Just been diagnosed with osteoarthritis in both hands and wrists

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Hi im looking for some tips and which medication to try for pain relief in both hands and wrists due to osteoarthritis.  Im 46years old this has come as quite a shock.  Im fit and healthy apart from recurrent shingle attacks.  Ive had the pain for about 6 months, went for xrays for confirmation of condition. Any advice would be greatly apreciated.Thanks

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  • Posted

    Hello lisa. I was diagnosed about a year ago and it's been a real roller coaster because I have at times suffered from severe pain. I've been prescribed codeine because I just can't tolerate anti inflammatory drugs. However one drug that helped was Nefopam (also known as Acupan). It's not an opiate so less chance of addiction but is often given following surgery and to women in labour. The really good thing about it is that you can take it alongside other pain medication as it works differently. It has helped me and I have osteoarthritis in my shoulders, knees, feet and hands, all confirmed by X-ray. Hope that helps.
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    • Posted

      thankyou for your reply, i am going back to doctor tomorrow to sort pain relief out. i will ask about what u recommended.its so frustrating because the pain is there all the time,no matter what im doing.its bad enough in hands and wrists so goodness knows how you cope.many thanks lisax
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  • Posted

    Hi, GP originally prescirbed me Naproxen but i have now converted GP!   I went to a hand surgeon who took xrays etc and then sent me to a hand therapist who made me hand splints. Surgeon explained that if you immobilise them, scar tissue will form between the joint - wore them continually for 3 months. Now i just wear them when i am e.g. driving for 4 hours, or if i;ve done something that make them hurt, i wear them at night. The scar tissue is slow growing. The splints dont stop you doing anything.   Typing on computer sets it off sometimes but if i pop on the splints, pain gone within couple of hours. 

    I am no longer on pain relief. GP now reommends them to everyone he sees. Just get splints. I have 2 pairs, one soft and one hard. If i am doing e.g. heavy work, e.g. shopping hedge or something, i wear hard ones. Soft ones are more comfy but they dont immobile the joint so much.  I kind of alternate them.   Not in much pain at all any more - maybe once or twice a month whereas had been continuous.   Dont go anywhere without my splints. 

    If really bad, maybe onece every couple of months when i;ve been typing for hours then i rub in some Voltarol, which was recommended by hand surgeon as being better than the stuff GP's normally prescribe as cheaper than a prescriptions and its OTC in Boots.

    Good luck. Find a hand therapist  - they will make you splints. 

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  • Posted

    My hair stylist suffers from arthritis in her hands. She takes a tablespoon of apple cider vinegar - the one with the "mother" which is a special kind- and mixes it with water, ice water or ice, water and a table spoon of honey. This has helped her a great deal.

    She recently got a cortisone shot in each hand which helped, too.

    She typically takes an Aleve every 12 hours in addition to the above.

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  • Posted

    Hi,

    The good news is (and this comes direct from the 'official source' - the NICE guidelines) is that 41% of over 45's have x-ray evidence of degenerative changes in the joints of the hands - almost half the population. Yet only 3% are symptomatic.

    Xrays therefore don't prove that your pain is due to osteoarthritis. There is no test for osteoarthitis - it is a diagnosis of exclusion. There is still a possibility that you symptoms are due to something treatable and you x-ray findings are aysmptomatic (as with most of the population).

    It does no harm to look into whether trigger points (treatable by self-massage) are causing some or all of your symptoms. Trigger points can occur in the hands themselves, the forearms (the muscles that act on the joints in the hands), or even referred pain from the muscles in the back, shoulders and chest. Don't dismiss this lightly - it is very common and with treatment being free and harmless it makes sense to try it. There is plenty of advice available freely online, although I highly recommend a book called "The Trigger Point Therapy Workbook" - you can get it very cheaply on Amazon. I believe they also have a book specifically aimed at hand pain although I can't personally vouch for that.

    I was never diagnosed with hand OA but did have problems with pain in hands and mine was a direct result of trigger points in my upper back and shoulders. It felt 100% as if it was coming from my hands - my hands would even become temporarily paralized. But it was cased by those tight back muscles. Nerves running to the hands have to pass through all this tight tissue. I've also experienced hand pain from tight knots in hand and forearm muscles. It feels SO much like joint pain but massaging those tight knots really can eliminate it.

