{"id":11168,"date":"2024-07-08T06:00:56","date_gmt":"2024-07-08T05:00:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11168"},"modified":"2024-07-09T11:23:37","modified_gmt":"2024-07-09T10:23:37","slug":"the-msk-playbook-hand-arthritis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2024\/07\/08\/the-msk-playbook-hand-arthritis\/","title":{"rendered":"The MSK playbook &#8211; hand arthritis"},"content":{"rendered":"<p><b>Introduction<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Hand osteoarthritis (OA) is a common presentation in the musculoskeletal (MSK) clinic, impacting millions of patients worldwide.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">It typically presents with pain, stiffness, and a significant reduction in joint function, which collectively disrupt daily activities and patients\u2019 quality of life.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">To effectively manage hand OA, MSK clinicians must be adept at diagnosing the condition and distinguishing it from similar disorders such as rheumatoid arthritis, calcium pyrophosphate deposition (CPPD)\u00a0and gout.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">In this blog, we discuss the key patterns of joint disease to be aware of, and what future treatments are on the horizon.\u00a0<\/span><\/li>\n<\/ul>\n<p><b>What do we know about hand OA?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Despite the high prevalence of hand OA, we are still understanding the exact mechanisms of its disease progression and trying to identify the most effective mechanism-based therapies for treatment.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">As with other forms of OA, current research is pointing towards a complex interplay of genetic, metabolic, and lifestyle factors that influence disease progression.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Increasing life expectancy, and obesity rates, are two factors that are projected to increase the prevalence of OA globally (1).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Research on hand OA is still ongoing to help us evaluate clinical scoring systems, and criteria to assess the severity and how the disease may progress over time (prognosis) (2).<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11173\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-1-253x300.jpg\" alt=\"\" width=\"337\" height=\"400\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-1-253x300.jpg 253w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-1.jpg 431w\" sizes=\"auto, (max-width: 337px) 100vw, 337px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure<\/span> 1: Hand osteoarthritis summarised<\/p>\n<p><b>Who gets it?\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">The prevalence of hand OA in adults varies, by age sex, family history<\/span> <span style=\"font-weight: 400\">and trauma history!<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Symptomatic hand OA prevalence in adults (2.0-6.2%) (3).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Symptomatic hand OA prevalence in elderly adults (4.7-20.4%) (3).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Hand OA (prevalence) women&gt;men.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Previous history of trauma (fracture or intra articular injury) and repetitive manual tasks are associated with an increased risk of Post traumatic OA (4).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Post traumatic OA may account for up to 12% of all cases of Osteoarthritis (4).\u00a0<\/span><\/li>\n<\/ul>\n<p><b>How common are X-ray changes in older adults?<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Radiographic osteoarthritis (ROA) in at least one hand joint is observed in 67% of women and 54.8% of men aged 55 years and older (5).<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11174\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-2-212x300.png\" alt=\"\" width=\"303\" height=\"429\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-2-212x300.png 212w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-2.png 362w\" sizes=\"auto, (max-width: 303px) 100vw, 303px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 2:<\/span> Risk factors for OA<\/p>\n<p><b>Classifying hand OA and typical X-ray changes seen\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Hand osteoarthritis (OA) \u2013 The Typical pattern defines by (EULAR) (6)<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">nodal OA:\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">non-nodal OA:\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">thumb base OA:\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><a href=\"https:\/\/radiopaedia.org\/articles\/erosive-osteoarthritis?lang=gb\"><span style=\"font-weight: 400\">erosive O<\/span><\/a><a href=\"https:\/\/radiopaedia.org\/articles\/erosive-osteoarthritis?lang=gb\"><span style=\"font-weight: 400\">A<\/span><\/a><span style=\"font-weight: 400\">:<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11179\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-3-137x300.png\" alt=\"\" width=\"219\" height=\"480\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-3-137x300.png 137w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-3.png 233w\" sizes=\"auto, (max-width: 219px) 100vw, 219px\" \/><\/span><\/p>\n<p><span style=\"font-weight: 400\"><span style=\"text-decoration: underline\">Figure 3<\/span>: X-ray hand OA \u2013 base of thumb\u00a0<\/span><\/p>\n<p><b>Hand Arthritis the pattern of joint disease; tells the tale!