hands - Musculoskeletal Health Australia (MHA)

08/Apr/2024

Are you like me and find supermarkets ridiculously cold? It doesn’t matter what season it is outside; inside a supermarket, it’s Arendelle, and Elsa has just turned everything into snow and ice ❄⛄.

This can be really uncomfortable, especially if you have a musculoskeletal condition. And if you have Raynaud’s phenomenon, it can make your extremities – especially your fingers – turn white and numb.

What is Raynaud’s phenomenon?

Apart from having a really cool name – it’s a phenomenon, for goodness sake! 🙃 – what is Raynaud’s??? First, it’s named after the French doctor who originally described it, Maurice Raynaud, and being French, it’s pronounced ‘ray-nose’ (with a silent D).

Raynaud’s phenomenon causes the blood vessels to the extremities, usually the fingers and toes, to constrict more than usual in response to cold temperatures or stress. When this happens, the blood flow is restricted, causing the extremities to become cold and turn white, then blue. When blood flow returns, the skin becomes red and returns to its normal colour.

Raynaud’s phenomenon can occur on its own – this is primary Raynaud’s phenomenon. Or it can occur alongside or ‘secondary’ to another disease or condition – this is secondary Raynaud’s phenomenon.

Both primary and secondary Raynaud’s phenomenon episodes can last from a few minutes to hours.

Other parts of your body, such as the nose, lips and ears, can be affected too.

Fortunately, Raynaud’s phenomenon rarely causes permanent damage.

Maintaining a balance: vasoconstriction and vasodilation

Your body protects your internal organs (your core) by maintaining a stable core temperature – it’s not too hot, not too cold, but just right 🐻🐻🐻.

One of the many ways your body maintains this stable temperature is through vasoconstriction and vasodilation. This essentially means that your blood vessels (vaso) narrow (constrict) or widen (dilate) as needed.

In the cold, blood vessels constrict to reduce blood flow to your extremities, such as the fingers and toes. This keeps your core warm. In the heat, blood vessels dilate, and blood flow increases to your skin, moving the warm blood away from your core.

These processes help your core remain at a constant temperature, usually around 36-37°C.

For people with Raynaud’s phenomenon, for some unknown reason, blood vessels constrict, not to keep your core temperature stable but in response to cold, stress or emotional upset.

Blood vessels in your extremities narrow quickly, and your skin changes colour due to a lack of blood supply. During a Raynaud’s episode or attack, you may experience pins and needles, tingling and/or numbness in your fingers or toes. You might find it difficult to do things with your hands, as lack of blood can make them clumsy and stiff. And when the blood returns to the area, you may feel slight discomfort or stinging pain.

These changes occur in the extremities, most often the fingers. Circulation in the rest of the body is generally normal.

Primary Raynaud’s phenomenon

This is the most common form of Raynaud’s phenomenon. It’s also called Raynaud’s disease. Women, generally under 30, are more likely to develop primary Raynaud’s phenomenon than men. It can also run in families, so if you have a family member with primary Raynaud’s, you’re more at risk of developing it.

Secondary Raynaud’s phenomenon

People living with conditions such as scleroderma, systemic lupus erythematosus (lupus) and rheumatoid arthritis may develop secondary Raynaud’s phenomenon. This usually occurs later in life but can happen at any age, depending on the underlying cause.

Other risk factors for secondary Raynaud’s phenomenon include:

mechanical vibration – for example, using a power tool for extended periods
medicines – e.g. beta-blockers, some migraine or cancer drugs, amphetamines
smoking.

Diagnosing Raynaud’s phenomenon

Your doctor can determine if you have Raynaud’s by talking with you about your symptoms. It can be helpful to take a photo of your hands if you experience a Raynaud’s episode so you can show this to your doctor.

Although it’s generally not too difficult to diagnose Raynaud’s phenomenon, it can sometimes be hard to tell whether it’s primary or secondary Raynaud’s. Your doctor may use a range of methods to work this out, such as:

taking a complete medical history, including asking about family members who may have Raynaud’s phenomenon
a physical examination
blood tests
examining fingernail tissue with a microscope.

Living with Raynaud’s phenomenon

Most people with Raynaud’s phenomenon can manage it effectively with self-care and lifestyle changes. In some cases, medicines may be necessary.

Self-care

To prevent a Raynaud’s episode, the best thing you can do is to keep your body and extremities warm. Dress appropriately for the cold with gloves, thick socks and warm layers. It can be helpful to keep a spare pair of gloves or hand warmers in your car or bag that you can use if you’re caught out in a cold or stressful situation (e.g. a trip to the supermarket! 😱).

If you’re outside and your extremities start feeling cold and numb, go indoors and soak your fingers or toes in warm (not hot) water. Or you can warm them with a heater. Just be very careful of the heat – it’s easy to burn yourself when your skin is numb.

If you can’t go indoors, try these things to increase the circulation to your extremities:

Wiggle your fingers or toes.
Rub your hands together.
Make circles with your arms.
Massage your hands or feet.
Place your hands in your armpits. However, if you’re like me, your armpits aren’t always warm enough, and you may need to ‘borrow’ someone else’s warmth! Make sure it’s someone you’re close with – random strangers won’t appreciate your ice-cold fingers in their armpits! 😂
If a stressful situation triggers the attack, remove yourself from the situation, take some deep breaths and try to relax.

