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    Lisa Bywaters
    13/Oct/2022
    Health InformationMSK articles

    Osteoarthritis: It’s not ‘just’ arthritis

    Osteoarthritis is the most common form of arthritis. And because of this, I think it’s often dismissed, and its effects underestimated.

    I mean, how often have you heard people say, ‘it’s just wear and tear’, ‘we’ll all get it eventually’, or my personal favourite ‘it’s just a bit of arthritis’ 😤? These offhand comments trivialise the considerable pain and disability that osteoarthritis (OA) causes many Australians.

    If you have OA or know someone who does, you know it can significantly impact every aspect of life. Symptoms such as persistent pain, fatigue, stiff and swollen joints, weakened muscles, anxiety, depression, and sleep problems can affect a person’s ability to be as involved in social, community and work activities as they might like.

    So, no, it’s not ‘just’ arthritis.

    Let’s look at what it is.

    What is osteoarthritis?

    As we know, OA is the most common form of arthritis. It’s most likely to develop in people over 45, but it can also occur in younger people. It frequently affects weight-bearing joints, such as the knees, hips, feet, and spine. The joints of the hands, including the thumbs, are also commonly affected.

    While it was once thought to be an inevitable part of ageing, resulting from a lifetime of wear and tear on joints, we now know it’s a complex condition and may occur due to many factors.

    Osteoarthritis and your joints osteoarthritis

    To understand how OA affects your body, it’s helpful to know a little about your joints.

    Joints are places where bones meet. Bones, muscles, ligaments and tendons work together so you can twist, bend and move about.

    Covering the ends of your bones is a thin layer of tissue called cartilage. It provides a slippery cushion that absorbs shocks, helps your joints move smoothly and prevents bones from rubbing against each other.

    Around most of your joints is a tough capsule that holds your bones in place. The inside of the capsule is lined with synovial membrane, which produces synovial fluid. This fluid lubricates and nourishes the cartilage and other structures in the joint.

    With OA, the cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float in the synovial fluid. Because the cartilage no longer has a smooth surface, the joint becomes stiff and painful to move.

    Eventually, the cartilage can break down so much that it no longer cushions the two bones. Your body tries to repair this damage by creating extra bone. These are bone spurs (or osteophytes). Bone spurs don’t always cause symptoms but can sometimes cause pain and restrict joint movement.

    OA causes and risk factors

    Many things can increase your chances of developing OA, including:

    • your age – people over 45 are more at risk
    • being overweight or obese
    • your genetics – the genes you inherit can play a role in developing OA
    • other conditions – such as rheumatoid arthritis and gout, can cause damage to your joints and lead to OA
    • gender – 3 in 5 people who have OA are women
    • repetitive movements associated with your job or occupation (e.g. constant kneeling, squatting, lifting heavy loads)
    • significant injury, surgery, damage or overuse of a joint.

    Signs and symptoms

    The symptoms of OA can vary from person to person. Some of the more common symptoms include:

    • joint pain, stiffness and swelling (inflammation)
    • grinding, rubbing or crunching sensation (crepitus)
    • muscle weakness.

    These symptoms can sometimes worsen, especially when you feel stressed, upset, overdo things, or don’t get enough sleep. This is called a flare or flare-up.

    Diagnosing OA

    If you’ve been experiencing joint pain, it’s essential you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly. This will give you the best possible outcomes.

    To diagnose your condition, your doctor will do some exams or tests. They may include:

    • Your medical history. Your doctor will ask you about your symptoms, family history and other health issues.
    • Physical examination. Your doctor will look for swelling in and around the joint and test your joint’s range of movement. They’ll also feel and listen for grinding, rubbing or creaking in the joint.

    Imaging (e.g. x-rays, ultrasound or MRI) and blood tests aren’t routinely used to diagnose OA. However, they may sometimes be needed if there’s uncertainty around your diagnosis.

    Treating OA

    There’s no cure for osteoarthritis; however, your symptoms can be effectively managed with exercise, weight management, medicines, and self-care.

    Exercise

    Because of the old ‘wear and tear’ myth, many people are worried that exercising joints with OA will cause more joint damage. But regular exercise can actually help reduce some of your symptoms (e.g. pain, stiffness) and improve your joint mobility and strength. It will also move synovial fluid through the joint, providing essential nutrients and removing waste.

    Exercises that move your joints through their range of movement will also help maintain joint flexibility; this is often lost due to OA. Strengthening the muscles around your joints is also important. The stronger they are, the more weight they can take. This will help support and protect your joints.