<\/b><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11175\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/Screenshot-2024-07-01-at-15.42.28-297x300.png\" alt=\"\" width=\"425\" height=\"429\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/Screenshot-2024-07-01-at-15.42.28-297x300.png 297w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/Screenshot-2024-07-01-at-15.42.28-150x150.png 150w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/Screenshot-2024-07-01-at-15.42.28-768x775.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/Screenshot-2024-07-01-at-15.42.28-640x646.png 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/Screenshot-2024-07-01-at-15.42.28.png 1070w\" sizes=\"auto, (max-width: 425px) 100vw, 425px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 4:<\/span> Joint distribution of hand arthritis<\/p>\n<p><span style=\"font-weight: 400\">Plain X-rays features, as classified by the Kellgren and Lawrence system, are used to evaluate hand OA patterns. The presence of \u201costeophytes, joint space narrowing, sclerosis and bone deformity at the joint line\u201d are all key criteria. Osteophytes are the most common but least specific, x-ray feature of hand OA.<\/span><\/p>\n<p><b>Unpicking Hand OA from key differentials in clinic!<\/b><\/p>\n<p><span style=\"font-weight: 400\">\u201cHand pain\u201d is common presenting complaint in clinic, and the diagnosis can be made based upon a focused history that considers the:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">speed on onset<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">diurnal variation (pattern through the 24-hour day)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">effect of movement and load,\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">the number and location of joints involved,<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">the patient\u2019s profile (genetic predisposition, occupation, metabolic profile)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">systemic symptoms.\u00a0<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11180\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-5-300x212.png\" alt=\"\" width=\"432\" height=\"305\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-5-300x212.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-5.png 512w\" sizes=\"auto, (max-width: 432px) 100vw, 432px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 5:<\/span> The Arthritic Hand<\/p>\n<p><span style=\"font-weight: 400\">Hand OA:\u00a0 can start in a single joint (monoarthritis) or present in a more widespread pattern (polyarthritis). Symptoms usually start insidiously and much slower than inflammatory or crystal<\/span><span style=\"font-weight: 400\">&#8211;<\/span><span style=\"font-weight: 400\">arthritis (arthropathy). Changes tend to occur in a row across joints, at the same level (e.g. distal interphalangeal joint) with common signs such as (Heberden\u2019s or Bouchard nodes) but the MCP\u2019s are usually spared.\u00a0<\/span><\/p>\n<p><b>Key give aways in the history of OA<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pain related to activity.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pain is worse with repetitive movements or forceful heavy movements.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Short lived morning stiffness (typically, &lt; 15 mins)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Nocturnal discomfort<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Quiet joint line (minimal redness, swelling or heat)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">In more severe cases\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Loss of joint function, and significant deformity,\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Often accompanied b<\/span><span style=\"font-weight: 400\">y OA symptoms to other large joints (Hip\/ Knee)<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11187\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-6-212x300.png\" alt=\"\" width=\"378\" height=\"536\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-6-212x300.png 212w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-6.png 362w\" sizes=\"auto, (max-width: 378px) 100vw, 378px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 6:<\/span> Hand OA features<\/p>\n<p><b>Using imaging to unpick the causes of hand pain<\/b><\/p>\n<p><span style=\"font-weight: 400\">MSK imaging can be useful to help you determine which structures could be driving the pain.\u00a0<\/span><\/p>\n<p><b>1. X-ray\u00a0<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The most widely used imaging modality for hand pain.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Although not essential for the diagnosis of hand OA, it can help to define the number and pattern of joints affected.