Osteoathritis of the hand and wrist
- 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.
- 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.
- 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.
- 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.