Hand and Upper Extremity
SR: Efficacy and Safety of Non-Pharmacological, Pharmacological, and Surgical Treatments for Hand Osteoarthritis
16 Jan, 2025 | 10:54h | UTCBackground: Hand osteoarthritis (OA) affects a substantial proportion of older adults, contributing to pain, reduced grip strength, and functional limitations. While several clinical guidelines recommend patient education, exercise, and topical or oral non-steroidal anti-inflammatory drugs (NSAIDs), the level of evidence remains varied. In 2018, a systematic review identified efficacy data from 126 studies. This updated review includes 65 new randomized controlled trials (RCTs) published through December 2023, aiming to provide the most current evidence on hand OA treatments.
Objective: To summarize and evaluate the efficacy and safety of non-pharmacological, pharmacological, and surgical interventions for hand OA, highlighting both short-term (<3 months) and long-term (≥3 months) outcomes for pain, function, and grip strength.
Methods: The authors searched PubMed/MEDLINE, Embase, and Cochrane CENTRAL for RCTs published from June 2017 to December 2023. Risk of bias was assessed using the RoB2 tool, and certainty of evidence was evaluated with GRADE criteria. Interventions included hand exercises, orthoses, assistive devices, thermal modalities, pharmacologic therapies (e.g., oral/topical NSAIDs, glucocorticoids, disease-modifying anti-rheumatic drugs), and various surgical techniques. Meta-analyses were conducted when appropriate, and outcomes were expressed as standardized mean differences or relative risks with 95% confidence intervals.
Results:
- Non-Pharmacological Interventions: Low- to moderate-certainty evidence supports hand exercises, thumb orthoses, and assistive devices for improving pain and function. Hand exercises showed a small long-term effect on pain, while thumb orthoses offered a moderate long-term effect on pain. Assistive devices demonstrated a moderate long-term benefit for function. Few mild adverse events were reported in these categories.
- Pharmacological Interventions: There is high-certainty evidence for a very small short-term functional improvement with topical NSAIDs and low-certainty evidence of moderate short-term pain relief with oral NSAIDs. Oral glucocorticoids likely yield a small, short-term functional benefit. Methotrexate showed a possible small long-term effect on pain but no clear impact on function. No new data support intra-articular steroid injections, hydroxychloroquine, or biologic DMARDs for meaningful improvements; in these trials, sponsor bias and cost considerations underscore the need for critical appraisal, given the typically higher expense of advanced agents like biologics.
- Surgical Interventions: Ten new studies compared various surgical techniques but did not include robust controls versus nonsurgical management or sham surgery. Heterogeneity precluded pooling of results, and no definitive superiority emerged for any particular procedure.
Conclusions: This systematic review reaffirms the central role of non-pharmacological interventions, especially exercise, orthoses, and assistive devices, for improving pain and function in hand OA with minimal adverse events. Pharmacological treatments offer modest short-term benefits, particularly oral NSAIDs, although cost, side-effect profiles, and real-world adherence should be considered. Surgical approaches lack high-quality comparative data, highlighting the need for well-designed trials.
Implications for Practice: Clinicians should prioritize patient education, exercises, and readily accessible interventions (e.g., orthoses, assistive devices) given their demonstrated safety and moderate efficacy. Oral or topical NSAIDs remain suitable options for acute pain management, with the understanding that longer-term use warrants caution due to possible adverse effects. In contexts where advanced pharmacologic agents (such as biologics) are evaluated, practitioners must scrutinize costs, potential sponsor influence, and marginal benefits relative to standard care.
Study Strengths and Limitations: Strengths of this review include a comprehensive literature search, systematic appraisal of risk of bias, and application of GRADE to gauge certainty. However, most RCTs were small in size or had high or unclear risk of bias, and considerable heterogeneity in study designs reduced comparability. Additional limitations include the scarcity of direct comparisons for surgical versus non-surgical approaches and inconsistent reporting of adverse events.
Future Research: High-quality, larger-scale RCTs are needed to clarify subtypes of hand OA and tailor treatments accordingly. Trials should evaluate long-term outcomes, systematically measure adverse events, and compare surgery directly with non-surgical options. Studies employing mobile health (mHealth) tools and addressing ways to enhance grip strength may further advance evidence-based hand OA management.