Medical care

Talk with your doctor if your Raynaud’s isn’t controlled by these simple measures. You may need to use medicines that widen your blood vessels and improve circulation.

For secondary Raynaud’s phenomenon, it’s also essential that the underlying condition (e.g. lupus) is treated effectively.

Tips for avoiding triggers

There’s no cure for Raynaud’s phenomenon, so avoiding things that trigger a Raynaud’s episode is key.

Avoid being out in the cold for long periods, especially if you’re not dressed warmly.
Make sure your whole body is kept warm, using several layers of clothing to trap body heat.
Keep your extremities warm with gloves, woollen socks, earmuffs and/or a beanie.
Use hand warmers. These small, often disposable products produce heat on demand and are helpful when gloves aren’t enough; you can buy them from supermarkets and chemists.
Remember, hand sanitisers often have a cooling effect, so when using them, be prepared to warm your hands quickly.
Avoid smoking cigarettes or drinking caffeinated drinks as nicotine and caffeine constrict blood vessels.
Review your medicines with your doctor; if they’re causing the problem, discuss possible alternatives.
Be aware that holding something cold, such as a can of drink, can trigger symptoms.
Learn to recognise and avoid stressful situations.
Keep a journal of when episodes or attacks happen, as this may help identify triggers.
Look after the skin on your hands and feet – with our frequent hand washing and use of hand sanitiser, it’s easy for our hands to become dry and cracked. Cracked skin is an opening for germs to get in and potentially cause an infection.
Exercise regularly to maintain blood flow and skin condition. Being active also has many other health benefits.

Complications

For most people, Raynaud’s phenomenon is uncomfortable and a nuisance but is basically harmless, with no lasting effects. However, in rare cases, loss of blood flow can permanently damage the tissue. This may lead to skin ulceration, tissue loss and scarring.

Talk with your doctor if you notice any changes in your symptoms.

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm (excluding public holidays) on 1800 263 265; email helpline@msk.org.au or via Messenger.

More to explore

Patient education: Raynaud phenomenon (Beyond the Basics)
UpToDate
Put your hands together and applaud … your hands!
Musculoskeletal Australia
Raynaud phenomenon
Australasian College of Dermatologists
Raynaud’s disease
Mayo Clinic
Raynaud’s phenomenon
American College of Rheumatology
Raynaud’s phenomenon
Cleveland Clinic
Raynaud’s phenomenon
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Raynaud’s phenomenon
Versus Arthritis

Karla Wignall

08/Apr/2024

It’s all in the hands!

Hands…they tend to be two things we take for granted. They really do an awful lot for us. But what happens when using our hands is painful or difficult?

Hand osteoarthritis – signs and symptoms

Osteoarthritis (OA) is the most common form of arthritis. It commonly affects the hands, fingers, base of the thumb and the wrist. OA causes the cartilage on the ends of your bones to become thin and rough. When this happens, bones don’t move as smoothly as they should causing pain and stiffness. OA of the hand most commonly affects women over the age of 50.

For more detailed information click here.

What are the hand signals?

As mentioned, pain and stiffness can be the first sign. You may also notice changes in the shape and structure of the joints in your hand. Some people will develop firm, knobby swellings on the finger joints which means the bones are trying to repair themselves but as a result there is excess bone developing.

Thumbs up – what to do

Unfortunately, there is no cure for osteoarthritis of the hand. So, the focus is on relief of symptoms and trying to avoid excess strain on your hand joints. As we all know, doing something that we know is going to be painful usually means we avoid it, but it is really important to exercise these joints. Other things we can do include using pacing strategies and avoiding lifting or carrying heavy weights.

A hand therapist can help with this as well as advice on aids and other strategies.

Latest updates

A new study using an existing drug called methotrexate for the treatment of osteoarthritis of the hand with synovitis (inflammation of the lining of the joint) is showing some promising results especially with improvements in pain. The study looked at the safety as well as the benefits of a 6-month course of methotrexate. 97 participants were randomly given 20mg of methotrexate once a week as compared to placebo. The methotrexate group had a moderate but clinically significant reduction in pain providing important evidence that it could have a role in treating this condition. This is a small study, and further trials are needed to see if the benefits continue after 6 months as well as how long treatment is needed. But it is a promising start!

As with all medications, and as part of discussions with your health care team, you will need to weigh up any possible side effects of methotrexate.

The lead researcher of the study, Prof Cicuttini, is planning an extension trial and hopefully answer these and other questions like can it prevent joint damage which is often quite severe in post-menopausal women with OA of the hand with inflammation.

So…grab life by the hands

Whilst OA hand is very painful there are things that can help.

putting less strain on the joints
implementing simple strategies like pacing and
using practical and well researched aids to provide support and assistance can help.

Making sure you are up to date with the latest information, support and research (through MHA of course) is essential. As well as working with your health care team about options including the use of medications like methotrexate to provide relief.

Also, make sure you register for MHA’s upcoming webinar Understanding and managing thumb arthritis on 23rd April at 7 pm. Click here to register

References

https://versusarthritis.org/about-arthritis/conditions/osteoarthritis-of-the-hand-and-wrist/

https://ard.bmj.com/content/78/1/16

A well-established drug can improve hand osteoarthritis symptoms: study – Monash University

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm (excluding public holidays) on 1800 263 265, email helpline@msk.org.au or via Messenger.