<\/span><\/li>\n<\/ul>\n<p><b>2. Ultrasound<\/b><span style=\"font-weight: 400\"> \u2013 good for assessing soft tissue structures,\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Rheumatoid arthritis<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Used to detect early signs of synovial hypertrophy, joint tissue swelling\/oedema, osteophytic lipping and inflammation (power doppler signal).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Erosions may also be seen in later disease.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Peripheral spondyloarthropathies<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Used to detect extra-articular changes in peripheral spondyloarthropathies (tenosynovitis &amp; enthesis).<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Crystal arthropathies<\/span>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Used to detect, tophi, double contour sign &amp; snowstorm appearance of synovial fluid\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>3. MRI<\/b><span style=\"font-weight: 400\"> \u2013 Good for assessing soft tissue structures, and inflammation\/ infection. This imaging modality is expensive and not easily available.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Although not required for the diagnosis of hypermobility syndrome or fibromyalgia, the use of imaging in clinic (Point of care ultrasound) where available can be considered for patient education. To demonstrate that joint movements are unrestricted, and no significant pathology is visible of the joint or soft tissue structure.<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td><b>Condition<\/b><\/td>\n<td><b>Key features\/ risk factors\u00a0<\/b><\/td>\n<td><b>Diagnosis<\/b><\/td>\n<td><b>Gold Standard investigation (if any)<\/b><\/td>\n<\/tr>\n<tr>\n<td><b>Rheumatoid Arthritis<\/b><\/td>\n<td><span style=\"font-weight: 400\">FH of rheumatoid arthritis.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Smoking history<\/span><\/p>\n<p><span style=\"font-weight: 400\">Middle age presentation<\/span><\/td>\n<td><span style=\"font-weight: 400\">Rheumatoid factor (positive status) &#8211; sensitivity 41%\u201366% for early RA.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Rheumatoid factor \u2013 has higher sensitivity in established disease.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Anti-CCP positive status linked with higher disease activity\/ inflammation.<\/span><\/td>\n<td><span style=\"font-weight: 400\">Clinical history + Anti-CCP \u2013 positive status\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Gout [7]<\/b><\/td>\n<td><span style=\"font-weight: 400\">Metabolic syndrome features.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Positive family history in early onset disease.\u00a0\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">MTP joint, acute inflammation (&lt;1 day onset of maximum pain)<\/span><\/p>\n<p><span style=\"font-weight: 400\">Elevated serum urate &gt;360mmol + clinical features of gout flare.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Tophi + Positive fluid aspirate\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Positive DECT scan (sens 81% spec 88%)- in chronic\/challenging cases<\/span><\/td>\n<td><span style=\"font-weight: 400\">Clinical history and hyperuricemia or positive joint aspiration (Negative birefringent crystals)<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>PsA<\/b><\/td>\n<td><span style=\"font-weight: 400\">f\/h of PsA<\/span><\/td>\n<td><span style=\"font-weight: 400\">Accepted criteria (CASPAR)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Combination of clinical history and imaging features.<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>OA [8]<\/b><\/td>\n<td><span style=\"font-weight: 400\">f\/h\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">manual job\/hand dominant sport<\/span><\/td>\n<td><span style=\"font-weight: 400\">Can be made on clinical history \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">But imaging features can be used to support the diagnosis\/pattern of disease (Xray\/US)<\/span><\/p>\n<p><span style=\"font-weight: 400\">US more specific for early-stage disease.<\/span><\/td>\n<td><span style=\"font-weight: 400\">X-ray changes.<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Pain sensitisation \/ fibromyalgia\u00a0<\/b><\/td>\n<td><span style=\"font-weight: 400\">Widespread pain<\/span><\/p>\n<p><span style=\"font-weight: 400\">hypermobility<\/span><\/td>\n<td><span style=\"font-weight: 400\">Clinical<\/span><\/p>\n<p><span style=\"font-weight: 400\">Imaging can be used to exclude other diagnosis.\u00a0<\/span><\/td>\n<td><span style=\"font-weight: 400\">Imaging often normal, or only age-appropriate changes seen.<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11186\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-7-1-300x219.png\" alt=\"\" width=\"420\" height=\"306\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-7-1-300x219.