Osteoathritis of the hand and wrist

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Patient Information


GP Information

Background Information

  • A progressive degenerative disorder of the small joints of the hand.
  • Patients typically complain of pain and deformity.
  • Examination may reveal heberdens nodes and mucous cysts (DIPJ OA), or Bouchards nodes(PIPJ OA) and joint contractures.

Investigation Guidelines

  • Blood tests and radiography are not usually indicated as part of a primary care assessment of suspected small joint osteoarthritis and are not required prior to commencing treatment or for referral.

Management Recommendations

  • Utilise a shared decision-making approach.
  • NICE core treatments are safe, low cost and widely accepted. Provide information and advice through leaflets and alternative sources.
  • Initial treatment includes.
  • Exercise.
  • Paracetamol (regular better than ‘as required’) and NSAIDs (standard NSAID precautions).
  • When symptoms affect activities of daily life refer to physiotherapy or Occupational therapy for joint protection training, protective splints, and assistive device.
  • Steroid injections have limited efficacy but may provide temporary relief.
  • Surgical interventions include fusion, joint replacement and denervation.
  • Referral indications: Diagnostic uncertainty, Referral for physical therapy, Referral for intra-articular steroid injection, A fit patient willing to undergo surgery with pain/stiffness/loss of function significantly impacting quality of life and refractory to non-surgical treatment.