Lisa Bywaters

31/Aug/2022

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

It’s no secret I love hands! They’re amazing, complex and delicate structures. They help us connect with the world and each other. They allow us to touch, feel, carry objects, pick up kids and perform all kinds of everyday tasks.

That’s why I’m passionate about people being proactive and looking after them.

As an Accredited Hand Therapist* I’m often asked about the things people can do to look after their hands. Here are my top five tips.

1. Look after the skin on your hands

Your skin protects your hands from the outside world. It’s constantly renewing itself. Every time you wash your hands, you rub away dead skin cells. It’s important to look after your skin by keeping it as clean as possible and using a gentle hand wash. In some cases, gloves might be a good idea, for example if you’re using chemicals to clean your shower, or work in a café washing dishes.

Keeping your hands clean isn’t just about them looking good. It’s also about avoiding infections. Anyone who’s had an infection in their hand will tell you it‘s very painful. This is due to the many nerve endings you have in your fingertips. And because you use your hands so often, it’s hard to avoid banging or knocking an infected or injured hand.

An infection can also limit your hand’s movement, which, if left untreated, can become permanent.

Obviously, keeping your hands clean is impossible with some jobs, so keeping the skin in good shape is essential. Using a good moisturiser or barrier cream after washing is recommended to avoid small cracks developing in the skin. These cracks allow dirt and germs to enter your body, increasing your risk of infection.

Keeping your skin hydrated and moist helps keep your skin supple and leads to faster healing.

2. Stay strong

Many people don’t realise they’re losing strength in their hands until they have a functional problem, such as pain when opening a jar or difficulty gripping a doorknob.

That’s why I recommend exercises to strengthen your hands when you start to notice a problem. Many people strengthen their hands by squeezing a ball; if this is the case, I recommend a softer ball so your fingers can move through a greater range when squeezing. A cheap alternative to squeezing a ball is squeezing plumbing insulation. You can buy it by the metre at hardware stores for a few dollars and in different diameters to suit your hand size.

Accredited Hand Therapists can provide you with exercises for specific muscles or to deal with particular issues you’re having. They may use strengthening tools, exercise putty, and/or exercise bands.

3. Keep your joints moving

As the saying goes, ‘motion is lotion’ as far as your joints are concerned, so don’t let them stiffen up!

At the ends of the bones in your joints, you have a layer of cartilage. Cartilage is a firm cushion that absorbs shock and enables the bones to glide smoothly over each other. The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid is the oil in your joints. It provides nutrition for the cartilage and helps provide a cushion between the cartilage. It moves across the joint’s surfaces like a drop of oil on a door hinge. When you move your hands, the synovial fluid is spread around the joint. So tasks that have you holding something for a long period without changing grip aren’t good for the joints. It’s not allowing the synovial fluid to lubricate the joint. Rather than not perform the activity, take frequent breaks and move your fingers. And try to avoid activities that push your fingers into extremes of range, for example, lifting items that are too large using only one hand.

Similarly, use bigger, stronger joints where possible. For example, carry shopping bags on your forearm rather than with your fingers.

Accredited Hand Therapists can instruct you in exercises for specific joints, such as the joint at the base of the thumb. To maintain good movement, moving your joints through the full range of movement and stretching out to the ends of the range is important. Tendon gliding exercises are often used for this purpose as they glide one set of tendons over the other and move each joint through its full range. Click here for examples of tendon glide exercises.

4. Use the right tool for the job.

We often force our hands into extreme positions or keep going with a task until our hands are aching, especially if we’re in a rush or just want to get a job done.

But using the right tools can be gentler on your hands. For example, large or fat handles can spread loads more evenly or over several joints. Tools that use a lever to reduce the required force are also preferable; for example this tool (see image) helps open ring-pull cans.

There are also many electric tools for use in and around the home, reducing the required force. For example, instead of hand pruning a hedge, you can use electric shears. I know which I’d prefer!

You can buy aids and other tools from supermarkets, chemists, hardware stores, and home health care stores. Musculoskeletal Australia also has a range of tools available through their online shop.

5. Seek professional help

If pain or inflammation persists for more than a few days, seek professional help. Pain can be a warning sign that your joints are being overworked. Inflammation can be due to joints, muscles and/or tendons being overused or other health issues such as diabetes or heart disease. Prolonged inflammation can make it difficult to move your fingers. It may be that the structures in your hand need a rest to allow them to heal.

Your GP or a practitioner in hand therapy can help diagnose the problem and provide you with techniques to manage the pain or prevent the problem from becoming worse.

Accredited Hand Therapists can be located via the Australian Hand Therapy Association’s web page under the “Find an Accredited Hand therapist” section.

And check out my other article, ‘Can a hand therapist help you?’.

*As awarded by the Australian Hand Therapy Association

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

Lisa Bywaters

10/Aug/2022

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

A surgeon once told me that the human body’s most elegant anatomy was in the hand. I might be slightly biased, but I had to agree! The hand is amazing and complex in the way it’s structured and works.

There are 27 bones in your hand compared with just 3 in your leg. These bones are moved by over 30 muscles, all working in unison to provide smooth, coordinated movements. Your nerves help you control these movements enabling you to adjust your strength or fine coordination to suit the task.

