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The Hand and Wrist

The hand and wrist are a complex array of 27 bones and multiple joints, plus countless ligaments, tendons, nerves and blood vessels. They make it possible for you to use your hands in a vast number of ways. For example, the fingers can bend, flex, move side to side, pick things up, wrap themselves around objects, unscrew jar tops and engage in fine motor activities like writing, drawing, buttoning and threading a needle. The wrist can bend, flex and rotate the hand in a complete circle, while providing enough strength for the gripping and lifting of heavy objects.

Five metacarpal bones form the framework of the palm of the hand. The digits (the fingers and thumb) are attached to and extend from the metacarpals. Each digit is made up of small bones called phalanges, with two in the thumb and three in each finger, adding up to 14 bones in the digits, with 9 joints connecting them. The digits join the metacarpals (bones in the palm) at the metacarpophalangeal joints (MCP joints), otherwise known as the main knuckle joints. All of the finger joints work like hinges, allowing you to bend and straighten your fingers. But the MCP joints also allow side to side movement, so you can spread or cross your fingers.

On the other end of the metacarpals are the joints that connect the hand to the wrist. The wrist is a highly complex joint that contains 8 small bones called carpal bones that form two rows. There are five carpal bones in the first row, each of which connects to a metacarpal bone, and three in the second row, connecting the wrist to the forearm bones (radius and ulna). Every one of these carpal bones forms a joint with the bones that sit next to it, which means that just one small bone is a part of several joints.

Arthritis and Joint Pain of the wrist and Hand

The word arthritis means inflammation of a joint, a broad definition that includes more than 100 different diseases, syndromes and conditions according to The Arthritis Foundation. They range from the familiar osteoarthritis and rheumatoid arthritis to lesser-known versions such as medial plica syndrome and Sjogren's syndrome. These diseases have a variety of causes and courses, symptoms and treatments, but they all produce pain and difficulty using the affected joint.

Some forms of arthritis can be dealt with quickly and effectively: infectious arthritis, for example, is often vanquished by antibiotics. Other forms may go away on their own: in rare cases, rheumatoid arthritis will vanish for no obvious reason. But many kinds of arthritis do not go away and must be managed through rest, physical therapy and/or medicines so that the person can continue to enjoy an active life.

Arthritis is, unfortunately, a common disease, striking 1 of every 5 adults in the United States.1 The prevalence rises with age and has been diagnosed in 50% of those age 65 or older. 2 But arthritis is not just a disease for adults: more than 290,000 children (under the age of 18) have some form of arthritis or a related condition.3 In its various forms, arthritis is the second most common chronic disease in the United States, costing the national economy almost $130 billion per year.4

Types of Arthritis of the Hand and Wrist

The 27 bones of the hand and wrist come together to create numerous joints - which means there are a great many places for arthritis to strike. The most common forms of arthritis of the hand are osteoarthritis, post-injury arthritis, and rheumatoid arthritis. Other forms of the disease that can strike the hands, fingers or wrists include carpal tunnel syndrome, psoriatic arthritis, infectious arthritis and gout.

1. Osteoarthritis of the Hand and Wrist

If you hold one of your fingers up and bend it forward, you'll see key joints in action: the MCP joint (knuckle joint at the base of the finger), the proximal interphalangeal joint almost halfway up the finger, and the distal interphalangeal joint near the tip. In each of these joints, the bones come together but don't quite touch each other. And it's a good thing they don't touch, because if they did their ends would rub against each other, creating friction and damaging the bone surface.

Instead, each bone is capped with a thin layer of cartilage. Thanks to this smooth, slick, rubbery surface, the bone ends can slide easily across each other. Imagine how easily two very flat, slightly wet ice cubes would slide across each other: healthy cartilage is actually five to eight times more slippery than ice! Cartilage also helps absorb the shock created by activities such as typing, playing the piano or using your hands in any other way that puts pressure on the joints.

But should the cartilage dry out, crack or wear away, the ends of the bones may begin to rub against each other, literally grinding each other down over time and triggering pain and other symptoms. And the shock generated by movement would strike the unprotected bone ends with much greater force.

Such is the case with osteoarthritis, a disease that generally strikes in middle age and progresses slowly. Pain is an early symptom, and as the disease becomes worse other symptoms may strike, including inflammation and joint stiffness. In an attempt to heal the damage, the body may produce growths at the bone ends of the afflicted joints which, in effect, cause the bone to grow a little bit longer in parts and will trigger more grinding in the joints and worse pain.

In osteoarthritis, the most commonly affected joint is the proximal interphalangeal joint, followed by the distal interphalangeal joint, and finally the MCP joint. Mild and moderate cases of osteoarthritis of the hands can usually be managed with medicines and supplements to relieve the pain and inflammation, the application of heat and/or cold, rest, and the use of wrist or finger splints. More serious cases may require surgery to fuse or reconstruct joints.