Reference:
Kjeken I, Bordvik DH, Osteras N, Haugen IK, Fjeldstad KAA, Skaalvik I, Kloppenburg M, Kroon FPB, Tveter AT, Smedslund G. Efficacy and safety of non-pharmacological, pharmacological and surgical treatments for hand osteoarthritis in 2024: a systematic review. RMD Open. 2024; e004963. DOI: https://doi.org/10.1136/rmdopen-2024-004963
Postoperative ulnar neuropathy: a systematic review of evidence with narrative synthesis
25 May, 2023 | 11:16h | UTC
RCT | Colchicine ineffective for pain relief in hand osteoarthritis patients
16 May, 2023 | 14:42h | UTCColchicine twice a day for hand osteoarthritis (COLOR): a double-blind, randomised, placebo-controlled trial – The Lancet Rheumatology (link to abstract – $ for full-text)
Commentary: Colchicine Does Not Relieve OA-Related Hand Pain Compared With Placebo – DocWireNews
Commentary on Twitter
NEW RESEARCH—@AnnaDossing and colleagues report the results of the COLOR trial; #colchicine twice a day did not relieve #pain vs placebo in people with hand #osteoarthritis https://t.co/LfKTwVONGM pic.twitter.com/jTBh076LZ6
— The Lancet Rheumatology (@TheLancetRheum) April 5, 2023
RCT | Effectiveness of nail bed repair in children with vs. without replacing the fingernail
4 Apr, 2023 | 13:33h | UTCNews Release: New approach to nail bed injury surgery could significantly cut NHS costs – University of Oxford
SR | Local corticosteroid injection versus placebo for carpal tunnel syndrome
29 Mar, 2023 | 13:00h | UTCLocal corticosteroid injection versus placebo for carpal tunnel syndrome – Cochrane Library
Summary: Local steroid injection for carpal tunnel syndrome – Cochrane Library
Commentary on Twitter
https://twitter.com/CochraneUK/status/1621853332003344385
SR | Splinting for carpal tunnel syndrome
17 Mar, 2023 | 12:57h | UTCSplinting for carpal tunnel syndrome – Cochrane Library
Summary: Splinting for carpal tunnel syndrome – Cochrane Library
M-A | Above elbow vs. below elbow immobilization for conservative treatment of distal end radius fracture in adults
7 Feb, 2023 | 13:49h | UTC
SR | Bioengineered nerve conduits and wraps for peripheral nerve repair of the upper limb
2 Feb, 2023 | 14:41h | UTCSummary: Use of nerve repair devices in the arm, forearm, and hand – Cochrane Library
RCT | Nonoperative vs. operative treatment for displaced finger metacarpal shaft fractures
9 Jan, 2023 | 13:58h | UTC
Pictorial Review | Nerve entrapment syndromes of the upper limb.
15 Dec, 2022 | 13:25h | UTCNerve entrapment syndromes of the upper limb: a pictorial review – Insights into Imaging
Guideline | Lateral elbow pain and muscle function impairments.
5 Dec, 2022 | 00:15h | UTC
M-A | Collagenase clostridium histolyticum injections vs. percutaneous needle fasciotomy vs. limited fasciectomy in the Dupuytren’s contracture.
1 Nov, 2022 | 12:05h | UTC
Randomized controlled trials in hand surgery: a scoping review.
13 Oct, 2022 | 13:32h | UTCRandomised controlled trials in hand surgery: a scoping review – BMJ Open
Management of hand osteoarthritis: from an US evidence-based medicine guideline to a European patient-centric approach.
24 Aug, 2022 | 14:09h | UTCRelated:
Erosive hand osteoarthritis: latest findings and outlook – Nature Reviews Rheumatology
ACR Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee
Research: Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis
M-A of RCTs | Efficacy of corticosteroids for hand osteoarthritis.
18 Jul, 2022 | 11:07h | UTC
RCT | Immobilization of torus fractures of the wrist in children.
4 Jul, 2022 | 12:46h | UTC
Commentary from the author on Twitter (thread – click for more)
The FORCE study is in @TheLancet – https://t.co/oyYvMMxjln has awesome stuff to implement result – ED pathway, animations & patient info leaflets (multiple languages).
