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Category: osteoarthritis

Physio FusionNewsosteoarthritis
By Physio Team Appointments & Fees, body parts, chronic pain, ergonomics, Exercises, hand and wrist pain, Home exercises, Injury, muscles, OA, osteoarthritis, pain, pain management, physical health, Physio, post-op, pre-op, rehabilitation, Sprain, tendon, Therapy, Work Injury

Wrist pain: De Quervains tenosynovitis

De Quervains tenosynovitis is a painful condition caused by inflammation of two prominent tendons that are located at the wrist and thumb.

The two tendons called the Extensor pollicus brevis  and Abductor pollicus longus originate from the middle of the forearm travel down towards and over the wrist to insert into the thumb. Collectively they function to extend the thumb, whilst abductor pollicus longus extends and also abducts the thumb (lifting thumb up to the ceiling).

What causes it?

The most common cause of De Quervains tenosynovitis is the repetitive overuse of thumb and wrist whether it is occupational or hobby related. For example, the repetitive thumb movement whilst using scissors by hair dressers, landscapers using shears or whilst gardening). Trauma to the tendons from injuries to the wrist or the thumb can cause inflammation of the tendons.

In some cases, age related degeneration of the tendon sheath or underlying conditions such as rheumatoid arthritis increases the risk of the developing De Quervains tenosynovitis. Hormonal changes resulting in fluid build up in young mothers can commonly result in De Quervains tenosynovitis.

Symptoms

Commonly your symptoms may include:

  • Pain located at base of your thumb
  • Pain elicited by movement of thumb (gripping or making a fist)
  • Grating or snapping feeling
  • Tightness in the wrist
  • Swelling surrounding the base of thumb and wrist

How is De Quervains tenosynovitis diagnosed?

Your doctor or physiotherapist will be able to diagnose the condition based on your symptoms and after doing a thorough movement assessment to rule out any other potential diagnosis.

  • Finkelstein test is used to elicit symptoms to confirm De Quervains tenosynovitis.

How to test:

  1. Wrap your thumb with your fingers.
  2. Slowly bend your wrist down

A positive test would elicit pain at the site of the two tendons.

Radiological investigations in lights of ultrasound and an x-ray might be recommended for further investigations, particularly to confirm clinical diagnosis or to rule out any other possible causes of De Quervains such as osteoarthritis.

What treatment options are available?

Conservative (non-surgical) management

Conservative management measures are generally recommended as the first line of management for mild to moderate symptoms. This is because up to 60-70% of symptoms are likely to improve over a period of 6-8 weeks of regular physiotherapy intervention. In this period, the following strategies are recommended by your therapist to fast-track your recovery

  • Rest and application of heat or cold packs
  • Avoid repetitive use of thumb
  • Pain medications (anti-inflammatory medications) such as diclofenac or ibuprofen
  • Splints or braces
  • Steroid injection

Surgical management

In more severe cases when conservative management has failed, surgery may be recommended by an orthopaedic specialist or surgeon.

Prior to your surgery you will have the opportunity to thoroughly discuss with your surgeon the details of the surgical procedure and about the post operative rehabilitation process.

  • Surgical procedure

Surgery may be performed under general or local anaesthesia. A small incision is made at the wrist and thumb region. The covering of the tendons (sheath) is then separated and expanded to provide the tendon space to allow the tendon to move smoothly within the sheath. After this the, the incision in then sutured with a firm dressing applied over the suture site.

  • While you recover from the surgery, an information sheet with post operative guidelines will be provided to you by your surgical team. It is important that you must follow the guidelines recommended by your surgeon for optimal recovery.
  • In most cases your will have a follow up with your surgeon few weeks after your surgery to check your wound healing and your progress. You are often times referred to physiotherapy for strength and conditioning of your wrist and hand movements to facilitate your recovery.
By Physio Team acute pain, Appointments & Fees, chronic pain, Home exercises, Injury, Lockdown, lockdown wellbeing, online consultations, osteoarthritis, pain management, physical health, Physio, RA, rehabilitation, Rheumatoid arthritis, Rheumatoid arthritis (RA), Therapy , , , , , , , , , , , , , , , , , ,

Dealing with Rheumatoid Arthritis

Rheumatoid arthritis (RA), a chronic inflammatory condition associated with swelling, pain, fatigue, and joint deformity. Although there are no known cures for this condition at present, a combination of treatments are available to help manage your symptoms. RA is the 2nd most common form of arthritis after osteoarthritis and is known to affect 1–2% of New Zealand’s population.