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-7-1.png 512w\" sizes=\"auto, (max-width: 420px) 100vw, 420px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 7:<\/span> X-ray displaying features of gout<\/p>\n<table>\n<tbody>\n<tr>\n<td><b>Condition<\/b><\/td>\n<td><b>Best modality for Early disease\u00a0<\/b><\/td>\n<td><b>Key Xray findings<\/b><\/td>\n<td><b>Key US findings<\/b><\/td>\n<td><b>Key MRI findings\u00a0<\/b><\/td>\n<td><b>Other imaging tests<\/b><\/td>\n<\/tr>\n<tr>\n<td><b>Rheumatoid Arthritis (9)<\/b><\/td>\n<td><span style=\"font-weight: 400\">US<\/span><\/p>\n<p><span style=\"font-weight: 400\">MRI not routinely used but can help to diagnose this<\/span><\/td>\n<td><span style=\"font-weight: 400\">Articular erosions<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ulnar deviation<\/span><\/p>\n<p><span style=\"font-weight: 400\">(advanced)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Synovitis\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Power doppler signal<\/span><\/p>\n<p><span style=\"font-weight: 400\">Erosions<\/span><\/td>\n<td><span style=\"font-weight: 400\">Synovial hypertophy\/synovitis,<\/span><\/p>\n<p><span style=\"font-weight: 400\">Bursitis\/bursal hypertrophy<\/span><\/p>\n<p><span style=\"font-weight: 400\">Tenosynovitis\/tenosynovial hypertrophy<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u00a0bone marrow oedema (precedes erosions)<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Gout<\/b><\/td>\n<td><span style=\"font-weight: 400\">US<\/span><\/td>\n<td><span style=\"font-weight: 400\">Periarticular erosions<\/span><\/td>\n<td><span style=\"font-weight: 400\">Gouty tophy (shimmer sign)<\/span><\/p>\n<p><span style=\"font-weight: 400\">Double contour sign(less reliable)<\/span><\/p>\n<p><span style=\"font-weight: 400\">Snowstorm sign<\/span><\/td>\n<td><span style=\"font-weight: 400\">Synovitis<\/span><\/p>\n<p><span style=\"font-weight: 400\">Tophi<\/span><\/td>\n<td><span style=\"font-weight: 400\">DECT scan<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>PsA (10)<\/b><\/td>\n<td><span style=\"font-weight: 400\">US<\/span><\/td>\n<td><span style=\"font-weight: 400\">Marginal erosions with hypertrophy in typical patterns<\/span><\/td>\n<td><span style=\"font-weight: 400\">Synovitis\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Flexor tenosynovitis<\/span><\/p>\n<p><span style=\"font-weight: 400\">ECU tenosynovitis<\/span><\/p>\n<p><span style=\"font-weight: 400\">Enthesitis<\/span><\/td>\n<td><span style=\"font-weight: 400\">Synovial hypertrophy<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>OA (11)<\/b><\/td>\n<td><span style=\"font-weight: 400\">US<\/span><\/td>\n<td><span style=\"font-weight: 400\">Joint space narrowing, Subchondral sclerosis, osteophytes<\/span><\/td>\n<td><span style=\"font-weight: 400\">Osteophytes,<\/span><\/p>\n<p><span style=\"font-weight: 400\">Synovial hypertrophy,<\/span><\/p>\n<p><span style=\"font-weight: 400\">Atrophy of fibrocartilaginous complex<\/span><\/td>\n<td><span style=\"font-weight: 400\">Loss of articular cartilage<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Pain sensitisation<\/b><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<td><span style=\"font-weight: 400\">Normal<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>CRPS<\/b><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<td><span style=\"font-weight: 400\">May show localised osteopenia<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil<\/span><\/td>\n<td><span style=\"font-weight: 400\">May show bone marrow oedema<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nil\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><b>Treatments \u2013 Starting with patient education and hand therapy<\/b><\/p>\n<p><span style=\"font-weight: 400\">Clinical treatment for Hand Osteoarthritis primarily focuses on maintaining function, through joint range, strength and supporting the use of the upper limb. It is important to consider the patient&#8217;s occupational demands and hobbies as part of treatment goals. The use of low stress environments such as warm water, hand putty, or wax therapy can be trialled.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Joint supports (1<\/span><span style=\"font-weight: 400\">st<\/span><span style=\"font-weight: 400\"> CMC brace and gel caps for DIP joints) can impact range of motion and be cumbersome with movement. It is important to counsel patients on regular breaks from repetitive tasks and positioning techniques to reduce stress on symptomatic joints. Reducing systemic inflammatory factors such as smoking cessation, weight loss, optimised sleep and stress reduction can be helpful in the long term.\u00a0<\/span><\/p>\n<p><b>Preventing Hand injuries in sports<\/b><\/p>\n<p><span style=\"font-weight: 400\">Traumatic hand injuries commonly occur in combat sports &amp; ball sports where contact is made with the hand (e.g., basketball, volleyball, and goalkeepers in football (13). Common injuries include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">fractures (e.g., phalangeal, metacarpal, carpal),\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">ligamentous injuries (e.g., scapholunate, collaterals, CMCJ, and knuckle sagittal bands)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">tendon ruptures (e.g., jersey finger, mallet finger, central slip, and pulley injuries in rock climbers) (13)<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11183\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-8-300x125.png\" alt=\"\" width=\"355\" height=\"148\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-8-300x125.