What is the diagnosis and recommended treatment for a patient with moderate degenerative changes in both hands and postoperative changes in the distal right radius?

Diagnosis and Management of Bilateral Hand Osteoarthritis with Post-Surgical Distal Radius Changes

What This Means

Your X-ray shows moderate osteoarthritis (degenerative joint disease) affecting both hands, along with evidence of previous surgery on your right wrist—there is no acute injury requiring immediate intervention. 1

The findings indicate:

• Moderate degenerative changes (osteoarthritis) affecting multiple joints in both hands, most commonly involving the distal interphalangeal (DIP) joints at the fingertips, proximal interphalangeal (PIP) joints in the middle of the fingers, and potentially the base of the thumb (carpometacarpal joint) 1
• No erosions detected, which is important because it helps rule out inflammatory arthritis like rheumatoid arthritis or erosive osteoarthritis 1, 2
• Post-operative changes in your right wrist from previous surgery—this is expected scar tissue and bone remodeling, not a new problem 1
• No acute fracture or dislocation, meaning no emergency treatment is needed 1

Recommended Treatment Approach

First-Line Conservative Management (Start Here)

Begin with topical NSAIDs applied directly to painful hand joints, as these are safe and effective for hand osteoarthritis, especially in older adults. 1

• Apply topical NSAIDs (such as diclofenac gel) to symptomatic joints 3-4 times daily 1
• If topical agents are insufficient, use oral NSAIDs at the lowest effective dose for the shortest duration, monitoring for gastrointestinal and cardiovascular side effects 1
• Use a hand orthosis (splint) for the base of the thumb if that joint is symptomatic—this provides pain relief, improves function, and may prevent progression 1

Weight Management (If Applicable)

• If you are overweight (BMI ≥25) or obese (BMI ≥30), aim for 5-7.5% weight loss, as this provides symptomatic benefit even for hand osteoarthritis 1

Physical Therapy and Exercise

• Engage in hand-specific exercises and occupational therapy to maintain range of motion and grip strength 1
• Balance exercises and yoga may provide additional benefit 1

Second-Line Options When Conservative Measures Fail

If the above measures provide insufficient relief after 3-6 months:

• Intra-articular corticosteroid injections can be considered for individual severely symptomatic joints, particularly the carpometacarpal (thumb base) joint 1
• Ultrasound guidance improves injection accuracy but is not mandatory 1
• Duloxetine (a serotonin-norepinephrine reuptake inhibitor) may be considered for chronic pain management 1

Surgical Consideration

Surgery should only be considered if you have marked disability, reduced quality of life, and failed conservative treatment for at least 6 months. 1

• Surgical options include joint replacement (arthroplasty) for the thumb carpometacarpal joint if severely symptomatic 1, 3
• Other procedures like joint fusion may be appropriate depending on which specific joints are most problematic 4, 5

Important Caveats

What to Avoid

• Do not use therapeutic ultrasound—it is not effective for hand osteoarthritis 1
• Avoid bisphosphonates, methotrexate, colchicine, and hydroxychloroquine—these are not indicated for osteoarthritis 1
• Do not assume all hand pain is from osteoarthritis—if you develop sudden onset of severe inflammation, soft tissue swelling (rather than bony enlargement), or involvement of the knuckles (metacarpophalangeal joints), return for re-evaluation to rule out rheumatoid arthritis, psoriatic arthritis, gout, or other inflammatory conditions 1

Red Flags Requiring Re-Evaluation

Watch for these warning signs that suggest something other than simple osteoarthritis:

• Sudden onset of severe joint swelling with warmth and redness (possible gout or infection) 1
• Predominant involvement of the knuckles (MCPJs) rather than finger joints (suggests rheumatoid arthritis) 1
• Marked morning stiffness lasting >30 minutes (suggests inflammatory arthritis) 1
• Elevated inflammatory markers (CRP, ESR) if checked (may indicate erosive osteoarthritis or inflammatory arthritis) 1

Monitoring Your Condition

• Hand osteoarthritis typically progresses slowly over years—rapid progression over weeks to months warrants re-evaluation 6
• The absence of erosions on your current X-ray is reassuring, as erosive osteoarthritis has a worse prognosis with more pain and deformity 1, 2
• Your postoperative wrist changes are stable findings and do not require intervention unless you develop new symptoms in that area 1