BLOG

cold-hands.jpg
30/Jul/2020

….your hands!

Did you know that each of your hands has 27 bones, 27 joints, 34 muscles, and over 100 ligaments and tendons?

They really are amazing, complex and delicate structures. And we often take them for granted – until something happens – we hit our thumb with a hammer, we slam a finger in a drawer or we develop a musculoskeletal condition 😣.

Many conditions such as osteoarthritis and rheumatoid arthritis cause pain, swelling and sometimes disfigurement in hands. Other conditions such as Raynaud’s phenomenon and carpal tunnel syndrome can make your hands painful, and can cause pins and needles, as well as numbness.

For many people who have hand conditions, the colder months can make it worse. Your joints may ache more because of the cold, the constant hand washing can make your skin dry and the use of hand sanitiser (which often has a cooling effect) makes it feel like your fingers are about to drop off 😒.

But there are things you can do to decrease hand pain, deal with the cold and COVID, and make everyday activities easier.

Look after your hands. Inspect them for things such as swelling, nail and skin changes and any changes to the joint shape or direction of fingers and/or thumbs. By being aware of our hands and any changes that occur, you can seek advice sooner and prevent things from getting worse..

Wash and dry your hands regularly and thoroughly. Just as washing with soap and water for at least 20 seconds is necessary to help prevent the spread of germs (including SARS-CoV-2), drying your hands thoroughly is also important. Germs love moisture and thrive in moist places. Drying your hands reduces your chances of spreading or picking up germs when you touch things with damp or wet hands.

Apply a moisturising hand cream regularly to keep your skin healthy and nourished. With our more frequent hand washing and use of hand sanitiser, it’s easy for our hands to become dry and cracked. Cracked skin is an opening for germs to get in and potentially cause an infection. And if you have a condition such as scleroderma or psoriatic arthritis, skin care is an important part of your overall management plan. You may need to use a medicated skin cream, rather than an over-the-counter product. Talk with your doctor or pharmacist for more info.

Use assistive devices if your hands are painful and stiff. They can help if you have difficulty gripping or holding everyday items. Assistive devices such as jar openers, book holders, tap turners, button hook and zipper aids and easy grip utensils can make tasks easier by reducing joint stress and eliminating tight grasps. You may need to speak with an occupational therapist about what equipment is best suited to you. Also check out our online shop. We have some products available to help you with your everyday activities.

See a hand therapist if you have hand/wrist pain or a condition that affects your hands, especially if it’s causing you issues with your day to day activities. Hand therapists are occupational therapists or physiotherapists that have undergone advanced training to become experts in the assessment, diagnosis and treatment of upper limb problems (shoulder to hand). They can provide advice on joint protection and energy conservation (e.g. splints) as well as recommendations for adaptive devices/equipment to improve hand function.

Splints and other supports may be an option. They can give support to a painful joint by providing mild compression, warmth and/or joint protection. There are two main types of hand or wrist splints – resting splints and working splints. The choice of splint will depend on your condition and your current needs. Splints need to fit your hand comfortably and correctly, so speak with a hand therapist about what’s best for you and how often you should wear them.

Exercise your hands, as well as the rest of your body. Regular hand exercises can reduce stiffness and support your joints by keeping your muscles strong. If you’re considering hand exercises, it’s best to get advice from a hand therapist or other specialist as to which exercises are most suitable for you. Exercises should be mild and should not cause you additional pain when you’re doing them. See our Hand information sheet for some basic range of motion exercises.

Wear gloves in the cold weather, especially if you have Raynaud’s phenomenon. Hand warmers are also helpful. If you’re going to the shops for supplies and you have to use hand sanitiser before you enter, be aware that many of them have a cooling effect. This can really aggravate your condition. Having a couple of hand warmers in your pockets can help. You can get disposable hand warmers, or reusable ones. Just remember if you use the reusable ones to thoroughly wash the fabric pouch it’s contained in between uses. They can easily become contaminated, and hygiene is everything during this pandemic.