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-8.png 512w\" sizes=\"auto, (max-width: 355px) 100vw, 355px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 8:<\/span> Common hand injuries<\/p>\n<p><b>Taping strategies are an effective way to minimise hand injuries in sport?<\/b><\/p>\n<p><span style=\"font-weight: 400\">Injury prevention strategies for hand trauma should look to identify the intrinsic and extrinsic factors of each \u201cat risk\u201d sport. The most employed strategy is external \u201ctaping\u201d across the small and large joints of the hand to reduce the forces transmitted to the hand. The location and distribution of taping varies by each sport, discipline and the rules governing the level of support allowed during competition.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Some sports have quite visible distinctive preventative taping (e.g. digits in volleyball or rugby, or the entire hand-wrist in boxing, which is then fitted in a glove). In boxing, adding tape provides a 25-30% reduction in wrist motion, placing the hand in a better position to withstand forces and thereby reducing the likelihood of injuries (14, 15).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11181\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-9-236x300.png\" alt=\"\" width=\"308\" height=\"392\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-9-236x300.png 236w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-9.png 293w\" sizes=\"auto, (max-width: 308px) 100vw, 308px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 9:<\/span> Taping strategies<\/p>\n<p><b>Medications<\/b><\/p>\n<table>\n<tbody>\n<tr>\n<td><b>Medication Type<\/b><\/td>\n<td><b>Indications<\/b><\/td>\n<td><b>Benefits<\/b><\/td>\n<td><b>Potential Side Effects<\/b><\/td>\n<td><b>Guideline Recommendations<\/b><\/td>\n<\/tr>\n<tr>\n<td><b>Paracetamol (PCM)<\/b><\/td>\n<td><span style=\"font-weight: 400\">Initial mild to moderate pain<\/span><\/td>\n<td><span style=\"font-weight: 400\">Well-tolerated, easy to access<\/span><\/td>\n<td><span style=\"font-weight: 400\">Limited efficacy, liver toxicity at high doses<\/span><\/td>\n<td><span style=\"font-weight: 400\">Use with caution, limited benefits observed<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Topical NSAIDs<\/b><\/td>\n<td><span style=\"font-weight: 400\">Localized mild to moderate pain<\/span><\/td>\n<td><span style=\"font-weight: 400\">Effective, fewer systemic side effects<\/span><\/td>\n<td><span style=\"font-weight: 400\">Skin irritation, minimal systemic absorption<\/span><\/td>\n<td><span style=\"font-weight: 400\">Recommended for initial treatment, especially in patients with comorbidities<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Oral NSAIDs<\/b><\/td>\n<td><span style=\"font-weight: 400\">More severe pain<\/span><\/td>\n<td><span style=\"font-weight: 400\">Strong anti-inflammatory and pain relief<\/span><\/td>\n<td><span style=\"font-weight: 400\">Gastrointestinal, cardiovascular, renal risks<\/span><\/td>\n<td><span style=\"font-weight: 400\">Use if topical NSAIDs are inadequate, monitor for side effects<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Opioids<\/b><\/td>\n<td><span style=\"font-weight: 400\">Severe pain, other treatments ineffective<\/span><\/td>\n<td><span style=\"font-weight: 400\">Potent pain relief<\/span><\/td>\n<td><span style=\"font-weight: 400\">Nausea, vomiting, dizziness, dependency<\/span><\/td>\n<td><span style=\"font-weight: 400\">Not generally recommended due to risk of adverse effects<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Steroid Injections<\/b><\/td>\n<td><span style=\"font-weight: 400\">Severe inflammation<\/span><\/td>\n<td><span style=\"font-weight: 400\">Rapid relief from pain and inflammation, some placebo effect<\/span><\/td>\n<td><span style=\"font-weight: 400\">Temporary relief, potential for joint damage<\/span><\/td>\n<td><span style=\"font-weight: 400\">Consider if other medications fail; limit frequency of use<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><b>Specialist Hand OA treatment<\/b><\/p>\n<p><span style=\"font-weight: 400\">Early onset OA (&lt;40 yrs of age) needs specialist input as secondary causes e.g. haemochromatosis, hypermobility syndromes and connective tissue disorders such as stickler syndrome need to be considered. Such patients usually have comorbid symptoms of diabetes, joint subluxations, ocular or auricular complications. Similarly, inflammatory or erosive OA may have associated underlying conditions e.g. primary hyperparathyroidism or calcium pyrophosphate disease (CPPD). In such cases, the specialists may consider short courses of corticosteroids, colchicine or intra-articular injections. Though there is no role of conventional or biological disease modifiers as employed in inflammatory arthritides, in cases of co-existing CPPD arthritis, there is limited data of their utility.<\/span><\/p>\n<p><b>The Latest Evidence on what drives OA \u2013 What is coming?<\/b><\/p>\n<p><span style=\"font-weight: 400\">OA was traditionally considered a &#8220;wear and tear&#8221; disease, but recent evidence has expanded this concept to &#8220;wear, failed repair, and low-grade systemic inflammation.