General Guideline Principles for Hand / Finger Osteoarthrosis
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Hand / Finger Osteoarthrosis.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Hand / Finger Osteoarthrosis of Hand, Wrist and Forearm Injuries

A history and physical exam are sufficient for the majority of cases, but x-rays are occasionally required. X-rays can be used to show how deeply involved something is.
However, x-rays may not show any disease in people with symptomatic osteoarthrosis or may show disease in people with asymptomatic osteoarthrosis.

Diagnostic Studies of Hand / Finger Osteoarthrosis

Diagnostic Studies of Hand / Finger Osteoarthrosis X-Rays

Diagnostic Studies of Hand / Finger Osteoarthrosis X-Rays to Evaluate Hand Osteoarthrosis are recommended in a small group of patients to establish conclusive proof of the severity of hand osteoarthrosis

Rationale for Recommendation – Most patients can be diagnosed and treated clinically without the need for x-rays. However, in some circumstances, x-rays are beneficial and might help with the condition’s diagnosis and treatment.

Medications of Hand / Finger Osteoarthrosis

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even though the majority of research indicates it is only marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective at treating pain as opioids, such as tramadol.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic upper Hand Osteoarthrosis Pain

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic upper Hand Osteoarthrosis Pain are recommended for the relief of hand osteoarthritis pain that is either acute, subacute, or chronic.

   Indications – NSAIDs are advised as a treatment for sudden, gradual, or persistent hand osteoarthritis pain. First, try over-the-counter (OTC) medications to see if they work.

   Frequency/Duration: Many Patients may find it reasonable to use as needed.

   Indications for Discontinuation: the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended for patients at high risk of gastrointestinal bleeding to take misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors concurrently.

   Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is planned. At-risk patients include those with a history of prior gastrointestinal bleeding, elderly, diabetics, and cigarette smokers.

   Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. There is not generally believed to be substantial differences in efficacy for prevention of gastrointestinal bleeding.

   Indications for Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDS for Patients at Risk for Cardiovascular Adverse Effects

   The advantages and disadvantages of NSAID therapy for pain should be discussed with patients who have a history of cardiovascular disease or who have multiple cardiovascular risk factors.

    

   • NSAIDS for Patients at Risk for Cardiovascular Adverse Effects

     NSAIDS for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

      

   • NSAIDS for Patients at Risk for Cardiovascular Adverse Effects

     NSAIDS for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in patients receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin

      

4. Acetaminophen for Treatment of Hand Osteoarthrosis Pain

   Acetaminophen for Treatment of Hand Osteoarthrosis Pain is recommended for the treatment of hand osteoarthritis pain, especially in patients who have NSAID contraindications.

   Indications: Acute, subacute, chronic, and post-operative hand osteoarthrosis pain in all patients.

   Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of hepatic toxicity.

   Indications for Discontinuation: relief from discomfort, negative effects, or intolerance

    

5. Topical NSAIDs of Hand / Finger Osteoarthrosis

   may reach therapeutically relevant tissue levels. When systemic administration is generally contraindicated (such as in patients with hypertension, cardiac failure, peptic ulcer disease, or renal insufficiency), the low level of systemic absorption can be advantageous overall by allowing the topical use of these medications.

    

6. Topical NSAIDs of Hand / Finger Osteoarthrosis

   Topical NSAIDs of Hand / Finger Osteoarthrosis are recommended to manage the pain brought on by hand osteoarthrosis.

   Indications – Hand osteoarthrosis can be mild, moderate, or severe.

   Frequency/Duration – See the manufacturer’s advice.

   Indications for Discontinuation – Resolution, intolerance, unfavourable outcomes, or a lack of advantages.

    

7. Opioids of Hand / Finger Osteoarthrosis

    

   • Opioids – Oral, Transdermal, and Parenteral (Includes Tramadol)

     Opioids – Oral, Transdermal, and Parenteral (Includes Tramadol) are not recommended for pain from hand/finger osteoarthrosis that is acute, subacute, or chronic.

      

   • Opioids – Oral, Transdermal, and Parenteral (Includes Tramadol)

     Opioids – Oral, Transdermal, and Parenteral (Includes Tramadol) are recommended for brief (no longer than seven days) use as an adjunctive therapy to more potent treatments in the management of postoperative pain.

     Indications: A brief prescription of opioids is frequently needed for post-operative pain management, especially at night, as an adjunct to more effective treatments (especially NSAIDs, acetaminophen).

     Frequency/Duration: As needed during the day, only at night later, and finally completely discontinued.

     Rationale for Recommendation: Some patients have insufficient pain relief

     Therefore, using opioids responsibly may be beneficial, especially for

     nighttime use. Opioids are advised for brief, selective use in postoperative patients, with nighttime use being the main recommendation for achieving postoperative sleep.

Complimentary / Alternative Therapies of Hand / Finger Osteoarthrosis

1. Complimentary/ Alternative Therapie

   Complimentary/ Alternative Therapies is not recommended Osteoarthrosis patients occasionally use glucosamine, chondroitin sulphate, methyl-sulfonyl methane, diacerein (diacerhein, diacetylrhein), harpagophytum, avocado soybean unsaponifiables, ginger, oral enzymes, and rose hips as complementary and alternative therapies.

    

2. Capsaicin

   Capsaicin is recommended for the treatment of acute osteoarthritis flare-ups or chronic hand osteoarthrosis.

   Indications – Pain or acute flare-ups from hand osteoarthrosis (rheumatoid arthritis patients were also included in the study).

   Frequency/Duration – Up to 4 times a day.