Your hands can convey your feelings through touch and gesture and help to communicate your thoughts. In fact, some people will tell you they can’t talk without using their hands!

Your wrists, elbows and shoulders work together to position your hands in space. Any problem along the chain of your upper limbs affects your ability to fully function. Imagine how difficult it would be to reach up to do your hair if your shoulder was stiff, or to do downward dog in yoga with a painful wrist!

We connect with the world through our hands, performing everyday activities, and many of us earn our living with our hands. That’s why it’s essential that we take good care of our hands.

For some people, this may include seeing a professional.

What is hand therapy?

Considering the importance of our hands, it should be no surprise that there are professionals devoted solely to their rehabilitation.

Hand surgeons are either orthopaedic or plastic surgeons who’ve undergone additional training and study to specialise in treating problems of the hands, wrists and arms. They may use surgical and/or non-surgical treatments.

Hand therapy practitioners are qualified physiotherapists or occupational therapists registered with the Allied Health Practitioner Regulation Agency (AHPRA). They have extensive knowledge and skill in understanding and treating problems with the fingers, wrists, elbows and shoulders. The Australian Hand Therapy Association (AHTA) defines hand therapy as “the art and science of rehabilitation of the upper limb – shoulder to fingertip”.

What is an Accredited Hand Therapist (AHT)?

In 2017, the Australian Hand Therapy Association implemented a credentialing program to ensure accredited therapists offer a high standard of practice. All Accredited Hand Therapists have undertaken advanced education and assessment of the upper limb and have had over 3,600 hours of hand therapy clinical practice. After they’re assessed as competent to provide safe, evidence-based diagnosis, advice, and treatment, they’re awarded the credential of Accredited Hand Therapist by the Australian Hand Therapy Association Credentialing Council.

What conditions are treated?

Accredited Hand Therapists diagnose and treat a large variety of musculoskeletal conditions of the upper limb. They include:

arthritis
nerve compressions (e.g. carpal tunnel syndrome)
fractures, joint injuries and dislocations
tendinopathies (e.g. tennis elbow) and other soft tissue injuries
pain conditions
nerve and tendon injuries
burns and scar management
sporting injuries
work-related injuries
post-surgical conditions.

What happens at an appointment?

When you meet with an Accredited Hand Therapist, you’ll work together to develop a treatment plan. It will take into consideration your specific situation, symptoms, and the environment in which you live and work.

Some treatments aim to resolve a problem, for example, improving muscle strength or range of motion after a fracture. Some treatments may be preventive and involve teaching you to manage symptoms like pain or swelling in response to an injury or illness.

Assessments may involve specific measurements; for example, the therapist measures your wrist’s range of movement or grip strength. Assessments also include your experience of the problem, for example, when you describe the location of the problem, how your symptoms feel and affect you, and the things you noticed or experienced when you first noticed your symptoms.

Treatments often use heat, ice or electrotherapy to improve healing, orthoses (splints) to rest soft tissues (e.g. muscles, tendons, ligaments), and specifically targeted exercises to improve movement and strength.

You’ll be encouraged to complete a home program when possible, so education will also be a large part of your treatment.

To achieve the best outcomes, therapists may collaborate with other health professionals such as hand surgeons, rehabilitation consultants or GPs.

Where do I find an Accredited Hand Therapist?

Accredited Hand Therapists can be found throughout Australia in private practice (sometimes co-located with hand surgeons), in public hospitals and in community settings. In Australia, there are over 400 Accredited Hand Therapists in metropolitan, rural and remote locations. You can contact a hand therapist through the AHTA “Find an Accredited Hand therapist” web page or email the AHTA at enquire@ahta.com.au.

You use your hands all day long, so receiving the best care to recover after surgery, injury, or a medical condition is essential. Your hands deserve the best, and so do you!

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

Lisa Bywaters

07/Jul/2022

Guest blog by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT

The advent of COVID has seen many more people riding their bikes, either for exercise or for their daily commute. It’s a great exercise for the heart and lungs and a low-impact exercise for people with musculoskeletal conditions.

In recognition of the health and environmental benefits of riding a bike, the United Nations declared June 3rd to be World Bicycle Day. Unfortunately, as a hand therapist, I frequently hear patients complain that hand and upper limb pain or weakness limits their ability to ride.

Hand therapists are experts in rehabilitating the upper limb. We understand anatomy and how it relates to everyday activities. We can help determine what’s causing the problem, if it’s due to an injury, illness or activity, and provide appropriate treatment.

Some pain experienced when riding a bike may be due to vibration transmitted up through the bike into the arms or due to the prolonged time or force with which the handlebars are gripped.

If you love to ride but find it a bit painful, here are my top 10 tips for protecting your hands and upper limbs while riding. The best place to start is from the ground up.

1. Tyres

If you’ve ever ridden a bike or billy cart with solids tyres rather than rubber, air-filled, pneumatic tyres, you know what a difference a little air and rubber can make!

Yet even with pneumatic tyres, vibrations or jolting through the handlebars can be painful for people with arthritis or joint injury. Ensuring the tyres on your bike are properly inflated can help reduce stress going up through the arms and into your body. The current thinking in the biking world is that wider tyres with less pressure offer better rolling resistance and comfort.

Wheels for bikes can also vary in stiffness depending on the design and the material they’re made from, so some are better at absorbing shock than others.