    Assuming though that you do indeed have osteoarthritis that can't be treated through massage of trigger points here is what the NICE guidelines have to say:

    "Hand osteoarthritis has a particularly good prognosis. Most cases of interphalangeal joint osteoarthritis become asymptomatic after a few years, although patients are left with permanent swellings of the distal or proximal interphalangeal joints (called Heberden’s and Bouchard’s nodes respectively).  Involvement of the thumb base may have a worse prognosis, as in some cases this causes continuing pain on certain activities (such as pinch grip), and thus lasting disability."

    Chances are this won't last forever. Even if you can't eliminate your symptoms through massage it makes good sense to work on both massage and mobilization of the hands as this will keep them in the best possible shape giving you greater chance of full resolution and good function when the pain does pass.

    Good luck!

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    • Posted

      thank you susan, im reading your reply as im waiting in my doctors surgery and have plenty to ask my GP.many thanks for your advice and i will definately buy that book you recommend.thanks again.Lisax
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  • Posted

    Hi, 

    I slightly disagree with the last post... rfom my personal experience....

    1. A GP is unlikely to know an awful lot about hands and thumbs. They are generalists.  I gave up on the GP and went to a speciliast hand surgeon. You can ask your GP to refer you but i paid privately to go to a top guy. This only cost £150 for the appointment and £250 for the X-Ray. I appreciate this is a lot but i can only say i'd pay again in a trice to be out of pain.   Between seeing the Gp and Hand Surgeon i went to A&E at local hospital in case i had dislocated it somehow as it kind of felt out of place. They told me categorically i did not have arthritis when i asked. (they were wrong). Thus in my case, both GP and hospital were wrong.

    2. The Hand Surgeon took time to show me the X-rays and speciically showed me the osteo-phytes which showed me and convinced me that i did indeed have OA.  I ased why the Gp and hospital had stated otherwise and he indicated that you had to take the x-rays at a certain angle. However, i believed him as i could see the bones myself. There was nothing to dispute. 

    3. He told me that there is one chainof thought to exercise the hands and thumbs, find trigger points etc but he told me to ignore this. He stated that there was no possibility of cartilege re-growing as the body does not re-grow cartilege but the body does try to heal itself through growing scar tissue between the joints if immobilised (i.e. opposite of last post).  He told me scar tissue was very slow growing and i shoudl wear splints for 6 weeks as it might save me long run. I went back after 6 weeks and the thumb had stiffened up a bit which was the right result - the cartilege gets more damaged if there is lots of movement inthe thumb. He recommended i kept them on for another 6 weeks which i did as even i could tell that the pain was going.   After 3 months the pain had gone. I only wear them now when i am doing something for a long period of time or gardening or something.   I have a pal who is also a top phsyio in the UK - really one of the top 10 in terms of medical research in the field and she uses soft ones. I find the hard plastic ones sort thepain out almost instantaneously but the soft ones easier to wear but take longer to dissipate pain so i alternate. 

    4. There is a lot of research that shows (go to Google Scholar to get the real research and med journals) that the more overweight you are, the more likely you are to get hand arthritis. They dont really know why this is - it amkes sense for knees and hips but not necessarily intuitive for thumbs and hands However, it is the case. They believe that the fat cells trigger chemical reactions inthe joints.  As soon as i knew this i went on a fruit, veg, fish,nuts, seeds diet and lost 2 stone to to being a healthy weight over 9 months. Maybe this helped too. Dont know. All i know is that i feel 15 years younger, have lost the pain, swear by my splints and am off all painkillers.  But i am convinced the surgeon was right and that immobilising them gave the scar tissue time to heal the jont as best as it could. I can still do everything. I can turn jars again.   TYping on compute for long periods sets it off a bit so i wear soft splints when i do that and have no problems.

    I would not exercise - surgeon told me hands and fingers get more than enough exercise - until you have seen a hand specialist. Mine was brilliant - lives in Maidenhead if you are anywhere near - Chris Koo and Meryl his hand therapist. 

    Dont however let anyone operate on your thumb as apparently that is really a last resort.  Surgeon also agreed with this and luckily i seem to have got a good surgeon who knew he shoudl only be the very last resort and helped me.

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    • Posted

      Sparkle1 - all different opinions for people to try and see what works. I'm not disagreng that what you say may well work for some people.

