From the Guidelines
Management of common hand conditions should prioritize a combination of non-pharmacological and pharmacological treatment modalities individualized to the patient's requirements. The optimal approach varies based on the specific diagnosis, with a focus on reducing inflammation, protecting injured structures, allowing proper healing, and restoring function. For osteoarthritis, treatment should be individualized according to localization of OA, risk factors, type of OA, presence of inflammation, severity of structural change, level of pain, disability, and restriction of quality of life 1.
Some key management options include:
- Education concerning joint protection and an exercise regimen for all patients with hand OA 1
- Local application of heat, especially before exercise, and ultrasound as beneficial treatments 1
- Splints for thumb base OA and orthoses to prevent or correct lateral angulation and flexion deformity 1
- Topical NSAIDs and capsaicin as effective and safe treatments for hand OA 1
- Paracetamol as the oral analgesic of first choice, with oral NSAIDs used at the lowest effective dose and for the shortest duration in patients who respond inadequately to paracetamol 1
It's also important to consider the role of imaging studies in the evaluation of chronic hand or wrist pain, with radiography usually appropriate as the initial imaging study, and MR arthrography or MRI without IV contrast as the next imaging study for chronic wrist pain following normal radiographs or radiographs remarkable for nonspecific arthritis 1.
Overall, the goal of management is to improve morbidity, mortality, and quality of life outcomes for patients with common hand conditions, and a comprehensive approach that incorporates both non-pharmacological and pharmacological treatments, as well as appropriate imaging studies, is essential for achieving this goal.
From the Research
Management Options for Common Hand Conditions
The management options for common hand conditions, such as carpal tunnel syndrome (CTS), can be divided into non-surgical and surgical approaches.
Non-surgical treatments include:
- Splinting: Night-only splinting is as effective as continuous wear, and a neutral wrist splint may be more effective than an extension splint 2, 3
- Corticosteroid injections: Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 2, 3
- Hand therapy: Hand therapy, including physical therapy and therapeutic ultrasound, can be used to manage CTS symptoms 3, 4
- Change of working position and medications: Changing working position and using medications, such as nonsteroidal anti-inflammatory drugs, can also be used to manage CTS symptoms 5
Surgical treatments include:
- Open carpal tunnel release: This is a traditional surgical method that involves making an incision in the wrist to release the transverse carpal ligament 2, 3
- Endoscopic carpal tunnel release: This is a minimally invasive surgical method that involves making small incisions in the wrist and using an endoscope to release the transverse carpal ligament 2, 3
- Carpal tunnel release using the MANOS CTR system: This is a new surgical method that uses a blade to divide the transverse carpal ligament through wrist and palm skin punctures 6
Severity of Carpal Tunnel Syndrome
The management approach for CTS depends on the severity of the condition.