Thanks to @PERUKItweep and everyone who made it possible. https://t.co/Wq67MgcQhB pic.twitter.com/mrA03tGzCs
— Dan Perry (@MrDanPerry) July 1, 2022
Review: Common hand conditions.
29 Jun, 2022 | 11:57h | UTCCommon Hand Conditions: A Review – JAMA (free for a limited period)
Audio Clinical Review: Diagnosis and Treatment of Common Hand Conditions
Long-term follow-up of a RCT: Plating vs. closed reduction for fractures in the distal radius in older patients.
28 Jun, 2022 | 10:42h | UTCPlating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Secondary Analysis of a Randomized Clinical Trial – JAMA Surgery (link to abstract – $ for full-text)
Commentary: Surgery No Better for Wrist Fracture in Older Adults – HealthDay
Original Study: Surgical Plating vs Closed Reduction for Fractures in the Distal Radius in Older Patients: A Randomized Clinical Trial – JAMA Surgery
Commentary on Twitter
In this study, in patients 60 years and older, surgical treatment with volar-locking plates did not provide any important functional advantages over nonsurgical treatment at 12 and 24 months. https://t.co/KdNibc6SxK pic.twitter.com/T57XsKYUyZ
— JAMA Surgery (@JAMASurgery) April 27, 2022
Systematic Review: Interventions for treating supracondylar elbow fractures in children.
10 Jun, 2022 | 11:07h | UTCInterventions for treating supracondylar elbow fractures in children – Cochrane Library
Podcast: Hand and wrist pain.
8 Jun, 2022 | 10:44h | UTC#339 Hand and Wrist Pain with Dr. Ted Parks – The Curbsiders
International consensus meeting on venous thromboembolism in orthopedic surgery.
28 Mar, 2022 | 09:45h | UTCHomepage: International Consensus Meeting on Venous Thromboembolism (free articles for a limited period)
Recommendations from the ICM-VTE: General
Recommendations from the ICM-VTE:: Foot & Ankle
Recommendations from the ICM-VTE: Hand & Wrist
Recommendations from the ICM-VTE: Hip & Knee
Recommendations from the ICM-VTE: Oncology
Recommendations from the ICM-VTE: Pediatric
Recommendations from the ICM-VTE: Shoulder & Elbow
Recommendations from the ICM-VTE: Sports
Recommendations from the ICM-VTE: Trauma
Recommendations from the ICM-VTE: Spine
Case Report: “Popeye deformity” associated with proximal biceps tendon rupture.
15 Mar, 2022 | 08:25h | UTC
Erosive hand osteoarthritis: latest findings and outlook.
3 Mar, 2022 | 08:01h | UTCErosive hand osteoarthritis: latest findings and outlook – Nature Reviews Rheumatology (if the link is paywalled, try this one)
Commentary on Twitter
#MarchIssue | Read our #Review on the clinical features and risk factors of erosive hand #osteoarthritis (an aggressive condition with poor outcomes), and progress in biomarkers, imaging, classification and treatmenthttps://t.co/GSvgnXYYPS pic.twitter.com/PSzeucO0cH
— NatRevRheumatol (@NatRevRheumatol) February 28, 2022
Dupuytren’s Disease—etiology and treatment.
17 Feb, 2022 | 08:25h | UTCDupuytren’s Disease—Etiology and Treatment – Deutsches Ärzteblatt International
RCT: Metal pins no better than traditional plaster cast for a broken wrist.
21 Jan, 2022 | 09:51h | UTCNews Release: Metal pins no better than traditional plaster cast for a broken wrist – BMJ
Original Study: Surgical fixation with K-wires versus casting in adults with fracture of distal radius: DRAFFT2 multicentre randomised clinical trial – The BMJ
Commentary: Wrist fractures: study compares casting to surgical fixation – MedicalResearch.com
Commentary on Twitter
Fascinating to read the results of #DRAFFT2 in the BMJ. Lots to think about: No difference in wrist function at 12 months but higher reoperation rate for loss of position in cast-only group (13% v 0.4%) #orthotwitter https://t.co/QJO43XBdB6 pic.twitter.com/IMCpcsoiSh
— Tom Lewis (@thomasllewis) January 20, 2022