From the Guidelines
Management for degenerative changes in the left hand involving the DIP joint, thumb carpometacarpal joint, and intercarpal joints should follow a stepwise approach, prioritizing non-pharmacological therapies as the first line of treatment, as recommended by the 2019 EULAR guidelines 1. The initial treatment should include education on joint protection and self-management principles, as well as exercises to improve hand function and reduce pain, with a focus on individualized treatment plans considering the patient's specific needs and comorbidities 1. Some key non-pharmacological interventions that can be considered include:
- Physical therapy focusing on hand strengthening exercises, particularly for the thumb and fingers, implemented 2-3 times weekly for 4-6 weeks
- Splinting the affected joints, especially at night or during activities that exacerbate pain, to reduce inflammation and provide stability
- Topical NSAIDs such as diclofenac gel 1% applied to painful areas 3-4 times daily for localized relief with fewer systemic side effects For patients who do not respond to non-pharmacological therapies, pharmacological options such as oral NSAIDs or acetaminophen can be considered, with the goal of minimizing systemic side effects and maximizing symptom relief 1. The use of corticosteroid injections, such as methylprednisolone 20-40mg mixed with lidocaine, may be considered for persistent pain, but should be used judiciously and with careful consideration of the potential risks and benefits 1. Ultimately, the goal of treatment is to reduce inflammation, preserve joint function, and delay disease progression, with surgical options such as joint fusion, arthroplasty, or joint replacement considered only after conservative measures have failed, and particularly for the thumb carpometacarpal joint where surgical outcomes are generally favorable 1.
From the Research
Management of Degenerative Changes in the Left Hand
The patient's condition involves degenerative changes in the DIP joint, carpometacarpal joint of the thumb, and intercarpal joints. The recommended management for this condition can be based on the following approaches:
- Conservative Treatment: Studies have shown that conservative treatment methods can be effective in managing degenerative changes in the hand. For example, a study on De Quervain's tendinopathy found that conservative treatment complemented by eccentric training can provide significant improvements in pain intensity and hand functionality 2.
- Manual Therapy: Manual therapy techniques such as mobilization with movement (MWM) have been shown to be effective in reducing pain and improving functional status in patients with carpal tunnel syndrome 3. Similarly, an orthopedic manual physical therapy approach emphasizing first CMC manipulation has been found to be effective in managing De Quervain's tendinopathy 4.
- Therapeutic Activities: Therapeutic activities that mimic daily living activities have been found to be more effective than traditional therapeutic exercises in improving hand function in young adult patients with hand injuries 5.
- Multimodal Intervention: A multimodal intervention approach that includes exercise, manual therapy, and education has been found to be effective in managing patellofemoral pain, a condition that shares some similarities with degenerative changes in the hand 6.
Key Considerations
When managing degenerative changes in the left hand, the following key considerations should be taken into account:
- Individualized Approach: A tailored approach that takes into account the patient's specific needs and condition is essential.
- Pain Relief: Immediate pain relief should be a priority to gain patient trust.
- Patient Empowerment: Patient empowerment through education and active interventions is important.
- Activity Modification: Good patient education and activity modification are essential to prevent further degeneration.