What are the treatment options for hand cramps?

Treatment Options for Hand Cramps

For hand cramps, topical treatments are preferred first-line therapy, particularly topical NSAIDs and capsaicin, which are both effective and safe with minimal systemic side effects. 1

First-Line Treatments

Topical Therapies

• Topical NSAIDs: Highly effective for pain relief (Effect Size = 0.77) with safety profile equivalent to placebo for GI side effects 1

  • Apply 3-4 times daily to affected areas
  • Particularly effective when only a few joints are affected
  • Causes no more systemic side effects than placebo

• Topical capsaicin (0.025%-0.075%):

  • Apply 3-4 times daily for up to 6 weeks 1
  • Very effective with Number Needed to Treat (NNT) of 3 1
  • Patients should be warned about initial burning/stinging sensation
  • May be more effective for osteoarthritis-related hand cramps

• Topical lidocaine 5% patches:

  • May be more effective than cream/ointment formulations 1
  • Delivers medication gradually over hours
  • No systemic absorption or toxicity reported

Second-Line Treatments

Oral Medications

• Paracetamol (acetaminophen):

  • Up to 4g/day as first-choice oral analgesic 1
  • Safe GI profile compared to NSAIDs
  • Less effective than NSAIDs but better safety profile

• Oral NSAIDs:

  • Consider only if topical treatments and paracetamol fail
  • Use lowest effective dose for shortest duration
  • Higher risk of GI side effects than topical NSAIDs or paracetamol

• Cyclobenzaprine:

  • For cramps associated with muscle spasm
  • Short-term use only (up to 2-3 weeks) 2
  • Adjunct to rest and physical therapy

Physical Interventions

• Splints/orthoses:

  • Particularly effective for thumb base osteoarthritis 1
  • Full splints (covering both thumb base and wrist) provide more pain relief than half splints

• Heat application:

  • Local heat can provide symptomatic relief 3
  • Simple and safe intervention

• Stretching exercises:

  • Regular stretching of hand muscles can prevent and relieve cramps 4
  • Should be performed several times daily

Advanced Options for Refractory Cases

• Amitriptyline-ketamine topical compound:

  • Compounded mixture of amitriptyline 1-2% with ketamine 0.5-5% 1
  • Applied up to 3 times daily
  • 75% of patients report improvement in pain
  • Requires preparation by compounding pharmacy

• Gabapentin/Pregabalin:

  • Consider for neuropathic hand pain 1
  • Gabapentin: Start at 300mg at bedtime, up to 2400mg daily in 3 divided doses
  • Pregabalin: 75-300mg every 12 hours

Important Considerations

• Hand cramps may be idiopathic or secondary to medications or metabolic disorders 4
• Important to rule out underlying neurological conditions (neuropathy, radiculopathy, plexopathy) 4
• Isolated cramps may not require pharmacological treatment 4
• Magnesium supplementation has not shown consistent benefit for muscle cramps 5

Treatment Algorithm

1. Begin with topical therapies:

   • Topical NSAIDs as first choice
   • Topical capsaicin as alternative or adjunct

2. Add physical interventions:

   • Stretching exercises
   • Heat application
   • Splints if associated with osteoarthritis

3. If inadequate response, add oral medications:

   • Paracetamol (up to 4g/day)
   • Short course of oral NSAIDs if needed
   • Cyclobenzaprine for associated muscle spasm (short-term only)

4. For refractory cases:

   • Consider topical amitriptyline-ketamine compound
   • Consider gabapentin/pregabalin if neuropathic component suspected

Most hand cramps are self-limiting and respond to conservative measures. Pharmacological treatment should focus on topical agents first to minimize systemic side effects.