashadi et al., 2012).
GOALS AND TREATMENT OPTIONS IN MANAGING OSTEOARTHRITIS
When working with clients experiencing the signs and symptoms of OA, each health professional will establish goals pertinent to their specialty in concert with the goals of the client. Generally, all health professionals have goals that include: ● Maintenance or restoration of daily function. ● Reduction or elimination of pain. ● Maximization of joint function. ● Diminishment of stiffness and improvement in dexterity. ● Improvement in mobility. ● Client empowerment through education and environmental adaptations. As with any treatment team approach, the physician, OT, or PT working with a client who is experiencing hand and wrist OA must coordinate management, goals, and content to capitalize on the teaching principle of repetition of information and avoid giving the client conflicting information. Client education is critical and should be a priority for all health professionals. Helping a client understand that there are ways to improve their functional ability is a large part of any management program. The Arthritis Foundation publishes a web page dedicated to OA that can be recommended to clients and can be used by professionals. The Agency for Healthcare Research and Quality developed its Chronic Disease Self-Management Program for Conservative medical management As with OA in other joints, OA of the hand has multiple causes and leads to deformities and limitations that vary from client to client. The medical management approach must be tailored to each individual. Depending on the localization of the OA, the erosive/nonerosive pattern, the degree of pain and disability, and the client’s perception of pain and functional impact, various therapeutic approaches can be used (Gabay & Gabay, 2013). As described by Gabay and Gabay (2013), the management of hand OA includes both pharmacological and nonpharmacological methods. Nonpharmacological methods include: ● Education such as teaching methods for pain reduction, joint protection, and work simplification. ● Exercise and yoga to maintain strength and flexibility, as well as joint health. ● Nutrient/herbal supplements such as glucosamine, chondroitin sulfate, and curcumin—despite mixed evidence concerning their effectiveness (Sawitzke et al., 2008; Zeng et al., 2021). Physical rehabilitation OTs work with clients diagnosed with OA who are experiencing limitations in occupational participation in several ways. OTs assist the client (and the client’s family, as indicated) to use tools, establish realistic goals, and retain a lifestyle despite the presence of disease or disability. OTs also assist clients by designing adaptive equipment, assistive devices, and orthoses to decrease pain and prevent stress on weakened joints. Like
people with chronic conditions (Agency for Healthcare Research and Quality [AHRQ], 2020). Both programs include techniques for stress reduction, pain control, and exercise; offer instruction in self-help strategies; and should be shared with clients as part of a comprehensive program. See the Resources section of this course for more information. Confirmation of an OA diagnosis and determination of the extent of the disease and disability are the responsibility of all team members. Treatment efficacy and impact on participation are paramount to the management of OA of the wrist and hand. Methods of management include conservative medical management, PT/OT, pharmacological treatments, physical agent modalities, physical therapy interventions, and appropriate medical or surgical interventions. Team members must help their client cope with the symptoms of the condition to the fullest extent possible and may advise use of available self-help programs, if appropriate. It is the responsibility of the client—the one who must live with OA and its impact—to follow through with suggested treatment options. To enable client follow- through, education is the core of all management programs—the client must understand what OA is and what it does. The roles of interventions and professionals are described below. ● Transcutaneous electrical nerve stimulation (TENS), an electrical stimulation unit used to increase comfort in those with chronic or intractable pain (Knight & Draper, 2013). ● Therapeutic touch, including massage, as a means of reducing muscular spasms and increasing circulation for pain reduction (Knight & Draper, 2013). ● Low-level laser or high-intensity laser therapy, which can help decrease pain and reduce inflammation (Akaltun et al., 2021). Pharmacological approaches include paracetamol/ acetaminophen, conventional nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 selective inhibitors, topical NSAIDs, topical capsaicin, symptomatic slow-acting drugs for OA (SYSADOA), intra-articular corticosteroids, and intra-articular and hyaluronic acid preparations (Gabay & Gabay, 2013). The use of topical NSAIDs such as diclofenac gel yields significant improvement of pain and function compared to placebo trials (Wolff et al., 2021). physical therapists, OTs focus on the client-centered, long-term goals of reducing pain and improving function. The role of the OT also involves prevention of future deformity, future pain, and further occupational dysfunction. The OT evaluates all aspects of functional performance in context to design treatment plans that prevent future difficulties.
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