    An exercise program that promotes muscle strength, joint flexibility, improved balance and coordination, and general fitness will give you the best results. Start exercising slowly and gradually increase the time and intensity of your exercise sessions over weeks and months. A physiotherapist or exercise physiologist can help you work out an exercise program that’s right for you.

    Weight management

    Being overweight or obese increases your risk of developing OA and the severity of your condition. The additional weight also increases pressure on your joints, especially your weight-bearing joints (e.g. hips, knees, feet), which is likely to cause further pain and damage.

    The amount of overall fat you carry is also significant because fat releases molecules that contribute to low but persistent levels of inflammation across your whole body. This, in turn, increases the level of inflammation in the joints affected by OA.

    For these reasons, maintaining a healthy weight is essential if you have OA. Your doctor or dietitian can advise you on safe weight-loss strategies if you need to lose weight.

    Weight loss can be a long process for many people. It’s challenging, especially when pain affects your ability to be as active as you’d like. But it’s good to know that any weight loss can reduce your pain and increase your ability to exercise. So making small, achievable changes to your eating and exercise habits can bring big results. It just takes time, commitment, and support.

    Medicines

    No medicines can affect the underlying disease process of OA, but combined with exercise, weight management, and self-care, medicines may provide temporary pain relief and help you stay active.

    The most commonly used medicines for OA are:

    • Non-steroidal anti-inflammatory medicines or NSAIDs (e.g. ibuprofen). These medicines are available over-the-counter and with a prescription, depending on their dosage and other ingredients. They come in tablet/capsule form (oral NSAIDs) or as a gel or rub applied directly to the skin (topical). It’s important to note that oral NSAIDs are designed to be taken at low doses for short periods. Always talk with your doctor before starting NSAIDs, as they can have side effects.
    • Paracetamol. Research has shown that paracetamol provides only low-level pain relief for osteoarthritis. However, some people report that it helps reduce their pain so they can be more active. For this reason, it’s worth discussing a trial of paracetamol with your GP to see if it‘s appropriate for you.
    • Corticosteroid (steroid) injections may be helpful for people who haven’t found relief from other treatments (e.g. exercise, weight loss) or other medicines. Corticosteroid injections into a joint can provide short-term pain relief; however, the number of injections you can have each year is limited due to potential harm.

    Note: Opioids are powerful pain-relieving medicines that effectively reduce acute pain (or the pain resulting from an injury or surgery). In the past, they were prescribed to treat pain associated with conditions like osteoarthritis; however, there’s strong evidence that they have little effect on OA pain. Opioids also have many potentially serious side effects. That’s why they’re not recommended in the management of OA. Read the Choosing Wisely Australia resource ‘5 Questions to ask about using opioids for back pain or osteoarthritis’ for more info.

    Self-care

    There are many other things you can do to reduce the impact of your symptoms, including:

    • Learning about your condition. Understanding OA and how it affects you means you can make informed decisions about your healthcare and actively manage it.
    • Learning ways to manage your pain. Pain is the most common symptom of osteoarthritis, so it’s crucial to learn to manage it effectively. Read our A-Z guide for managing pain for more information.
    • Working closely with your healthcare team. The best way to live well with OA is by working closely with the people in your healthcare team (e.g. GP, physio) and keeping them informed about how you’re doing and alerting them to any changes.
    • Protecting your joints. Supports such as walking aids, specialised cooking utensils, ergonomic computer equipment and long-handled shoehorns can reduce joint strain and make life easier. An occupational therapist can advise you on aids, equipment and home modifications. You can also check out our range of aids in our online shop.
    • Taping, knee braces and orthotics may be helpful if you have OA in your knees or feet. A physiotherapist or podiatrist can advise you on these.
    • Improving sleep quality. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have osteoarthritis and chronic pain can be challenging. If you’re having problems sleeping, talk with your doctor about ways you can address this.
    • Managing stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.
    • Eating a healthy, balanced diet. While there’s no specific diet for OA, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other medical problems, such as diabetes and heart disease.

    Surgery

    In most cases, surgery isn’t required for people with osteoarthritis. However, surgery may be an option if all non-surgical treatment options have been unsuccessful and you’re still experiencing significant pain and loss of function.

    The most common surgery for osteoarthritis is a joint replacement. When considering surgery, you should be informed about what it involves, the rehabilitation process, and its potential benefits and risks.

    Note: An arthroscopy isn’t recommended to treat knee OA. Evidence shows it’s not effective in improving OA knee pain or function.