2. The frame

If you plan to explore the world and take your bike with you, you need to consider the weight of your bike. Is the weight manageable for you?

And when choosing a bike rack, one mounted on the back of the car might be an easier option than lifting your bike over your head onto the roof of a car. Lower lifts reduce the strain on sore or stiff shoulders.

Carbon fibre and titanium bikes are much lighter than traditional steel-framed bikes but come at a cost.

Another consideration is that the further away your seat is from the handlebars, the more of your weight your arms will be supporting.

3. Shock absorbers

The front fork of a bike can have shock absorbers that reduce the force going up into your arms from uneven terrain while keeping the tyres in contact with the ground for better control. They can be easily adjusted to provide more or less bounce.

4. Stem flexibility

The stem attaches the handlebars to the bike, and the modern stems have pivots, elastomers and moving parts to provide suspension. They may be as effective at smoothing the force from rough terrain as the fork suspension but may be a cheaper option to retrofit to a bike.

5. Handlebar shape

There’s a huge variety of handlebar shapes, which roughly fall into three categories: swept back, drop or flat handlebars. Some of the handlebars offer several different grip positions enabling the rider to vary their grip.

For example, the drop bars enable the rider to use three different positions

the hooks, the part that curves or drops down, taking most of the weight through the hand;
the hoods are the rubber covers around the hinges of the levers. For smaller hands, it might be more comfortable holding the levers here, but there’s some loss of strength as the grip is near the hinge and not the end of the lever;
the third place you can hold a drop bar is on the top of the bar. This gives the rider a more upright position and places the hands in a palm down position, but this is a less anatomically friendly position for the wrist. Placing hands in a palm down position also puts pressure on the nerves in the palm of the hand, which can cause compression neuropathies such as carpal tunnel syndrome or cyclist’s palsy. Carpal tunnel syndrome affects the thumb side of the hand, while Bicycler’s neuropathy affects the little finger side; both conditions cause numbness and tingling in the hand.

6. Handlebar rise and sweep

Handlebar rise is the vertical rise measured from the centre of the bar to the bar end. The handlebar height can be adjusted by raising the stem or by increasing the rise of the handlebars. Increasing the rise changes the body position of the rider to a more upright position, meaning more weight is placed through the saddle, and less weight is placed through the shoulders, wrists and hands. Handlebars can have an upsweep and a backsweep. Sweep is the angle from the stem to the end of the bar either in an upward angle (upsweep) or in a backward angle (backsweep). More upsweep generally places more pressure on the hands, wrist and shoulders, whereas more backsweep places the wrists in a more natural (palms facing) position.

7. Handlebar material

The material the handlebars are made of can affect their ability to reduce or dampen the forces going through them. Carbon fibre and aluminium dampen vibrations better; however, steel and titanium flex. A little bit of flex in a handlebar is a good thing as it absorbs some of the force from bumps in the road.

There’s also a line of handlebars that have a foam-filled core to deaden the vibration through the core.

8. Grips and tapes

Larger grips generally distribute the weight more evenly through the hand. There are lots of commercially available grips, and many can be retrofitted to your bike.

Some change a flat handlebar to provide a vertical grip as well, allowing for a change of hand, wrist and elbow position. This can help reduce hand stiffness and provide rest from pressure on a particular joint or nerve. Tapes can either be gel or cork. The advantage of cork tapes over gel is that they don’t compress over high-pressure areas and are generally more durable.

9. Gloves

Gloves offer added protection from blisters and falls and improve grip. Glove fit should be firm so they don’t bunch up and cause pressure areas. They should also fit firmly around the cuff so water can’t leak in when it’s raining.

Keeping hands warm with waterproof or thermal gloves helps maintain hand dexterity, especially for arthritic hands. Lightweight, breathable summer gloves with wicking ability may be helpful to reduce sweaty palms, which reduce grip.

Some gloves have padding to reduce vibration, which irritates the nerves of the hand, or silicon tips or open tips to improve touch.

Gloves can provide skin protection in the case of a fall or protection for mountain bikers with inbuilt carbon fibre inserts to protect the backs of the hands from trees.

10. Gears and brakes

Traditionally gears fall into 3 categories:

Twist or grip shifters,
Trigger shifters, or
Shimano Total Integration (STI) brake lever shifters.

More recently, digital computerised gear mechanisms have been introduced. They require very little resistance to use, but unfortunately, they’re expensive to retrofit to your bike.

Twist shifters can only be fitted onto straight handlebars and are controlled by rotating the wrist. They’re easier on the fingers and the thumb as wrist motion is used to control the gears. So if you have painful fingers or reduced dexterity, twist gears might be advisable. Twist shifters are known to become stiffer over time, which might put undue strain on the wrist. They also require frequent repositioning of the wrist.

Trigger shifters generally require little force and can be activated with different fingers. To shift gears, the top lever is moved with the fingers, and the bottom lever is moved with the thumb. The benefit of trigger shifters is that the wrist stays in a neutral position. This is helpful if you have tennis elbow as it reduces strain in the muscles at the elbow joint.

STI Brake lever shifters are a combination of the gear shifter and the brake lever on the one fitting. This allows the rider to shift gears without moving their hand from the bars. They’re generally found on touring or racing bikes and can be activated while holding the hoods. They require minimal force to use.

