Treatments for Arthritis of the Hand

Capsulitis of the Thumb and Finger Joints

Diagnosis and Treatment

Prime cause: Overuse. Traumatic origin may also be recalled.

Capsular pattern or presentation:

Thumb: 

Pain and limited passive ranges of motion on:

adduction

extension

abduction

Other Digits:

Pain and limited passive ranges of motion on:

metacarpo-phalangeal joints:

extension with ulnar deviation

interphalangeal joints: painful and limited passive flexion

distal interpahlalangeal joints: painful and limited passive extension

Treatment Options may Include: 

Cold compresses on an off at five minutes each time would help deal with the acutely inflamed joint.

NAIDs have some benefit. Use must be weighed versus side-effects, and the probability that the pain cycle is properly cut.
DMARDs may be considered for chronic cases, as well as those with sub-acute components.
Standard TCM acupuncture has not been proven to be strongly beneficial.

Yamamoto new scalp acupuncture may be of some use if the Yamamoto points are distinctly identifiable.

Articulatory releases have proven benefit.

Instrument-assisted releases of associated soft tissue has proven benefit, and is among treatments that should first be considered. Prime candidates include the cases with longstanding low-grade inflammation and peri-lesional fascial adhesions.

Anatomy of Approach to Joint:

The first metacapal-trapezium joint is articulated at the apex of the anatomical snuff box. Keep in mind that the radial artery runs through the base of the snuff box. Taking the tractioned thumb into flexion-extension cycles delineates the joint.

Local steroid infiltration technique: mid-small guage needle (such as 25 G, 0.5 inch) is introduced at right angle to the skin surface at the joint line. A medial of lateral approach to the joint line may be used.

Illustration and Interventional Summary by Strix Toledo, M.D. (C)2010