    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 weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    CONTINUE READING
    hip-pain.jpg
    Lisa Bywaters
    24/Mar/2022
    Health InformationMSK articles

    Osteoarthritis of the hip

    Osteoarthritis (OA) is the most common type of arthritis, affecting 1 in 11 Australians.* It can develop in any joint but commonly occurs in weight-bearing joints like your knees and hips.

    Your hip joint hip joint osteoarthritis

    Joints are places where your bones meet. Bones, muscles, ligaments and tendons all work together so that you can bend, twist, stretch and move about.

    Your hips are one of the largest joints in the body. They’re called ball and socket joints. That’s because the head of your thigh bone (femur) is shaped like a ball that fits inside a rounded socket (acetabulum) in your pelvis.

    The ends of your bones are covered in a thin layer of cartilage that acts like a slippery cushion absorbing shock and helping your joints move smoothly.

    With OA, the cartilage becomes brittle and breaks down. Because the cartilage no longer has a smooth, even surface, the joint becomes stiff and painful to move.

    Eventually, the cartilage can break down so much that it no longer cushions the two bones. This causes pain, stiffness and swelling.

    Symptoms

    The symptoms of hip osteoarthritis usually happen gradually and vary from person to person. They may include:

    • pain in the hip joint
    • pain in your groin or thigh that radiates to your buttocks or your knee
    • stiffness and/or swelling of the hip joint
    • grinding, creaking or crunching sound when moving the hip
    • it may feel like your hip ‘locks’ or ‘sticks’ during periods of activity
    • reduced range of movement.

    Causes

    Many factors can increase your risk of developing osteoarthritis of the hip, including:

    • age – OA occurs more often in people over 45
    • being overweight or obese – extra weight on your hips can increase strain and may lead to premature or increased joint damage
    • gender – 3 in 5 people who develop OA are female*
    • family history of OA
    • joint damage – for example, from a sports injury or a car accident
    • joint abnormalities – for example, developmental dysplasia of the hip, a condition that affects the hip joint in babies and young children.

    Diagnosis

    If you’re experiencing pain or stiffness in or around your hip, it’s important that you discuss your symptoms 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.

    To diagnose your condition, 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
    • physically examine your hip.

    Imaging (e.g. x-rays, ultrasound or MRI) and blood tests aren’t routinely used to diagnose hip OA. However, they may sometimes be needed if there’s uncertainty around your diagnosis.

    Treatment

    There’s no cure for hip OA, but it can be managed effectively using exercise, weight management, medicines, self-management and in some cases, surgery.

    Exercise

    Exercise is one of the most important strategies for managing OA. A tailored exercise program developed by a physiotherapist or exercise physiologist can help reduce your hip pain and improve your hip function. Evidence suggests that while no one particular type of exercise is better than another, a combination of certain exercises is likely to be the most effective.

    These exercises include:

    • strength training specifically targeting your legs
    • aerobic exercise – these are exercises that get you moving and increases your heart rate (e.g. brisk walking, cycling, swimming) and will help improve the health of your heart and lungs (cardiovascular system)
    • balance training
    • exercises that move your joint through its full range (range of motion exercises).

    When choosing an exercise for yourself, think about what you enjoy and what you’re likely to keep doing. The best results occur when you exercise at least three times per week.

    If pain prevents you from exercising, you may find that warm water exercise is a good starting point. Warm water pools offer the comfort of warmth and the buoyancy of the water to ease the load on your joints. For those able, cycling is a good option for non-weight-bearing exercise.

    Weight management

    Being overweight or obese increases the risk of developing hip OA. It’s also highly likely to speed up how quickly your OA develops or progresses. Evidence shows a relationship between weight loss and relief of symptoms such as pain and stiffness; even a small amount of weight loss can help. If you’d like to lose weight to improve your symptoms, your doctor and/or a dietitian can assist you in losing weight safely.

    Medicines

    For some people, medicines are an important part of managing their OA. Tablets, creams, gels or injections may help to reduce pain and improve function.

    There are a variety of medicines used in the management of hip OA. Each comes with varying degrees of evidence to support them. These include:

    Non-steroidal anti-inflammatory medicines or NSAIDs (e.g. Nurofen, Celebrex, Voltaren)
    NSAIDs are available over-the-counter and with a prescription, depending on their dosage and any other ingredients. They may be taken by mouth (orally) as a tablet or capsule or applied directly to the skin (topical) in the form of gels and rubs.

    Oral NSAIDs are considered the preferred first-line drug treatment for OA and have been shown to reduce pain and symptoms in hip OA.

    Although there’s no solid evidence either for or against topical NSAIDs, it may be worth giving them a short trial to see if they help.