Although the exact cause of osteoarthritis is not known, risk factors for the disease have been identified. These include heredity, a previous injury to the joint and advancing age. About 50% of hand osteoarthritis can be attributed to genetics.7

Click here for more information on Osteoarthritis

2. Post-Injury Arthritis of the Hand and Wrist

The hands are at constant risk of being injured. Fingers can be jammed, twisted, hyperextended or stepped upon, hands can be caught in closing doors or in machinery, and any part of the hand, from finger tip to wrist, can be damaged during sports, especially those involving throwing, catching or hitting objects.

Injuries can set the stage for arthritis by damaging the cartilage or nudging a joint slightly out of alignment, thus causing the force exerted on a joint to be distributed unevenly. The damage may be so subtle that you don't notice it at first, and in some cases the symptoms come on so slowly that you don't connect them with the injury.

3. Rheumatoid Arthritis of the Hand and Wrist

Rheumatoid arthritis is a case of an immune system gone wild that attacks the body because it mistakes healthy body tissue for a foreign invader that must be destroyed. The joints are not the only targets of the errant immune system - the heart, lungs and other organs may be attacked - but they are often site of the first symptoms. That's because the rampaging immune system cells attack the lining of the affected joint (also known as the synovium), the tissue that produces the joint fluid which moistens and nourishes the cartilage. As the assault continues, the synovium becomes inflamed and the joint becomes painful, stiff, swollen, hot and red. Individual cells in the synovium begin to grow and divide abnormally and invade nearby cartilage and bone. Enzymes then begin to break down both cartilage and bone, in a joint that is misaligned, misshapen, twisted and possibly useless. A characteristic symptom of rheumatoid arthritis is the severe rotating of all of the fingers, including the little finger, toward the little finger side of the hand.

The signs and symptoms of rheumatoid arthritis include joint pain, inflammation, swelling, loss of mobility and pea-shaped bumps under the skin (rheumatoid nodules), as well as body-wide symptoms such as a general feeling of sickness, aching, stiffness, fatigue and weakness. A common characteristic of rheumatoid arthritis is that it attacks matched sets of joints: for example, it strikes both hands, both wrists, both elbows or both knees, rather than just one. When it strikes the hands, it tends to settle in the MCP joints and the proximal interphalangeal joints.

Rheumatoid arthritis strikes all ages and ethnic groups, as well as both genders. However women are more likely than men to develop the disease, especially between the ages of 20 and 50.

Click here for more on Rheumatoid Arthritis

4. Carpal Tunnel Syndrome

Inside the wrist is a narrow passageway made of bones and ligaments called the carpal tunnel, through which a major nerve runs that helps control the hand and the nine tendons that bend the fingers. If you press on that nerve, the hand would become numb, painful and weak. This is what happens in carpal tunnel syndrome. The medial nerve is "squeezed" as it runs through the carpal tunnel.

Since the medial nerve controls sensations to the palm side of the thumb and the fingers (with the exception of the little finger), the result can be a tingling, itchy numbness and a feeling of burning in the fingers and the palm. It may feel as if the fingers are swollen, even though there may be no actual swelling. Over time, the hand becomes weaker and the ability to distinguish hot and cold by touch may disappear.

There is no single cause of carpal tunnel syndrome. Injury to the wrist, genetic problems involving the wrist joint, performing certain types of repetitive work involving the hand, extensive use of vibrating hand tools and fluid retention are among the factors believed to contribute to the development of the syndrome.

Carpal tunnel syndrome usually attacks adults, and women are three times as likely as men to suffer from it.

Treatments and Supplements for Arthritis of the Hand and Wrist**

The primary goals of treatment for osteoarthritis of the hand and wrist are to reduce pain and improve the ability to use the hands. Rest and medicines to reduce pain and inflammation may be prescribed, along with splints or "soft sleeves" to support or immobilize certain joints.

Other treatments for osteoarthritis of the hand and wrist include:

• Heat therapy
  
• Exercise
  
• Dietary Strategies
  
• Physical and other therapies
  
• Surgery

Heat Therapy**

Applying heat to the afflicted joints in the form of paraffin wax is may improve circulation and help clear away toxins - and, of course, the heat itself feels good. The prestigious Cochrane Collaboration, which reviews the scientific evidence in order to rate the effectiveness of various therapies, found that four weeks of treatment with paraffin wax baths improved range of motion, grip strength and stiffness in those with rheumatoid arthritis of the hands (compared to those who did not receive these treatments.) The authors of this study stated that, "Paraffin wax baths combined with exercise can be recommended for beneficial short-term effects for arthritis of the hands."8

Exercise**

Keeping the hands, wrist and fingers moving is an important part of treatment; otherwise the joints may become stiffer, and the muscles may weaken further. Your physician or physical therapist may recommend a series of flexibility and strengthening exercises, which can include squeezing a soft ball, making and holding a fist for a count of 10, fanning your fingers and rotating your wrists in a circle.

Supplementation with JoMo, a 100% Natural Glucosamine and Chondroitin Formula for Maximum Joint and Cartilage Support

The body uses a number of substances to build and maintain cartilage. Among these are glucosamine and chondroitin, which help to keep the cartilage from drying and "flattening" out, and provide the building blocks for cartilage repair and growth.