Brakes can either be hydraulic or cable brakes.

Hydraulic brakes are preferable if you have upper limb problems as they take far less force to use. The back pedal (coaster) brakes are less common these days and are generally found on cruiser bikes or kids bikes. They’re worth considering if you have poor eye-hand coordination or poor hand strength. If the levers are too far out from the bars, people with smaller hands have difficulty reaching their fingers around the brake levers, making it difficult to grip forcefully. This can be adjusted with small rubber inserts placed at the hinge end of the brake lever.

Getting your bike tailored to meet your specific needs may just require some minor changes to your existing bike. But sometimes, purchasing a new bike can be more cost-effective. Remember, changing any part of your bike will affect your bike’s fit and may affect your bike’s handling. It’s worth getting your existing bike correctly fitted to you before making too many expensive changes.

If changing your bike isn’t helping, then you need to see a hand therapist to evaluate the cause of the pain and, if needed, provide upper limb exercises, treatments or supportive splints to enable you to keep riding. A hand therapist in your local area can be found on the Australian Hand Therapy website.

Our guest blogger Catherine Reid is an occupational therapist with a Master of Science in Hand and Upper Limb Rehabilitation. She’s a full member of the Australian Hand Therapy Association and works in her private practice Western District Hand Therapy, in Warrnambool, Victoria.

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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Lisa Bywaters

09/Feb/2022

You don’t really notice your thumbs until something makes you take notice. You whack one with a hammer, jam it in a door, or you get arthritis.

You then realise how often you use your thumbs every day 😖.

Your thumbs are more flexible than the rest of your digits. They can rotate, flex and touch the tips of your fingers. This allows you to perform all sorts of simple and complex movements.

So when something happens that impacts your thumb’s ability to move smoothly and painlessly, it gets your attention very quickly.

Arthritis

Many types of arthritis can affect your thumbs; however, osteoarthritis (OA) is the most common. OA occurs when the cartilage that covers the ends of the bones in a joint becomes brittle and breaks down. Healthy cartilage acts like a slippery cushion that absorbs shock and helps your joints move easily. When it breaks down, bone rubs against bone, causing pain and restricted movement. Your body tries to repair this damage by creating extra bone, called bone spurs. They may also cause pain and limited joint movement.

Other conditions such as rheumatoid arthritis, psoriatic arthritis, gout and lupus can also affect your thumbs.

This article will focus specifically on OA and thumbs.

Who gets OA in the thumbs?

You’re more likely to develop OA in your thumbs if you:

are female
over the age of 40
have had trauma or damage to the joints in your thumb
are obese
do work or activities that put stress on the thumb joints.

Symptoms

The symptoms of OA in the thumbs are:

pain
stiffness or limited movement of your thumb
joint swelling (inflammation)
grinding, rubbing or crunching sensation (crepitus)
loss of thumb strength.

Diagnosis

If you’re experiencing pain in your thumb that’s affecting your ability to do everyday activities, it’s important that you discuss this with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly. Early treatment will give you the best possible outcomes.

Your doctor will:

take your medical history – this will include finding out about your symptoms, how long you’ve had them, what makes them better or worse
examine your thumb – this will include feeling for warmth, listening and feeling for grinding or crunching (crepitus), and moving your thumb through it’s range of movement.

Your doctor may also request x-rays of your thumb to get a better look inside the joint and check for bone spurs.

Treatment

There’s no cure for thumb OA, but it can be managed effectively using self-care, splints, medications, and in some cases, surgery.

Self-care

Exercise – as with all musculoskeletal conditions, exercise is one of the most important things you can do to manage your pain and keep your joints moving. A study published in the BMJ Open from researchers at The University of Sydney found that hand exercises, when used with pain relief, splints and education, increased hand function and decreased pain in people with thumb OA. In Appendix 2 of the article, you can access the exercises used in this study. You can also see a hand therapist, a physiotherapist or an occupational therapist for exercises specifically tailored to you.
Heat and cold – cold packs/gels can help reduce inflammation, and heat packs/gels can loosen stiff muscles, both providing temporary pain relief.
Aids and equipment – such as jar openers, book holders, tap turners, button hook and zipper aids and easy-grip utensils can make tasks easier and more efficient by reducing the stress on your thumbs and eliminating tight grasps. You may need to speak with an occupational therapist about what equipment is best for you.
Avoid repetitive or repetitive activities that strain the thumb – e.g. hand sewing.

Hand therapy
A hand therapist is an occupational therapist or physiotherapist who has undergone advanced training to become experts in assessing, diagnosing, and treating upper limb problems (shoulder to hand). They can provide advice on joint protection and energy conservation (e.g. splints) as well as recommendations for adaptive devices/equipment to improve thumb and hand function. You can find a hand therapist via the Australian Hand Therapy Association website or talk with your doctor.

Splints
A splint can support your thumb, reduce your pain, protect your thumb while you do your everyday activities, and rest the joint. A hand therapist can give you advice on splints.

Medications
Your doctor may suggest medications such as analgesics (pain killers) and/or non-steroidal anti-inflammatory medications (NSAIDs) for temporary pain relief. Topical creams and gels are preferred over oral NSAIDs because less medication is absorbed into the bloodstream. Your doctor or pharmacist can advise you on the best medication to use for your specific health needs.