    It’s important to note that NSAIDs are designed to be taken at low doses for short periods. Always talk to your doctor before starting NSAIDs as they can cause harmful side effects, especially in older people.

    Paracetamol (e.g. Panadol, Panamax)
    Research has shown that paracetamol provides only low-level pain relief and, in some cases, no pain relief at all compared to a placebo in hip OA. However, some people do report that it helps reduce or take the edge off their pain so that they can be more active. If you can’t take NSAIDs they may also be an option. Before using paracetamol, talk with your GP to see if it’s appropriate for you.

    Corticosteroid injections
    If you have persistent hip pain and haven’t had relief from oral medicines or other treatments (e.g. exercise, weight loss), your doctor may suggest a corticosteroid (steroid) injection. Corticosteroid injections into the hip joint can provide short-term pain relief for some people with hip OA. However, the duration of pain relief can vary from a few days to a few weeks, and the number of injections you can have is limited due to potential harm. It’s important that you discuss the benefits and risks of steroid injections with your doctor to have all the information you need to make an informed decision.

    Opioids
    Opioids are powerful pain-relieving medicines. They’re effective at reducing acute pain (or the pain resulting from an injury or surgery), but evidence shows that they have little effect on OA pain. Opioids also have many potentially serious side effects. That’s why they’re not recommended in the management of hip OA.

    Glucosamine and chondroitin
    Studies have found that there’s no benefit from taking glucosamine for osteoarthritis. The Australian Rheumatology Association and the Royal Australian College of General Practitioners recommend against taking glucosamine.

    Glucosamine supplements are usually made of shellfish, so if you have a shellfish allergy, don’t use glucosamine. Glucosamine can also affect your blood sugar levels and may adversely affect diabetic, cholesterol, chemotherapy and blood-thinning medicines.

    Much like glucosamine, the effects of chondroitin are unclear. Some studies have found an impact, while others did not. Speak with your doctor before trying glucosamine or chondroitin.

    Stem cell injections
    Currently, there’s no evidence to support the use of stem cell injections in the treatment of hip OA despite it being commercially available. The International Society for Stem Cell Research and the Australian Rheumatology Association does not support the use of stem cell injections for osteoarthritis. It’s recommended that stem cell administration should only take place under a rigorously designed clinical study that prioritises individual health and safety.

    Self-management

    There are many things you can do to manage your OA:

    • Learn about your condition – knowing as much as possible about your OA means that you can make informed decisions about your healthcare and play an active role in managing your condition.
    • Learn a range of strategies to manage your pain – such as heat and cold, muscle relaxation, meditation, visualisation and massage. For more tips on managing pain, check out our online book Managing your pain – an A-Z Guide.
    • See a physio – a physiotherapist can provide you with techniques to improve movement and reduce pain. This can include designing an individualised exercise program tailored to your needs and offering advice on ways you can modify your daily activities.
    • Talk to an OT – an occupational therapist can advise on pacing yourself and managing fatigue, as well as how to modify daily activities both at home and work to reduce strain and pain on your joints.
    • Grab a gadget – things such as walking aids, long-handled shoehorns and long-handled reachers can reduce joint strain and movements that cause you pain. An OT can give you advice on aids and equipment to suit you. You can also check out some aids available in our online shop.

    Surgery

    For some people with hip OA, when all non-surgical treatment options have failed, and hip pain and reduced hip function impact their quality of life, surgery may be an option. In this case, your doctor may refer you to an orthopaedic surgeon to discuss your options.

    A total joint replacement of the hip is the most common type of surgery for hip OA. It can provide significant pain relief and improved function. However, it’s important to remember that a total hip replacement is major surgery and requires you to commit to months of rehabilitation.

    Contact our free national Help Line

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

    Download this information sheet (PDF).

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    Reference

    * Osteoarthritis, AIHW, 2020.

    CONTINUE READING
    thumbs.jpg
    Lisa Bywaters
    09/Feb/2022
    Health InformationMSK articles

    Osteoarthritis and your thumbs

    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

    CONTINUE READING
    cold-hands.jpg
    Lisa Bywaters
    30/Jul/2020
    Health InformationMSK articles

    Put your hands together and applaud

    ….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.

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    Lisa Bywaters
    30/Jul/2020
    Health InformationMSK articles

    Put your best foot forward

    Looking after your feet

    Our feet are amazing ‘feats’ of engineering (sorry, I just couldn’t resist that one).

    Each foot has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. They support us through thick and thin – whether we’re walking, running, jumping, dancing, skipping or hopping. We cram them into ill-fitting shoes, torture them in high heels and stub them against the bedside table in the middle of the night (or is that just me?).