      But what you must remember is surgeons know nothing about soft tissue problems. If you go to a surgeon then they will concentrate on the joints and be oblivious to what *might* be the real cause of symptoms. Likewise, if you go to someone with expertise in soft tissue problems all they'll see is soft tissue and may miss joint problems.

      The only way to diagnose OA is to rule out all other causes. The only way to rule out soft tissue causes is to treat imbalances, trigger points etc and see if any symptoms remain.

      GP's generally have little expertise - I agree. And phsyiotherapists aren't trained to identify and treat muscle imbalance causes of joint pain. It's EXTREMELY easy for treatable soft tissue causes of joint problems to be missed. Fortunately it's easy to rule them out for yourself.

      The NICE guidelines are based upon sound research. They state that 41% of the population (I believe over age 45) have xray evidence of degenerative changes in joints yet only 3% are symptomatic. This means that 38% of over 45's are walking around with degenerative changes in hands that they are blissfully unaware of. The NICE guidelines make it very clear that xrays aren't useful in diagnosing OA simply because research has shown no correlation between xray findings and symptoms. Some people have severe sysmptoms and no xray evidence; others have no symptoms and trashed joints.

      It's known beyond all doubt that there are LOTS of soft tissue causes of pain in hands. Entirely soft tissue related and 100% treatable. What would happen if one of those 38% of people with asymptomatic joint degeneration were to develop one of those treatable soft tissue problems - such as trigger points?

      A surgeon would look at an xray and, due to his complete ignorance of soft tissue causes, would find degenerative changes - so bone spurs and lost cartilage - that he would blame for your symptoms. The treatable soft tissue problems would never be addressed because the man considered to be the king of experts - the lofty surgeon - says you have incurable osteoarthritis. Few docs and physios have the balls to argue with the surgeon!

      I'm just pointing out the risk. He may well be right in your case and in other cases. But logic dictates that he'll often be wrong. Forwarned is forearmed!

      Soft tissue problems occur as the result of muscle imbalance. That happens when we use the muscles on one side of a joint more than on the other. This causes the bones in the joint to be pulled out of alignment and to track incorrectly. So exercise to CORRECT muscle imbalance needs to stretch the tight muscles and strengthen the weak muscles. But just regular movement in all directions can help things from siezing up too much.

      I'm speaking as someone that also paid an expensive private specialist with regards to my hip problem. I was told it was definitely OA - beyond all doubt. 10 years later I'm completely symptom free. It was always down to muscle imbalance. Had I taken the surgeon advice - well, the thought of where it would have led me terrifies me! It's always nice to get a diagnosis, but if you get a FALSE OA diagnosis it can prevent you from finding the real, treatable cause of your symptoms.

      I'm not saying your surgeons advice won't be sound in some cases. Just that there are other possibilities to consider - to rule out. It's important to get an accurate diagnosis. That's near impossible as every expert sees things differently. As the saying goes "If the only tool you have is a hammer, you'll treat everything as a nail".

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  • Posted

    I think it depends on the calibre of the guy you see... The guy i saw was magic really. I think if you can see osteophytes on the Xray it pretty much determines that you have arthritis and helped me believe that i did have. 

    For a separate injury (broke my ankle and got all srts of issues following) then i went to Physio London and they DID do trigger point massage on my achilles and i kind of swear by the physio i saw there too so in my experience, a good physio will do trigger point massage.  However, if this lady does have OA in her thumb, trigger point will as i understand it, make it worse.   Seh really needs an accurate diagnosis.  I had 2 bum diagnoses from GP and A&E before i saw the surgeon. I can only say that my surgeon had NO intention of operating on me; did Xrays and Utrasound and showed me the OA so i could see it and thus believed him.  He aso checked for carpal tunnel damage to the nerve. I dont really agree that they cant diagnose it - i think if there are osteophytes then it is pretty clear.   

    I think it is clear that this lady needs an accurate diagnosis. I would not rely on the GP to provide that diagnosis and i woudl ask to see the Xray for osteophytes or the ultrasound and ask for them to explain what they are seeing to you. Then ask if it woudl be better to wear splints as a first course of action or whether to go for trigger point. If however, you do have OA in base of thumb, then i think the latter may be harmful to you so an accurate diagnosis is fundamental.  Try and get the best guy in the area - and if they suggest surgery, ignore them and ask to see someone else. Whilst i went to a hand surgeon he had absolutely no intention of operating. He only wanted to help me conservatively and i have found that following his advice got rid of the pain.   By his own admission, he was the 'last resort' when all else fails. If you dont have OA, and have been wrongly diagnosed, it is true that trigger stuff may be the way forward.   Thus, get a diagnosis that you can see on teh x-rays and ultrasound what you have. Seeing it with my own eyes helped me to accept what i had and then i went into action mode to do something about it. 

