Hand pain stemming from arthritis can severely limit activities of daily living function as well as some job and sport activities. Three literature reviews published in the past 6 years have concluded that conservative rehabilitation can reduce pain and increase function in patients with hand osteoarthritis (OA). In a recent Advance Heathcare Network article (http://physical-therapy.advanceweb.com/) Dr. Carol Lewis, DPT and Dr. Jason Dring, DPT summed the beneficial approaches found in the literature. In 2012 and 2013, Villafane published two effective protocols for persons with OA of the thumb. He found that carpometacarpal joint mobilization decreased pain sensitivity and increased tip-pinch strength. Interventions were performed during 12 sessions over four weeks, and the manual technique was applied for three minutes followed by a one-minute rest, four times. Patients also completed exercises daily.
Effects of a hand-joint protection (JP) program with the addition of splinting and exercise by Boustedt showed that JP plus exercise and splinting resulted in more improvement and lasted up to a year. The JP-plus program was performed twice per week for five weeks and included education in JP, paraffin wax, ROM and PRE to all joints of the hand, splints for every affected joint (night splints, thumb splint all day), hot pack before performing hand exercises, and performing a home exercise program of exercises every day on their own, followed by five paraffin dips.
Paraffin dips alone were shown to decrease pain and tenderness while maintaining grip pinch and chuck strength. However, for improvement and not just maintenance, a study by Stamm showed increased grip strength, function, and improved pain. This program included joint protection instruction (30 minutes) followed by patients performing the following exercises: open and closed fists; PIP/DIP flexion; MP flexion; finger abduction, adduction, and opposition; and radial side stretch of each finger with hand flat on table.
Finally, hand arthritis pain can be reduced by massage therapy as shown in a study by Field.11 The study included two groups: one received massage once per week for four weeks and performed self-massage at home, while the other group was only measured. The massage group displayed lower anxiety, depression, and pain, and increased grip strength. The 15-minute massage included moderate-pressure fingertips to elbow: Begin by stroking wrist-to-elbow, then a wringing motion, then circular into hand, and end with rolling using the thumb and forefinger from hand to forearm. This technique was also taught to the patient for home treatment.
There is emerging high-quality evidence demonstrating rehabilitation’s role in treating osteoarthritis of the hand.
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