Also wear gloves when you’re gardening, washing dishes or doing any tasks that have the potential for your hands to get dirty or damaged.

Medications may provide some temporary pain relief, depending on the underlying condition causing the problem in your hand/s. Your doctor may suggest analgesics (pain relievers like paracetamol) as well as nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen. A cortisone injection is generally not recommended for osteoarthritis of the hand, but may be used for rheumatoid arthritis or acute attacks of gout. In conditions such as rheumatoid arthritis you may also be taking disease modifying anti-rheumatic drugs (DMARDs). It’s important to take these medications as prescribed by your doctor.

With conditions such as Raynaud’s, if simple measures like keeping your hands warm hasn’t helped, you may need to be prescribed medications that widen your blood vessels and improve circulation. Talk with your doctor for more info.

Making life easier on your hands

Sometimes simply changing the way you do everyday tasks can reduce pain and protect your joints. You can make life easier on your hands by considering the following:

Listen to your body – pain can serve as a warning sign that your joints are being overworked. Try to find a balance between activity and rest by pacing yourself. Take regular breaks when completing tasks and try not to overdo it on a good day. You might like to try heat or cold packs to help relieve pain. Some people also like to soak their hands in warm water or wrap their hands around a warm mug of tea.

Try to avoid using a tight grip for long periods. For example:

  • use foam or sponge to increase the grip size of handles on cutlery, pens and other hand held devices
  • use assistive devices with thick rubber grip handles (e.g. key turners, jar openers)
  • use rubber squares and gloves to help improve grip
  • consider lever handles around your home to minimise any twisting forces (e.g. mixer taps in bathrooms/kitchens).

Avoid repetitive movements. For example:

  • prolonged typing, pruning and power tool usage particularly those that vibrate
  • when gardening ensure your tools are sharpened and well maintained for ease of use
  • if you can’t avoid these repetitive movements, make sure you take regular breaks.

Try to use your body’s larger joints and muscles when you can. For example:

  • use your forearms to carry bags instead of your hands
  • when carrying items hold them closer to your body
  • when lifting heavier items squat and use your thigh muscles.

Spread the load – try to spread the load of an object over more than one joint. For example:

  • when picking up objects use two hands
  • slide sheets and swivel pads can help move items with less strain
  • divide shopping into smaller bags and try using a backpack and/or trolley.

Find an alternative. For example:

  • buy pre-cut meat and vegetables instead of trying to cut them up yourself
  • use electrical items instead of manual (e.g. can openers and graters)
  • look for items that are easier to use (e.g. push on pegs)
  • keep a pair of scissors handy to open packaging.

Rethink personal care/hygiene – for people with decreased hand function or fine motor skills, everyday tasks such as showering and toileting can be quite challenging. To make things easier you could use:

  • a bidet to help with cleaning difficult to reach areas
  • baby wipes/moist towelettes instead of toilet paper (but remember that they’re not flushable)
  • toilet paper tongs/aids to help with grip
  • soap dispensers instead of a bar of soap
  • items to make dressing easier e.g. sock sliders, elastic shoe laces, button hole hooks/zip pullers, front fastening bras as well as dressing aids for coats and cardigans o shoes with velcro fasteners instead of laces.

Our hands are complicated and important and we depend on them more than we realise. Painful hands can often be managed with simple self-care strategies, however if your hands are causing you a lot of grief, and affecting your day to day functioning, talk with your doctor for information and support.

Contact our free national Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore


gumboots.jpg
30/Jul/2020

Looking after your feet

Our feet are amazing ‘feats’ of engineering (sorry, I just couldn’t resist that one 😁).

Each foot has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. They support us through thick and thin – whether we’re walking, running, jumping, dancing, skipping or hopping. We cram them into ill-fitting shoes, torture them in high heels and stub them against the bedside table in the middle of the night (or is that just me?).

As well as the many injuries and calamities that befall our feet, many musculoskeletal conditions, such as osteoarthritis, rheumatoid arthritis and gout can affect the feet.

