Getting a Grip on Hand Problems: Carpal Tunnel, Arthritis : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

A general practitioner can treat these disorders, in most patients, with either exercise, rest, aspirin, or NSAIDs, such as Motrin or Naprosyn. But if relief does not occur within a few weeks, the physician may refer the patient to a specialist.

Occupational therapists can also help patients with these disorders to practice "joint protection," according to Jan Chmela, director of Sheltering Arms Day Rehabilitation Program in Richmond, Va.

Chmela, herself an occupational therapist, said that patients can learn to use their hands in "non-deforming positions." For example, instead of grabbing a key with a thumb and twisting, patients can learn to turn a key with adaptive equipment. They can learn to use their largest joints for a job, rather than their smaller, more vulnerable ones, for opening a jar, for example. She advocates teaching patients to use their hands closest to their anatomical position, outstretched as much as possible instead of twisting and turning them, because bending the hands stresses the joints.

As with most other disorders, however, prevention, where possible, is the best cure.

The National Institute for Occupational Safety and Health is focusing research on ways to redesign the workplace to make RSIs less likely.

The agency's McGlothlin said, "We don't want to try and fit the worker to the job, but the job to the worker, and that can best be done through engineering controls so that both the worker and the company benefit."

For instance, he suggests adjustable-height tables to accommodate workers of different heights and builds. McGlothlin also stressed that employers must be sensitive to the extreme demands on many of their workers and allow for recovery time.

"There are more and more demands on people these days. Many work two jobs or through the night. Women in the workplace may also be raising families. Employees need time off to rest. In order for ideas that we've developed to succeed, there has to be a partnership between workers and their companies to make it a more productive and helpful workplace," he said.

Employers can also cut down on RSIs by providing their workers with chairs that give them better postural support and adjustable work stations that allow them to adjust their screen, keyboard and wrists.

Diagnosis Important

Forty-three-year-old Barbara McGhee, a public affairs specialist at a Virginia Department of Health and Human Services Social Security Administration office, was diagnosed with rheumatoid arthritis at age 19.

Over the years, her hand joints have become rigid and misshapen by chronic inflammation. Her hand dexterity is poor — just shuffling through the pages of a book is difficult.

When McGhee first heard the diagnosis, she said she refused to despair. "I went to the library and learned all I could about it." Because unrealistic expectations only make it that much harder on patients, McGhee said she "needed information so I could make some important decisions. I needed to learn what I would and would not be able to do."

"I realized my attribute was my high energy level and if I cultivated it, I could put it to good use." Twenty-four years later, she is unable to waterski or horseback ride or participate in other sports she used to adore, but she has nevertheless found her niche. McGhee not only holds down a full-time job, but also volunteers for her local chapter of the Arthritis Foundation and the Richmond Mayor's Commission for Disabilities.

McGhee said she only wishes that she hadn't waited five years from the onset of her problems to seek the help of a physician. She said she wonders if she had paid attention to her condition earlier whether she could have avoided having one wrist and one ankle replaced, and the other ankle fused.

Because aches and pains are commonplace, people with early morning stiffness, difficulty in movement, or tenderness in one or more joints sometimes do not realize that they may need to see a doctor.

But it's important that people whose symptoms last longer than several weeks see their physician immediately. For example, in some cases of moderate to severe carpal tunnel syndrome, early treatment can prevent significant permanent damage to nerves.

Hayes Willis, assistant professor of medicine, division of rheumatology, allergy and immunology at the Medical College of Virginia, explained that, "damaged nerves just don't heal well."

He added that for both arthritis and RSIs, the earlier a diagnosis is made, the greater the likelihood of minimizing disability.

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