    As well as the many injuries and calamities that befall our feet, many musculoskeletal conditions, such as osteoarthritis, rheumatoid arthritis and gout can affect the feet.

    They’re the unsung heroes of this pandemic as we hit the streets, parks and trails for exercise. Walking has become the exercise of choice for people at the moment. Many of us can’t – or don’t feel safe to – return to gyms or exercises classes. And lots of people are walking instead of catching public transport to avoid being in close contact with others. As a result we’re all walking many more steps than we did pre-COVID.

    So we need to stop taking our feet for granted. We need to look after them so we can continue to do the things we want and need to do as pain-free as possible.

    So what can we do?

    Give your feet the TLC they deserve. It’s really important to look after your feet. Wash and dry them regularly. Inspect them for anything unusual such as cuts, blisters, changes to the nails and skin. By being aware of your feet and any changes that occur, you can seek advice sooner. And if they’re sore after a day of walking, maybe give them a warm soak in the bath, or in a bucket or a foot spa (if you have one) while you watch TV. Then dry them thoroughly and rub a moisturising foot cream into your skin. Take your time and give your feet a nice massage. Better yet, see if you can talk someone else into giving them a massage while you relax on the couch.

    Manage your condition. If you have a musculoskeletal condition that affects your feet, it’s important that you work with your doctor and healthcare team to look after your feet and manage your condition effectively. The treatments used for foot conditions will vary from person to person, depending on your condition and how it’s affecting you. And this may change over time as your condition and your feet change.

    See a podiatrist. If you have foot pain, or a condition that affects your feet, visit a podiatrist. They’re feet experts and can assess, diagnose and treat foot and lower limb problem, including skin and nail problems, foot and ankle injuries, foot complications related to medical conditions and problems with your gait or walking. Podiatrists can also give you advice on appropriate footwear, and can prescribe custom foot orthotics.

    Consider orthotics. Orthotics are corrective insoles that can help alleviate pain by redistributing pressure away from the painful area and support your arches. You can buy off-the-shelf orthotics or you can have orthotics made that are specifically fitted to your feet by a podiatrist.

    Fit your feet with appropriate footwear. With our worlds turned upside down due to COVID, and many of us having to stay home, it’s tempting to stay in our slippers all day. There’s something so comforting about warm, fluffy slippers. However our feet and ankles need proper support. Wear the right footwear for whatever you’re doing. Going for a walk? Put on your sneakers. Working at home? Wear your casual shoes/boots that support your feet and keep you warm. And lounging around in the evening? Get those slippers on.

    If you’re buying new shoes, make sure they fit properly, support your feet and are comfortable. Look for shoes that are light, flexible at the toe joints and are hard wearing. Shoes made of leather are preferable over synthetic materials as they breathe better. Avoid slip-on shoes and if laces are difficult to fasten due to arthritis in your hands, Velcro or elastic laces may be an option.

    Let them breathe. Did you know you have about 250,000 sweat glands in each foot? That’s a lot of sweat! So let your feet breathe to avoid smelly feet and fungal infections. Change your socks and shoes at least once a day. Wear shoes that allow air flow around your feet: leather, canvas, and mesh are good options, avoid nylon and plastic. And avoid wearing the same shoes two days in a row. Give your shoes time (at least a day) to dry and air out. And if the weather’s warm, set your feet free and let them go au naturale. There’s nothing better than walking barefoot on warm grass on a sunny day.

    Exercise your feet. I’m not talking about walking here…but other exercises that keep your joints moving. Try non-weight-bearing exercises such as swimming, especially if you have foot pain, as they take the pressure away from the painful areas. You can also do exercises while sitting in a chair. NHS Inform (Scotland) has some foot exercise videos you can try. If you want exercises tailored specifically for you, visit a podiatrist or physiotherapist.

    Medications might help. If you’re having a lot of foot pain, speak with your doctor about whether medications may be an option. Depending on the underlying condition causing the problem, your doctor may prescribe a short-term course of pain relievers or anti-inflammatory medications, or they may prescribe other medications, such as a cortisone injection into a joint for rheumatoid arthritis or medication for acute attacks of gout.

    Diabetes and feet. Many people with musculoskeletal conditions also have diabetes. So it’s really important if you have diabetes that you take care of your feet every day because of the increased risk of developing nerve damage, ulcers and infections. Talk with doctor about how to look after your feet properly if you have diabetes.

    Surgery may be required. For some people, surgery may be needed if other conservative treatments haven’t helped. A referral to an orthopaedic surgeon who specialises in feet is usually required.

    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.

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