 

 

Signs and Symptoms

RA may develop very quickly or gradually over time, with its signs and symptoms, as well as the severity varying from one person to another. This condition is associated with episodes of remission and flare ups, with or without apparent triggers.

Other symptoms may include

 

  • Swollen, tender joints- (often accompanied by warmth and redness)
  • Joint pain
  • Joint stiffness which worsens in the mornings and after a period of inactivity
  • Fever, loss of appetite weakness, and fatigue
  • Muscle pain
  • Changes to the skin and nails

In the early stages of RA, you may notice its impact on your smaller joints- especially in your toes and fingers. And as this condition develops, your symptoms typically branch out to the bigger joints- your shoulders, ankles, knees, wrists, hips and elbows. Symptoms are likely to affect your joints bilaterally. Over time, RA also causes joints to deform and shift out of place.

Because RA is a systemic condition, it is estimated that approximately 40% of the RA population may experience symptoms and signs other body systems than the joints. These may include:

  • Kidneys, lungs, heart
  • Skin, eyes, mouth
  • Bone marrow
  • Nerves and blood vessels

 

 

Causes and Risk Factors

Your immune system is designed to help protect your body from infection and disease. However, in RA, changes occur in your immune system that (for poorly understood reasons), causes it to mistakenly attack the healthy soft-tissues of joints resulting in pain, swelling and inflammation. Because of this ongoing process, over time damages to the lining of your joints and other soft-tissues may lead to bone erosion and joint deformity. It can also have an impact on your heart, lungs, nerves, eyes and skin.

One can get RA at any age, although it is more probable to develop in those in the age bracket of 25-50 years old. Though rare, under 16s may also develop Juvenile RA or Still’s disease.

Risk factors for the development of RA include:

  • Family history of RA
  • Age bracket of 25-50 years old
  • Smoking
  • Women are more likely to develop RA than men
  • Obesity

 

 

 

Diagnosis

 

At present there is no single test to confirm a clinical RA diagnosis. It is often difficult to differentiate this condition in its initial stages from other forms of connective tissue inflammation (fibromyalgia, lupus, gout etc.).

Your doctor will get your full medical history (as well as any familial history of RA), discuss your signs and symptoms, undertake a physical assessment- particularly of your joints, and refer you on for imaging and blood tests. X-rays may help evaluate RA progression in your joints over time, whilst MRI and ultrasound imaging may help evaluate the severity of RA in your body. The blood test will evaluate your level of anti-bodies and proteins (including the rheumatoid factor protein that is present in approximately eighty percent of the RA population), and markers of inflammation.

 

 

Management

At present, though there is no cure for RA, a range of treatments are available which may help slow its’ progression and reduce pain and inflammation, minimise and/or prevent joint damage and maximise joint movement.

A combination of prescribed medication as advised by your doctor and other treatment options as noted below are recommended:

  • Cease smoking if you are smoker
  • Physiotherapy will help improve and maintain your joint range of motion, increase your muscle strength, and decrease your pain. Additionally, your physiotherapist or occupational therapist will be able to teach you ways of using your body efficiently to reduce stress on your joints
  • Finding a balance between rest and activity
  • Use of heat and cold packs to help ease pain and inflammation
  • The use of splints or braces for joint support as needed
  • Hydrotherapy- exercising in water reduces the pressure on your joints, whilst the warmth of the water will relax your muscles and help lessen your pain.
  • Seeking regular medical advice and check-ups to monitor your RA symptoms and the progression of the condition
  • Adopting a healthy and active lifestyle
By Physio Team Appointments & Fees, body parts, chronic pain, Exercises, good posture, Home exercises, Injury, Lockdown, muscles, OA, online consultations, osteoarthritis, pain, pain management, physical health, Physio, rehabilitation , , , , , , , , , , ,

Managing Your Osteoarthritis

Osteoarthritis impacts millions of people worldwide and is typically known as the most common form of arthritis. It is associated with the wear and tear of the protective cartilage which cushions the ends of your bones in your joints over time. Though this condition may cause damage to any joint in the body, osteoarthritis primarily impacts the joints in your spine, hands, hips, and knees.