&#8221; It helps to frame discussions around the impact, of lifestyle interventions as part of treatment plans, and how weight loss and other health intervention can reduce symptoms. In the long-term preventing failed repair mechanisms are key to OA (12).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-11185\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-10-1-252x300.png\" alt=\"\" width=\"362\" height=\"430\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-10-1-252x300.png 252w, https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-10-1.png 430w\" sizes=\"auto, (max-width: 362px) 100vw, 362px\" \/><\/p>\n<p><span style=\"text-decoration: underline\">Figure 10:<\/span> Features of hand osteoarthritis<\/p>\n<p><b>Hand OA \u2013 Break down and failed repair at the joint\u00a0<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">OA leads to an inflammatory environment at the joint surface (16).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">OA leads to Higher chondrocyte activity (16).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">OA leads to a cycle of cartilage breakdown, and loss of protection to mechanical stress (16).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">OA leads to thickening of the joints synovial lining (often seen on ultrasound) &amp; an increase in cellular inflammatory signals (17).\u00a0<\/span><\/li>\n<\/ul>\n<p><b>What\u2019s new with hand OA treatments.\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Thanks to improved<\/span> <span style=\"font-weight: 400\">understanding of factors associated with OA progression, several disease modifying osteoarthritis drugs (DMOADs) have been trialled to prevent further structural deterioration, restore joint structure, and improve symptoms. Therapeutic mechanisms are based on stimulating cartilage growth by inducing anabolic factors e.g. fibroblast growth factor-18, transforming growth factor beta1, reducing joint degradation by inhibiting catabolic factors e.g. Wnt pathway or Cathepsin K inhibitor and abrogating inflammation with IL-10 induction or IL-1 downregulation. The dawn of mechanism-based targeted therapies is promising and provides hope of addressing the unmet therapeutic needs of hand OA.\u00a0<\/span><\/p>\n<p><b>Conclusion \u2013 4 key points\u00a0<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Hand OA \u2013 is linked to \u2013 \u201cWear, Failed repair and low-grade inflammation\u201d at the joints of the hand.\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">There are increasing links between, metabolic risk factors (diabetes \/ obesity) and the progression of hand OA.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A focussed assessment, to include the pattern of pain, joint involved and medical history can help to unpick OA from other causes of hand pain.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Currently there are no biological therapies for hand OA. but this is a future area of research.<\/span><\/li>\n<\/ol>\n<div><b>Authors and Affiliations: Dr Mohammed Subhi, Mr Ian Gatt, Dr Irfan Ahmed, Dr Imran Lasker, Dr Faisal Shaikh, Dr Rifat Hassan, Mr Jack March, Mr Ryan Linn, Dr Nisar Mohammed,\u00a0<\/b><\/div>\n<div><\/div>\n<div><u>Dr Mohammed Subhi<\/u><\/div>\n<div>GP Specialty Registrar<\/div>\n<div>NHS England \u2013 East of England<\/div>\n<div>@Moh_irak<\/div>\n<div><\/div>\n<div><u>Dr Ian\u00a0Gatt\u00a0PhD<\/u><\/div>\n<div>Institution: GB Boxing &amp; UK Sports Institute<\/div>\n<div>Role: Head of Performance Support &amp; Lead Physiotherapist<\/div>\n<div>Twitter: @iangattgattman<\/div>\n<div>Website:\u00a0<a id=\"m_6548214153018279510OWAe6315639-f482-e536-21f4-219fae92e9ff\" title=\"Original URL: https:\/\/linktr.ee\/allabouttheupperlimb. Click or tap if you trust this link.\" href=\"https:\/\/linktr.ee\/allabouttheupperlimb\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/linktr.ee\/allabouttheupperlimb&amp;source=gmail&amp;ust=1720597819257000&amp;usg=AOvVaw0YSEBiwSKDt_S-cwpSzhl2\">https:\/\/linktr.ee\/allabouttheupperlimb<\/a><\/div>\n<div><\/div>\n<div><u>Dr Irfan Ahmed\u00a0<\/u><\/div>\n<div>Consultant in Musculoskeletal, Sport &amp; Exercise Medicine<\/div>\n<div>@ExerciseIrfan<\/div>\n<div>Website :\u00a0<a href=\"http:\/\/www.mskplaybook.com\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/www.mskplaybook.com&amp;source=gmail&amp;ust=1720597819257000&amp;usg=AOvVaw3o4AG4TCIqXlp0rF4Vo4vu\">www.mskplaybook.com<\/a><\/div>\n<div><\/div>\n<div><u>Dr Imran Lasker<\/u><\/div>\n<div>Consultant Radiologist with Specialist interest in MSK<\/div>\n<div>Mid &amp; South Essex Foundation Trust<\/div>\n<div>@DocLasker<\/div>\n<div>Website:\u00a0<a href=\"http:\/\/www.mskplaybook.com\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/www.mskplaybook.com&amp;source=gmail&amp;ust=1720597819257000&amp;usg=AOvVaw3o4AG4TCIqXlp0rF4Vo4vu\">www.mskplaybook.com<\/a><\/div>\n<div>Links to MSK\/MRI courses:\u00a0<a href=\"http:\/\/imranlasker.com\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/imranlasker.com&amp;source=gmail&amp;ust=1720597819257000&amp;usg=AOvVaw2qwt5miTHpgk9RqpxAdqGE\">imranlasker.com<\/a>,\u00a0<a href=\"http:\/\/radiologyseminars.com\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/radiologyseminars.com&amp;source=gmail&amp;ust=1720597819257000&amp;usg=AOvVaw1QCn80OeQR4kPSjNr6Kpzo\">radiologyseminars.com<\/a>.