Your hand and wrist consist of a complex set of bones, joints, tendons, nerves, and muscles that work perfectly to bring seamless coordination to fine motor movements. Generally, wrist and hand arthritis becomes more common as we age and can be painful and debilitating. In complex cases, a cortisone shot in hand is an option.
Anatomy of the wrist and hand
All in all, there are 27 bones in the wrist and hand. The bones are made up of carpals, metacarpals, and phalanges. All these joints are covered by cartilage which allows frictionless and pain-free movements. However, in arthritis, there is loss of the cartilage leading to bone on bone movement. Consequently, pain results from the movement of these joints without cartilage.
Symptoms of wrist and hand arthritis
Initially, the first symptom is pain after excessive use, such as a whole day of gardening or playing tennis. As arthritis advances, simple activities such as opening a door or typing on a keyboard can become painful. Morning stiffness is also a common feature. General symptoms include swelling, restriction in movement, warmth, and cysts or nodules in the finger. These nodules have unique names in osteoarthritis called Bouchard and Heberden’s nodes.
It is essential to distinguish osteoarthritis from less common inflammatory arthritis such as rheumatoid disease. For example, some common rheumatoid changes are arthritis and swelling of the MCP joints, drifting of the fingers away from the thumb, and nail changes.
How do we make a diagnosis of wrist and hand arthritis?
In general, we perform three types of tests:
- Clinical assessment: Looking for and feeling for hand and wrist joint swelling can give clues to the diagnosis.
- X-rays of the wrist and hand provide information about the type of arthritis. Sometimes, ultrasound or MRI can give extra information.
- Blood tests are often crucial if inflammatory arthritis is suspected
Treatment options include a cortisone shot in hand
The goal of treatment is to reduce pain and improve function. Some of the treatment options include:
- Lifestyle modifications: Just a simple case of altering your activities slightly can reduce pain considerably.
- Wrist and finger splints: Splinting can provide support and allow you to perform simple activities without pain.
- Hand therapy: Seeing a therapist for help with exercises is essential. You can buy cheap but effective hand devices that will help keep the joints moving and improve strength in the fingers and wrist.
- Medication: Topical cream frequently applied to the sore wrist or finger joints provides excellent pain relief. Creams include ibuprofen or flexiseq.
- Injection therapy: a cortisone shot in hand can help reduce pain and improve mobility for a few months.
- Surgery such as fusion of the wrist or fingers is often the last resort.
More about a cortisone shot in hand
Cortisone is a powerful anti-inflammatory and reduces pain associated with arthritis. However, you need to be aware of the potential problems with cortisone injections. Certainly, it is not an option for everyone with arthritis.
Generally, we advise cortisone injections under ultrasound to improve accuracy and reduce side effects such as skin thinning and tendon damage. See the image below showing how ultrasound can direct the needle correctly into a wrist joint.
These blogs outline the potential side effects, time to work, and other issues associated with cortisone injections.
Apart from a cortisone shot in hand, are there other injection options?
Yes, but the evidence for the effectiveness of these options on the wrist and hand is limited.
Hyaluronic acid is a naturally occurring substance in bones and joints. Injection of hyaluronic acid into the joint improves pain. In addition, we think it might act as a lubricant to reduce pain.
We obtain Platelet-rich plasma or PRP from whole blood. First, the blood is spun, so the cells are separated from the plasma. We then isolate the plasma from the cells and inject it into the joints. While there is good evidence for use in knee arthritis, there is little evidence in wrist and hand arthritis. Nevertheless, some doctors are using PRP in the hand when people want to avoid surgery.
Final word from Sportdoctorlondon about a cortisone shot in hand
Overall, wrist and hand arthritis is a common condition as we get older. We use a combination of hand therapy, topical anti-inflammatory treatment, and a cortisone injection. Generally, we suggest an injection with ultrasound to improve effectiveness and reduce side effects. You should make sure the practitioner performing your injection has a medical degree and experience using ultrasound.
Other hand conditions: