What are the possible treatments for a 31-year-old male with dorsal spurring and soft tissue swelling over the metacarpals, but no signs of an acute fracture?

From the Guidelines

Treatment for a 31-year-old male with dorsal spurring and soft tissue swelling over the metacarpals without acute fracture should begin with conservative management, focusing on a combination of non-pharmacological and pharmacological treatments individualized to the patient's requirements, as recommended by the EULAR standing committee for international clinical studies including therapeutics (ESCISIT) 1.

Initial Management

• The patient should start with a regimen of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily with food for 1-2 weeks to reduce inflammation and pain.
• This should be combined with rest, ice application for 15-20 minutes every 2-3 hours for the first 48-72 hours, compression with an elastic bandage, and elevation of the hand above heart level when possible (RICE protocol) 1.

Physical Therapy and Exercise

• Physical therapy focusing on gentle range of motion exercises and hand strengthening should be initiated after acute pain subsides, typically within 1-2 weeks.
• Education concerning joint protection and an exercise regimen involving both range of motion and strengthening exercises are recommended for all patients with hand osteoarthritis, as suggested by the EULAR evidence-based recommendations 1.

Local Treatments

• Local treatments are preferred over systemic treatments, especially for mild to moderate pain and when only a few joints are affected, with topical NSAIDs and capsaicin being effective and safe treatments for hand osteoarthritis 1.

Intra-articular Injections

• For persistent symptoms, a corticosteroid injection (such as methylprednisolone 40mg mixed with lidocaine 1%) directly into the affected area may provide relief, as intra-articular injection of long-acting corticosteroid is effective for painful flares of OA, especially trapeziometacarpal joint OA 1.

Splinting

• Splinting at night for 2-3 weeks can prevent aggravation during sleep, and splints for thumb base OA and orthoses to prevent/correct lateral angulation and flexion deformity are recommended 1.

Surgical Intervention

• If conservative measures fail after 6-8 weeks, surgical intervention to remove the bone spurs may be considered, as surgery is a clinically effective treatment for patients with severe thumb base OA refractory to conventional treatment 1.

Key Considerations

• The dorsal spurring likely represents degenerative changes or post-traumatic osteophyte formation, and addressing both the bone abnormality and soft tissue inflammation is crucial for symptom resolution and preventing progression of joint damage.
• The treatment plan should be individualized according to the patient's specific needs, taking into account the 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, as well as comorbidity and co-medication 1.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain

The possible treatments for a 31-year-old male with dorsal spurring and soft tissue swelling over the metacarpals, but no signs of an acute fracture, may include NSAIDs such as naproxen to reduce pain and inflammation.

• Key considerations:
  • Use the lowest dose possible for the shortest time needed
  • exactly as prescribed
• Potential side effects:
  • stomach pain
  • constipation
  • diarrhea
  • gas
  • heartburn
  • nausea
  • vomiting
  • dizziness 2 2 2

From the Research

Possible Treatments for Dorsal Spurring and Soft Tissue Swelling

• The provided studies do not directly address the treatment of dorsal spurring and soft tissue swelling over the metacarpals.
• However, some general information about the treatment of pain and inflammation can be applied:
  • Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain and inflammation, but they have potential adverse effects on the gastrointestinal, cardiovascular, and renal systems 3, 4.
  • Conservative management, such as exercise therapy, can be an effective treatment for various conditions, including osteoarthritis and meniscal tears 5, 6, 7.
• In the absence of direct evidence, it is difficult to recommend specific treatments for dorsal spurring and soft tissue swelling over the metacarpals.
• Further research or consultation with a medical professional would be necessary to determine the best course of treatment for this specific condition.