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  • Posted

    I have OA in my fingers and have been seeing a hand consultant for about 5 years. As said by previous posts make sure you find a hand expert and a good one. I initially had lots of pain and he did the injection in the joint which made me pain free for a while, then I was on the voltarol gel. Eventually he announced, after years of telling me he doesn't do this, was that I needed a finger joint replacement. In that finger I am now pain free, albeit with limited movement, but million times better than before. This was done privately, I was advised difficult to get on the NHS.

    Then it started in another finger. Easy I thought, I know the drill, wait for the pain, then go see him. Well I waited, and waited, no pain, just got very stiff and would barely move. My GP agreed it was probably worth a visit so back I went. My surgeon was amazed when he saw the xray because in less than 8 months my finger had gone past the point of the first one and my joint replacement options were very limited. Had the second one done and now have more movement and of course no pain.  Again done privately.

    I realise that this can be expensive but I hopefully have a long life ahead of me and to be pain free is worth it. So I wouldn't put up with the pain and go see a consultant because there might be other options than pain meds.

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    • Posted

      Thank you for your reply wknight, i have seen my gp today who told me my xrays show osteoarthritis is in all the small joints in both hands and wrists. Started on Naproxen 500mg twice a day.  Hopefully this will help with the pain and i will have to look into seeing a specialist. I have found it hard to accept as im fit and healthy and only 46 years old.  Thanks again for your adviceLisa x
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  • Posted

    Hey Lisa, dont get discouraged. You are still fit and healthy. You just got OA in your fingers like the rest of us.  There are a million things worse and get to a hand specialist ASAP.  Its not the end of the world. Take up swimming; get healthy as you can; get to Boots and in their med section for about £15 they have these packs of 3 things blue red and yellow which help you open things - my bloke even uses them now they are so handy per se.  Get some splints and take care of your hands and you will be OK.  Its a right pain but dont let yourself get depressed by it as you will be OK.  Truly you will. 

    Naproxen is the standard for GP's to issue. Its stronger than Nurofen. However, if you havent tried e.g. Nurofen and Voltarol, i'd start with them first (Over the counter in Boots) as you dont want to get onto harder painkillers from day 1 - especially if you dont need them as you may need them later if it gets worse. But i'd get to a hand speciaist ASAP.   

    Whilst its a shock, as it was to all of us here, then you will be OK and stay positive... determine to get as fit as you can be will help and make you feel younger.  I felt 'old' when i was diagnosed for about a month then i thought sod it. I am going to get healthy and fit and towards lower end of my NHS BMI score, so i did and 9 months later can honestly say that i feel 15 years younger than i felt when i was diagnosed. So i'd recommend saying sod it, might have OA in fingers but in 6 months time i'm gonna feel 10 years younger than i feel now. What do i have to do to get there.... and you can and will... so dont get depressed. Lots of things to do, life to live, things to see.. go for it. xx

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  • Posted

    Hi Lisa, I am not normally found here as I am a committed member of the Hip replacement pages!  I am 51 and usually fit. Ihave OA in both hips in fact so bad that I had a Total Left Hip Replacement in June this year. 

    I was devastated at the diagnosis but went ahead with the operation as I basically had no choice. (I was Skiing last Christmas so you can see what a rapid onset I had). 

    The rambling point I am trying to make is that I also have OA in my hands confirmed by osteophyte Roth and the evidence of Bouchard and Hebredean nodes. However because of the pain in my hips I have largely ignored them!  I have been taking Volterol For hip pain. .... Naproxen did not help me. I have been reducing the Volterol and have tried days without it, hip is great but I have noticed that my hands are now stiff and painful without it!  So back to taking Volterol and I will take the good advice on here and get a referral to a hand specialist physiology for some splints. I also found last winter that keeping hands warm with hand warmers in the cold weather was essential!!! 

    Take care, although surgery on my hip was unavoidable, I can walk miles without a limp already, I would be a lot more cautious of hand surgery. X

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