\u00a0<a href=\"http:\/\/emergencyimaging.co.uk\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/emergencyimaging.co.uk&amp;source=gmail&amp;ust=1720597819257000&amp;usg=AOvVaw1VxZBBr5fEP9aBkaOgCN-K\">emergencyimaging.co.uk<\/a><\/div>\n<div><\/div>\n<div><u>Dr\u00a0Faisal\u00a0Shaikh<\/u><\/div>\n<div>GP, GPwER in MSK Medicine, Sports Medicine Registrar<\/div>\n<div>HIYOS, Surrey Community MSK and Pain Service, Oxford University Hospital<\/div>\n<div>Twitter: dr_faisalshaikh<\/div>\n<div>Website:\u00a0<a id=\"m_6548214153018279510OWA3b09a062-ec38-622f-3cfd-b2a4618e40b4\" href=\"https:\/\/www.linkedin.com\/in\/faisal-bin-muhammad\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=https:\/\/www.linkedin.com\/in\/faisal-bin-muhammad&amp;source=gmail&amp;ust=1720597819257000&amp;usg=AOvVaw3mL-BwhZwzgxAMixHjOc_f\">https:\/\/www.linkedin.com\/in\/faisal-bin-muhammad<\/a><\/div>\n<div><\/div>\n<div><u>Dr Rifat Hassan<\/u><\/div>\n<div>Foundation Year 1 doctor<\/div>\n<div>Norfolk &amp; Norwich University Hospitals<\/div>\n<div>@RifatHassan_<\/div>\n<div><\/div>\n<div><u>Mr Jack March<\/u><\/div>\n<div>Rheumatology Physiotherapist \/ Rheumatology Clinical Lead<\/div>\n<div>Chews Health<\/div>\n<div>@physiojack<\/div>\n<div><\/div>\n<div><i><u>Ryan Linn<\/u><\/i><\/div>\n<div>Final Year Medical Student<\/div>\n<div>University College London (UCL)<\/div>\n<div>Twitter: @Ryan_Linn_<\/div>\n<div><\/div>\n<div><u>Muhammad K\u00a0Nisar\u00a0<\/u><\/div>\n<div>Bedfordshire hospitals NHSFT<\/div>\n<div>Role: Consultant Rheumatologist &amp; Physician, Director R&amp;D<\/div>\n<div>Twitter: None<\/div>\n<div>Website :\u00a0<a id=\"m_6548214153018279510LPlnk\" href=\"http:\/\/www.drmuhammadnisar.com\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/www.drmuhammadnisar.com\/&amp;source=gmail&amp;ust=1720597819258000&amp;usg=AOvVaw1jP63VOir5X-XAnbRyjNDQ\">www.drmuhammadnisar.com<\/a><\/div>\n<div><\/div>\n<p><b>References<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400\"><b>Cross M, Smith E, Hoy D, et al.<\/b><span style=\"font-weight: 400\"> (2014). The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. <\/span><i><span style=\"font-weight: 400\">Annals of Rheumatic Diseases<\/span><\/i><span style=\"font-weight: 400\">, 73, 1323\u20131330.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Altman R, Asch E, Bloch D, et al.<\/b><span style=\"font-weight: 400\"> (1986). Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. <\/span><i><span style=\"font-weight: 400\">Arthritis and Rheumatism<\/span><\/i><span style=\"font-weight: 400\">, 29, 1039\u20131049.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Kloppenburg M, Kwok WY.<\/b><span style=\"font-weight: 400\"> (2011). Hand osteoarthritis\u2014a heterogeneous disorder. <\/span><i><span style=\"font-weight: 400\">Nature Reviews Rheumatology<\/span><\/i><span style=\"font-weight: 400\">, 8, 22\u201331.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Dilley JE, Bello MA, Roman N, et al.<\/b><span style=\"font-weight: 400\"> (2023). Post-traumatic osteoarthritis: A review of pathogenic mechanisms and novel targets for mitigation. <\/span><i><span style=\"font-weight: 400\">Bone Reports<\/span><\/i><span style=\"font-weight: 400\">, 18. doi: 10.1016\/J.BONR.2023.101658<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Dahaghin S, Bierma-Zeinstra SMA, Ginai AZ, et al.<\/b><span style=\"font-weight: 400\"> (2005). Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study). <\/span><i><span style=\"font-weight: 400\">Annals of Rheumatic Diseases<\/span><\/i><span style=\"font-weight: 400\">, 64, 682\u2013687.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Zhang W, Doherty M, Leeb BF, et al.<\/b><span style=\"font-weight: 400\"> (2009). EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT. <\/span><i><span style=\"font-weight: 400\">Annals of Rheumatic Diseases<\/span><\/i><span style=\"font-weight: 400\">, 68, 8\u201317.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Jia E, Zhu J, Huang W, et al.<\/b><span style=\"font-weight: 400\"> (2018). Dual-energy computed tomography has limited diagnostic sensitivity for short-term gout. <\/span><i><span style=\"font-weight: 400\">Clinical Rheumatology<\/span><\/i><span style=\"font-weight: 400\">, 37, 773\u2013777.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Solivetti FM, Elia F, Teoli M, et al.<\/b><span style=\"font-weight: 400\"> (2010). Role of Contrast-Enhanced Ultrasound in Early Diagnosis of Psoriatic Arthritis. <\/span><i><span style=\"font-weight: 400\">Dermatology<\/span><\/i><span style=\"font-weight: 400\">, 220, 25\u201331.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Terslev L, Naredo E, Aegerter P, et al.<\/b><span style=\"font-weight: 400\"> (2017). Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. <\/span><i><span style=\"font-weight: 400\">RMD Open<\/span><\/i><span style=\"font-weight: 400\">, 3, 427.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Leung YY, Tillett DW, de Wit M, et al.