Glucosamine and chondroitin supplements have been subjected to numerous scientific studies in the U.S. and abroad which have indicated that they can help relieve the symptoms of osteoarthritis and even slow the progression of the disease, while possibly helping the body to repair damaged cartilage.

The Mayo Clinic notes that, "The consensus of expert and industry opinion supports the use of chondroitin and its common partner agent, glucosamine, for improving symptoms and stopping (or possibly reversing) the degenerative process of osteoarthritis."9 The American Academy of Orthopedic Surgeons adds that recent studies appear to support the idea that glucosamine and chondroitin relieve osteoarthritis pain.10 Learn More

JoMo was developed by one of the leading orthopedic surgeons for an NBA basketball team to help relieve the pain and suffering of joint and cartilage related disorders.

JoMo's active ingredients include:

JoMo is 100% natural, shellfish free and contains no added sugar or artificial flavors or colors.

Click here for more on JoMo's Ingredients

It's important to take JoMo consistently for a few months to get the maximum benefit. The American Academy of Orthopedic Surgeons points out that...you may need to take the supplements (referring to glucosamine and chondroitin) for a couple of months before you see any results...Learn More

Dietary Strategies**

Healers have long searched for foods that relieve pain and other symptoms of arthritis. While a food that can eliminate arthritis has not yet been found, there are a number of dietary strategies that can be helpful, including the following:

• Reduce intake of inflammation-generating foods. Meat, poultry, many fast foods, corn oil, safflower oil and other foods containing linoleic acid may help "fuel" the inflammatory processes that are harming the joints. (The body converts linoleic acid into arachidonic acid, which plays a role in the inflammation process.) More on foods that increase inflammation
  
• Increase inflammation-reducing foods. Salmon, butternuts, green soybeans and other foods containing omega 3 fatty oils have the potential to reduce inflammation and provide nutrients for joint support. More on foods that decrease inflammation
  
• Increase nutrients that support strong bones to lessen risk of fracture. Calcium and vitamins D and K are among the nutrients the body needs to build strong bones. Calcium is found in milk, dried figs and cheese, vitamin D is found in vitamin D-fortified dairy products and cod liver oil, and vitamin K is found in broccoli, Romaine lettuce, spinach and other green leafy vegetables.
• Decrease intake of "Nightshade Vegetables"

Click here for more information on Diet and Arthritis

Physical and Other Therapies**

A number of therapies that involve physically manipulating the body or otherwise altering or influencing it are used to reduce the symptoms of arthritis and improve the body's ability to heal. These include:

• Acupuncture - Acting on the theory that blockages in the body's energy flow contribute to disease, acupuncturists insert fine needles into selected points in the body in order to unblock the energy flow and help the body heal itself.
• Electrical Stimulation - Transcutaneous electrical nerve stimulation (TENS) is used to introduce a mild electrical current into the painful area to reduce the perception of pain and/or "push" painkilling medicine through the skin and into the body.
  
• Infrared Sauna and Steam - Infrared radiation penetrates deeper into the body than the heat of a regular sauna, improving circulation and helping release toxins that contribute to the development of arthritis and/or worsening of its symptoms.
  
• Magnetic Therapy - Based on the theory that the body's self-healing properties depend on the proper electromagnetic balance, magnetic therapy is used to increase circulation and support the healing process.
  
• Massage Therapy - Massage therapy is designed to improve circulation, relieve stress and reduce symptoms by manipulating the soft tissues with motion, pressure and/or vibration.
  
• Osteopathy - A non-invasive form of treatment, osteopathy involves physical manipulation of the body to strengthen the musculoskeletal system and encourage the body's natural healing systems.
• Physical Therapy - Working closely with physicians, physical therapists employ a variety of techniques, including specially tailored exercises and the application of heat or cold to relieve symptoms and improve joint function.
• Reiki - A Japanese therapy for reducing stress, Reiki is a form of energy healing that involves the "laying of the hands" by the practitioner near the surface of the skin to improve the patient's energy system.
• Ultrasound - High-energy sound waves are directed into and around the area of the distressed joint to stimulate the flow of blood, and hence more nutrients, into the joint tissues.
  

Click here for more information on Alternative Therapies

Surgery for the Hand and Wrist**

Typically considered only after medicines, physical therapies and other options have been exhausted, surgery can be helpful in selected cases. Surgeries for arthritis of the foot include:

• Arthroscopic "clean up" - Distressed cartilage and abnormal bone growths are surgically removed to relieve symptoms and improve joint function. To reduce trauma and speed healing, the surgery can be performed arthroscopically, using narrow implements inserted into the joint through small incisions.
  
• Joint replacement - The damaged bones are removed and an artificial joint is inserted in order to relieve symptoms and improve joint function. Many, but not all, of the joints in the hand and wrist can be replaced. The concept is similar to hip replacement and knee replacement, but joint replacement in the hand is a newer technique and the long-term results are not clear.
• Joint fusion - Damaged bone surfaces are removed and certain bones are fused together to eliminate the pain. The downside is the joint can no longer bend or move.

NOTE: Surgery can be very helpful but is always risky, so you should discuss it very carefully with your physician before making a decision.

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