Your doctor may recommend a cortisone injection into the joint if other strategies such as medications, the use of a splint, and self-care activities haven’t reduced your pain. These injections can reduce pain and inflammation for several weeks to months. However, you can only have a limited number of injections into the same joint in the space of a year.

Surgery

If conservative treatments haven’t helped and arthritis in your thumb is causing significant pain and distress and impacting your quality of life, surgery may be an option. A referral to a specialist hand surgeon is usually required. https://muscha.org/surgery/

The most common types of surgery for thumb OA are:

Joint fusion (arthrodesis) – involves fusing two or more bones together. This essentially turns them into one bone and relieves pain because the joint no longer moves. However, you do lose flexibility in the thumb.
Osteotomy – involves cutting, shaping and repositioning bone to help correct joint alignment.
Trapeziectomy – involves removing one of the bones in your thumb joint (trapezium) to relieve pain.
Joint replacement (arthroplasty) – all or part of the affected joint is removed and replaced with an artificial implant.

Osteoarthritis in the thumb can be a painful and distressing condition. But the good news is that there are many things you and your healthcare team can do to manage your pain and keep you doing the things you love to do. The important thing is that you seek treatment early and follow your treatment plan.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

11 facts about the thumb
Mental Floss
Efficacy of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis: protocol for a randomised, controlled trial (COMBO)
BMJ Open
Five surgeries for thumb arthritis
Arthritis Foundation (USA)
Hand conditions and tips for joint protection
Musculoskeletal Australia
New approach to treating thumb osteoarthritis
The University of Sydney
Thumb arthritis
Mayo Clinic
Thumb arthritis: What to know
Medical News Today
Why does my thumb hurt and how to remedy it
Medical News Today

Lisa Bywaters

30/Jul/2020

….your hands!

Did you know that each of your hands has 27 bones, 27 joints, 34 muscles, and over 100 ligaments and tendons?

They really are amazing, complex and delicate structures. And we often take them for granted – until something happens – we hit our thumb with a hammer, we slam a finger in a drawer or we develop a musculoskeletal condition.

Many conditions such as osteoarthritis and rheumatoid arthritis cause pain, swelling and sometimes disfigurement in hands. Other conditions such as Raynaud’s phenomenon and carpal tunnel syndrome can make your hands painful, and can cause pins and needles, as well as numbness.

For many people who have hand conditions, the colder months can make it worse. Your joints may ache more because of the cold, the constant hand washing can make your skin dry and the use of hand sanitiser (which often has a cooling effect) makes it feel like your fingers are about to drop off.

But there are things you can do to decrease hand pain, deal with the cold and COVID, and make everyday activities easier.

Look after your hands. Inspect them for things such as swelling, nail and skin changes and any changes to the joint shape or direction of fingers and/or thumbs. By being aware of our hands and any changes that occur, you can seek advice sooner and prevent things from getting worse..

Wash and dry your hands regularly and thoroughly. Just as washing with soap and water for at least 20 seconds is necessary to help prevent the spread of germs (including SARS-CoV-2), drying your hands thoroughly is also important. Germs love moisture and thrive in moist places. Drying your hands reduces your chances of spreading or picking up germs when you touch things with damp or wet hands.

Apply a moisturising hand cream regularly to keep your skin healthy and nourished. With our more frequent hand washing and use of hand sanitiser, it’s easy for our hands to become dry and cracked. Cracked skin is an opening for germs to get in and potentially cause an infection. And if you have a condition such as scleroderma or psoriatic arthritis, skin care is an important part of your overall management plan. You may need to use a medicated skin cream, rather than an over-the-counter product. Talk with your doctor or pharmacist for more info.

Use assistive devices if your hands are painful and stiff. They can help if you have difficulty gripping or holding everyday items. Assistive devices such as jar openers, book holders, tap turners, button hook and zipper aids and easy grip utensils can make tasks easier by reducing joint stress and eliminating tight grasps. You may need to speak with an occupational therapist about what equipment is best suited to you. Also check out our online shop. We have some products available to help you with your everyday activities.

See a hand therapist if you have hand/wrist pain or a condition that affects your hands, especially if it’s causing you issues with your day to day activities. Hand therapists are occupational therapists or physiotherapists that have undergone advanced training to become experts in the assessment, diagnosis and treatment of upper limb problems (shoulder to hand). They can provide advice on joint protection and energy conservation (e.g. splints) as well as recommendations for adaptive devices/equipment to improve hand function.

Splints and other supports may be an option. They can give support to a painful joint by providing mild compression, warmth and/or joint protection. There are two main types of hand or wrist splints – resting splints and working splints. The choice of splint will depend on your condition and your current needs. Splints need to fit your hand comfortably and correctly, so speak with a hand therapist about what’s best for you and how often you should wear them.

Exercise your hands, as well as the rest of your body. Regular hand exercises can reduce stiffness and support your joints by keeping your muscles strong. If you’re considering hand exercises, it’s best to get advice from a hand therapist or other specialist as to which exercises are most suitable for you. Exercises should be mild and should not cause you additional pain when you’re doing them. See our Hand information sheet for some basic range of motion exercises.

Wear gloves in the cold weather, especially if you have Raynaud’s phenomenon. Hand warmers are also helpful. If you’re going to the shops for supplies and you have to use hand sanitiser before you enter, be aware that many of them have a cooling effect. This can really aggravate your condition. Having a couple of hand warmers in your pockets can help. You can get disposable hand warmers, or reusable ones. Just remember if you use the reusable ones to thoroughly wash the fabric pouch it’s contained in between uses. They can easily become contaminated, and hygiene is everything during this pandemic.

Also wear gloves when you’re gardening, washing dishes or doing any tasks that have the potential for your hands to get dirty or damaged.

Medications may provide some temporary pain relief, depending on the underlying condition causing the problem in your hand/s. Your doctor may suggest analgesics (pain relievers like paracetamol) as well as nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen. A cortisone injection is generally not recommended for osteoarthritis of the hand, but may be used for rheumatoid arthritis or acute attacks of gout. In conditions such as rheumatoid arthritis you may also be taking disease modifying anti-rheumatic drugs (DMARDs). It’s important to take these medications as prescribed by your doctor.

With conditions such as Raynaud’s, if simple measures like keeping your hands warm hasn’t helped, you may need to be prescribed medications that widen your blood vessels and improve circulation. Talk with your doctor for more info.

Making life easier on your hands

Sometimes simply changing the way you do everyday tasks can reduce pain and protect your joints. You can make life easier on your hands by considering the following:

Listen to your body – pain can serve as a warning sign that your joints are being overworked. Try to find a balance between activity and rest by pacing yourself. Take regular breaks when completing tasks and try not to overdo it on a good day. You might like to try heat or cold packs to help relieve pain. Some people also like to soak their hands in warm water or wrap their hands around a warm mug of tea.

Try to avoid using a tight grip for long periods. For example:

use foam or sponge to increase the grip size of handles on cutlery, pens and other hand held devices
use assistive devices with thick rubber grip handles (e.g. key turners, jar openers)
use rubber squares and gloves to help improve grip
consider lever handles around your home to minimise any twisting forces (e.g. mixer taps in bathrooms/kitchens).

Avoid repetitive movements. For example:

prolonged typing, pruning and power tool usage particularly those that vibrate
when gardening ensure your tools are sharpened and well maintained for ease of use
if you can’t avoid these repetitive movements, make sure you take regular breaks.

Try to use your body’s larger joints and muscles when you can. For example:

use your forearms to carry bags instead of your hands
when carrying items hold them closer to your body
when lifting heavier items squat and use your thigh muscles.

Spread the load – try to spread the load of an object over more than one joint. For example:

when picking up objects use two hands
slide sheets and swivel pads can help move items with less strain
divide shopping into smaller bags and try using a backpack and/or trolley.

Find an alternative. For example:

buy pre-cut meat and vegetables instead of trying to cut them up yourself
use electrical items instead of manual (e.g. can openers and graters)
look for items that are easier to use (e.g. push on pegs)
keep a pair of scissors handy to open packaging.

Rethink personal care/hygiene – for people with decreased hand function or fine motor skills, everyday tasks such as showering and toileting can be quite challenging. To make things easier you could use:

a bidet to help with cleaning difficult to reach areas
baby wipes/moist towelettes instead of toilet paper (but remember that they’re not flushable)
toilet paper tongs/aids to help with grip
soap dispensers instead of a bar of soap
items to make dressing easier e.g. sock sliders, elastic shoe laces, button hole hooks/zip pullers, front fastening bras as well as dressing aids for coats and cardigans o shoes with velcro fasteners instead of laces.

Our hands are complicated and important and we depend on them more than we realise. Painful hands can often be managed with simple self-care strategies, however if your hands are causing you a lot of grief, and affecting your day to day functioning, talk with your doctor for information and support.

Contact our free national Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

Hand conditions and tips for joint protection
Musculoskeletal Australia
Australian Hand Therapy Association
Exercises for wrist, hand and finger problems
NHS Inform (Scotland)

What is Raynaud’s phenomenon?

Maintaining a balance: vasoconstriction and vasodilation

Primary Raynaud’s phenomenon

Secondary Raynaud’s phenomenon

Diagnosing Raynaud’s phenomenon

Living with Raynaud’s phenomenon

Self-care

Medical care

Tips for avoiding triggers

Complications

Contact our free national Help Line

More to explore

Contact our free national Help Line

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

1. Look after the skin on your hands

2. Stay strong

3. Keep your joints moving

4. Use the right tool for the job.

5. Seek professional help

Contact our free national Help Line

Written by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT(USA)

What is hand therapy?

What is an Accredited Hand Therapist (AHT)?

What conditions are treated?

What happens at an appointment?

Where do I find an Accredited Hand Therapist?

Contact our free national Help Line

Guest blog by hand therapist Catherine Reid, B.App. Sci, (OT), M.Sci (H&UL rehab), MAHTA (As awarded by the AHTA), CHT

1. Tyres

2. The frame

3. Shock absorbers

4. Stem flexibility

5. Handlebar shape

6. Handlebar rise and sweep

7. Handlebar material

8. Grips and tapes

9. Gloves

10. Gears and brakes

Contact our free national Help Line

More to explore

Arthritis

Who gets OA in the thumbs?

Symptoms

Diagnosis

Treatment

Contact our free national Help Line

More to explore

….your hands!

Making life easier on your hands

Contact our free national Help Line

More to explore

Useful Links

Key Conditions

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