   Dose – See manufacturer’s recommendation

   Indications for Discontinuation –excessive skin burning or another intolerance Not advised for continuous use; rather, breaks from use have been advised.

Treatment of Hand / Finger Osteoarthrosis

Treatment of Hand / Finger Osteoarthrosis Splinting

Treatment of Hand / Finger Osteoarthrosis Splinting is recommended for sudden flares or long-term osteoarthrosis of the hands.

Indications: NSAIDs, acetaminophen, and/or topical medications are not sufficiently treating the symptoms of hand osteoarthrosis.

Injection Therapy of Hand / Finger Osteoarthrosis

1. Intraarticular Glucocorticosteroid Injections

   Intraarticular Glucocorticosteroid Injections is recommended for the treatment of subacute or chronic hand osteoarthrosis in a select group of patients.

   Indications – Moderate to severe hand osteoarthritis pain that NSAID(s), acetaminophen, and/or possible splinting and/or exercise cannot adequately control. Usually, the goal is to achieve enough relief to either resume medical management or postpone surgical intervention.

   Frequency/Duration – Instead of scheduling a series of three injections, just one should be done.

   Indications for Discontinuation – A repeat injection is an option for patients who respond with a few weeks of temporary partial pain relief that is pharmacologically appropriate but who later experience worsening pain and function. A second injection is not advised if the first one did not elicit a response.

   However, a second injection may be necessary if the doctor thinks the medication was not administered properly and/or if the underlying condition is so severe that one steroid bolus cannot be expected to adequately treat it. Beyond three injections per year, benefits are thought to be minimal.

   Rationale for Recommendations – A short to intermediate intervention with a three-month benefit is intraarticular glucocorticosteroid injections. They are suggested as a treatment option for people with hand OA, particularly when NSAID trials or other non-operative interventions have yielded insufficient results.

    

2. Intraarticular Hyaluronate Injection

   Intraarticular Hyaluronate Injection is recommended when other treatments have failed to treat subacute or chronic hand osteoarthrosis in a small number of patients.

   Indications –Pain from hand osteoarthritis that is difficult to manage with NSAIDs, acetaminophen, and perhaps splinting and/or exercise. Its typical goal is to achieve enough relief to either resume medical management or postpone surgical intervention.

   Dose/Frequency – See the manufacturer’s suggestions.

   Indications for Discontinuation – enough comfort to avoid the need for additional injections, failing to get better, or experiencing allergic reactions.

    

3. Prolotherapy Injections

   Prolotherapy Injections is not recommended for the use of prolotherapy injections for treatment of subacute or chronic hand osteoarthrosis.

Rehabilitation of Hand / Finger Osteoarthrosis

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to make an internal effort to finish a particular a task or exercise. The interventions known as passive therapy don’t require any effort. Rather, they depend on the modalities that are used, not on the patient’s effort by a counsellor.

Passive interventions are typically seen as a way to facilitate advancement in a therapy programme with active participation and concurrent achievement of the goal gains in functionality Active rather than passive interventions should be prioritised.

To extend the therapeutic process and maintain improvement levels, the patient should be advised to continue both active and passive therapies at home.

To facilitate functional gains, assistive devices may be used as an adjunctive measure in the rehabilitation plan.

Therapy – Active of Hand / Finger Osteoarthrosis

Therapeutic Exercise

Therapeutic Exercise is recommended to treat severe flare-ups or long-term hand osteoarthrosis.

Frequency/Dose/Duration –With documentation of ongoing objective functional improvement, the total number of visits may be as low as two to three for patients with mild functional deficits or as high as 12 to 15 for those with more severe deficits.

If there is evidence of functional improvement toward specific objective functional goals (e.g., increased grip strength, key pinch strength, range of motion, or improving ability to perform work activities), more than 12 to 15 visits may be necessary to address persistent functional deficits. A home exercise programme should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Therapy – Passive of Hand / Finger Osteoarthrosis

1. Self-Application of Ice

   Self-Application of Ice is recommended for chronic hand osteoarthrosis.

    

2. Self-Application of Heat

   Self-Application of Heat is recommended for severe flares or long-term osteoarthrosis of the hands.

   Indications – NSAIDs, acetaminophen, and/or topical medications are insufficiently used to treat the symptoms of hand osteoarthrosis.

   Frequency/Dose – applying heat to oneself, usually for 15 to 20 minutes, three to five times per day.

    

3. Low-level laser therapy

   Low-level laser therapy is not recommended in order to treat hand osteoarthrosis.

Surgery of Hand / Finger Osteoarthrosis

Patients with hand osteoarthrosis can receive treatment through a variety of surgical techniques. These include arthroplasty, arthrodesis, and other reconstructive procedures.

1. Reconstructive Surgery

   Reconstructive Surgery is recommended to treat a small number of people with trapeziometacarpal arthritis

    

2. Trapeziectomy

   Trapeziectomy is recommended to treat osteoarthritis of the CMC joint of the thumb. Th

    

3. Fusion

   Fusion is recommended for the treatment of selected hand osteoarthritis patients

   Reason for Recommendation: Joint fusion is typically beneficial for individuals under the age of 40 who have osteoarthrosis that is highly symptomatic and who engage in strenuous work activities but who do not receive enough relief from previous therapies.

    

4. Hardware Removal

   Hardware Removal is recommended When certain types of hardware are implanted, it is recommended that the hardware be removed later, depending on the doctor’s and the patient’s preferences.

   Indications: Indications: in situations where there is 1) protruding hardware, 2) pain associated with the hardware, 3) broken hardware on imaging, and/or 4) a positive anaesthetic injection reaction, as per the doctor’s or patient’s option.

What our office can do if you have Hand / Finger Osteoarthrosis

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.