 

Causes and Risk factors

Over time, the gradual deterioration of the cartilage which cushions the ends of your bones in your joints causes arthritis. Cartilage is a solid slippery tissue which allows almost frictionless joint movement. As the cartilage wears down, bone will eventually rub on bone.

This condition is typically characterized as a wear and tear degenerative disorder. However, in addition to the breakdown of the cartilage, it also impacts the joint as a whole. Osteoarthritis triggers alterations in the bone and damages connective tissue which holds the joint together and attaches your muscles to your bones. Inflammation of the lining of the joint is also triggered.

Factors which may put you at higher risk of developing osteoarthritis include but are not limited to:

  • Your age- the risk increases with getting older
  • Gender- though unclear why, but women are more perceptible to developing osteoarthritis
  • Bony deformities- those with abnormal joints or defective cartilage
  • Sustaining bony or joint injuries like those which take place during sport or from an accident.
  • The risk increases with obesity- the more you weigh, the greater your risk, as it adds more stress to your weight-bearing joints (particularly hips and knees)
  • Your occupation or a sport that you play which puts repetitive and excessive stress/loading on the joints, can eventually lead to the development of osteoarthritis.
  • Certain co-morbidities such as diabetes

 

Common symptoms

Below are some common examples of symptoms you may experience with arthritis. These may develop and worsen gradually over time

  • Pain: Your joints may hurt before and/or after undertaking an activity
  • Loss of joint range of motion– loss of overall joint flexibility and movement
  • Tenderness felt on applying light pressure to the joint
  • Joint stiffness that is most noticeable on waking up first thing in the morning or after a prolonged period of inactivity
  • Noticeable changes in joint pain with changes in the weather- particularly colder weathers
  • Sensations of grating and grinding// sounds of clicking and popping (crepitus) when you use the joint
  • You may notice swelling and redness around the joint, which may be triggered by soft tissue inflammation
  • Bony spurs that feel like hard bumps may develop around the impacted joint

 

How will I be diagnosed?

Osteoarthritis is typically diagnosed based on your medical and occupation history and a physical examination undertaken by your doctor. During the physical examination, your doctor will assess your affected joint(s) for swelling, tenderness, redness, and stiffness. X-rays may be recommended to reveal cartilage loss (the narrowing of the space between the bones of your joints), changes in bone, and bony spurs around the joint. Blood tests may be used to rule out other causes of joint pains like rheumatoid arthritis. Joint fluid analyses may also be used to test for inflammation to ascertain if the pain is triggered by an infection or gout instead of osteoarthritis.

 

Management

Though there isn’t a cure for osteoarthritis, various treatments which can help relieve symptoms of pain and disability are available.

Lifestyle modifications: Changes to your daily life may protect your joints and slow the progression of osteoarthritis.  Minimising activities which exacerbate your symptoms such as climbing stairs, squatting. Swapping high-impact activities like running and jogging to lower-impact activities such as cycling or hydrotherapy will decrease the stress on your joints. Weight-loss reduces the stress and loading on your joints, which then results in less pain with increased function.

Assistive aids: Using assistive aids like a stick/cane, wearing proper shoes w orthotics and supportive braces/sleeves may improve your stability and support your functional capabilities.

Physiotherapy: Targeted exercises may help improve your flexibility as well as build strength in your muscles. Your physiotherapist will develop a personalised active rehabilitation program which is safe and will meet your requirements and lifestyles.

Medications: Various kinds of medication (such as paracetamol and NSAIDs) maybe helpful in treating and controlling the symptoms of osteoarthritis. As everyone responds differently to medications, your doctor will prescribe medicines (type and dosage), which is safe and will work best for you.

Cortisones: Strong anti-inflammatory agents which is injected into the affected joint to give pain relieve and decrease inflammation for a short period of time. Due to potential side-effects, it may be recommended to restrict the number of injections to 2-3 per year.

Other: Heat and ice applications, self-massaging with pain-relieving creams/ointments and/or wearing elastic supports may provide some relief from your pain and give you support.

Surgery: Surgery may be recommended if there is considerable degeneration in your joints and/or if your osteoarthritic pain causes disability that is not relieved with conservative management. Your doctor or specialist will discuss your options with you.