<\/b><span style=\"font-weight: 400\"> (2023). Initiating Evaluation of Composite Outcome Measures for Psoriatic Arthritis: 2022 Updates From the GRAPPA-OMERACT Working Group. <\/span><i><span style=\"font-weight: 400\">Journal of Rheumatology<\/span><\/i><span style=\"font-weight: 400\">, 50, 53\u201357.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Sensitivity of radiographic features and specificity of scintigraphic imaging in hand osteoarthritis. <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7583178\/\"><span style=\"font-weight: 400\">PubMed<\/span><\/a><span style=\"font-weight: 400\"> (accessed 9 June 2024).<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Hunter DJ, Bierma-Zeinstra S.<\/b><span style=\"font-weight: 400\"> (2019). Osteoarthritis. <\/span><i><span style=\"font-weight: 400\">Lancet<\/span><\/i><span style=\"font-weight: 400\">, 393, 1745\u20131759.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Simpson AM, Donato DP, Veith J, et al.<\/b><span style=\"font-weight: 400\"> (2020). Hand and Wrist Injuries Among Collegiate Athletes: The Role of Sex and Competition on Injury Rates and Severity. <\/span><i><span style=\"font-weight: 400\">Orthopaedic Journal of Sports Medicine<\/span><\/i><span style=\"font-weight: 400\">, 8(12). doi: 10.1177\/2325967120964622<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Gatt IT, Allen T, Wheat J.<\/b><span style=\"font-weight: 400\"> (2023). Effects of using rigid tape with bandaging techniques on wrist joint motion during boxing shots in elite male athletes. <\/span><i><span style=\"font-weight: 400\">Physical Therapy in Sport<\/span><\/i><span style=\"font-weight: 400\">, 61, 82-90. doi: 10.1016\/j.ptsp.2023.03.002<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Avery DM 3rd, Rodner CM, Edgar CM.<\/b><span style=\"font-weight: 400\"> (2016). Sports-related wrist and hand injuries: a review. <\/span><i><span style=\"font-weight: 400\">Journal of Orthopaedic Surgery and Research<\/span><\/i><span style=\"font-weight: 400\">, 11(1):99. doi: 10.1186\/s13018-016-0432-8<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Loeser RF, Goldring SR, Scanzello CR, et al.<\/b><span style=\"font-weight: 400\"> (2012). Osteoarthritis: a disease of the joint as an organ. <\/span><i><span style=\"font-weight: 400\">Arthritis and Rheumatism<\/span><\/i><span style=\"font-weight: 400\">, 64, 1697\u20131707.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Scanzello CR, Goldring SR.<\/b><span style=\"font-weight: 400\"> (2012). The role of synovitis in osteoarthritis pathogenesis. <\/span><i><span style=\"font-weight: 400\">Bone<\/span><\/i><span style=\"font-weight: 400\">, 51, 249\u2013257.<\/span><\/li>\n<\/ol>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Introduction Hand osteoarthritis (OA) is a common presentation in the musculoskeletal (MSK) clinic, impacting millions of patients worldwide.\u00a0 It typically presents with pain, stiffness, and a significant reduction in joint function, which collectively disrupt daily activities and patients\u2019 quality of life.\u00a0 To effectively manage hand OA, MSK clinicians must be adept at diagnosing the condition [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2024\/07\/08\/the-msk-playbook-hand-arthritis\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":11187,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[2683,16068,16306],"class_list":["post-11168","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-arthritis","tag-featured","tag-msk"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>The MSK playbook - hand arthritis - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2024\/07\/08\/the-msk-playbook-hand-arthritis\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The MSK playbook - hand arthritis - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Introduction Hand osteoarthritis (OA) is a common presentation in the musculoskeletal (MSK) clinic, impacting millions of patients worldwide.\u00a0 It typically presents with pain, stiffness, and a significant reduction in joint function, which collectively disrupt daily activities and patients\u2019 quality of life.\u00a0 To effectively manage hand OA, MSK clinicians must be adept at diagnosing the condition [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bjsm\/2024\/07\/08\/the-msk-playbook-hand-arthritis\/\" \/>\n<meta property=\"og:site_name\" content=\"BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"article:published_time\" content=\"2024-07-08T05:00:56+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-07-09T10:23:37+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2024\/07\/MSK-hand-OA-6.png\" \/>\n\t<meta property=\"og:image:width\" content=\"362\" \/>\n\t<meta property=\"og:image:height\" content=\"512\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"bjsm\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"bjsm\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"14 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2024\\\/07\\\/08\\\/the-msk-playbook-hand-arthritis\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/2024\\\/07\\\/08\\\/the-msk-playbook-hand-arthritis\\\/\"},\"author\":{\"name\":\"bjsm\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/person\\\/02b7ae2dae6231c8629aa4da74bb9e6b\"},\"headline\":\"The MSK playbook &#8211; 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