They’re the unsung heroes of this pandemic as we hit the streets, parks and trails for exercise. Walking has become the exercise of choice for people at the moment. Many of us can’t – or don’t feel safe to – return to gyms or exercises classes. And lots of people are walking instead of catching public transport to avoid being in close contact with others. As a result we’re all walking many more steps than we did pre-COVID.

So we need to stop taking our feet for granted. We need to look after them so we can continue to do the things we want and need to do as pain-free as possible.

So what can we do?

Give your feet the TLC they deserve. It’s really important to look after your feet. Wash and dry them regularly. Inspect them for anything unusual such as cuts, blisters, changes to the nails and skin. By being aware of your feet and any changes that occur, you can seek advice sooner. And if they’re sore after a day of walking, maybe give them a warm soak in the bath, or in a bucket or a foot spa (if you have one) while you watch TV. Then dry them thoroughly and rub a moisturising foot cream into your skin. Take your time and give your feet a nice massage. Better yet, see if you can talk someone else into giving them a massage while you relax on the couch 😉

Manage your condition. If you have a musculoskeletal condition that affects your feet, it’s important that you work with your doctor and healthcare team to look after your feet and manage your condition effectively. The treatments used for foot conditions will vary from person to person, depending on your condition and how it’s affecting you. And this may change over time as your condition and your feet change.

See a podiatrist. If you have foot pain, or a condition that affects your feet, visit a podiatrist. They’re feet experts and can assess, diagnose and treat foot and lower limb problem, including skin and nail problems, foot and ankle injuries, foot complications related to medical conditions and problems with your gait or walking. Podiatrists can also give you advice on appropriate footwear, and can prescribe custom foot orthotics.

Consider orthotics. Orthotics are corrective insoles that can help alleviate pain by redistributing pressure away from the painful area and support your arches. You can buy off-the-shelf orthotics or you can have orthotics made that are specifically fitted to your feet by a podiatrist.

Fit your feet with appropriate footwear. With our worlds turned upside down due to COVID, and many of us having to stay home, it’s tempting to stay in our slippers all day. There’s something so comforting about warm, fluffy slippers 😁. However our feet and ankles need proper support. Wear the right footwear for whatever you’re doing. Going for a walk? Put on your sneakers. Working at home? Wear your casual shoes/boots that support your feet and keep you warm. And lounging around in the evening? Get those slippers on.

If you’re buying new shoes, make sure they fit properly, support your feet and are comfortable. Look for shoes that are light, flexible at the toe joints and are hard wearing. Shoes made of leather are preferable over synthetic materials as they breathe better. Avoid slip-on shoes and if laces are difficult to fasten due to arthritis in your hands, Velcro or elastic laces may be an option.

Let them breathe. Did you know you have about 250,000 sweat glands in each foot? That’s a lot of sweat! So let your feet breathe to avoid smelly feet and fungal infections. Change your socks and shoes at least once a day. Wear shoes that allow air flow around your feet: leather, canvas, and mesh are good options, avoid nylon and plastic. And avoid wearing the same shoes two days in a row. Give your shoes time (at least a day) to dry and air out. And if the weather’s warm, set your feet free and let them go au naturale. There’s nothing better than walking barefoot on warm grass on a sunny day 🙂

Exercise your feet. I’m not talking about walking here…but other exercises that keep your joints moving. Try non-weight-bearing exercises such as swimming, especially if you have foot pain, as they take the pressure away from the painful areas. You can also do exercises while sitting in a chair. NHS Inform (Scotland) has some foot exercise videos you can try. If you want exercises tailored specifically for you, visit a podiatrist or physiotherapist.

Medications might help. If you’re having a lot of foot pain, speak with your doctor about whether medications may be an option. Depending on the underlying condition causing the problem, your doctor may prescribe a short-term course of pain relievers or anti-inflammatory medications, or they may prescribe other medications, such as a cortisone injection into a joint for rheumatoid arthritis or medication for acute attacks of gout.

Diabetes and feet. Many people with musculoskeletal conditions also have diabetes. So it’s really important if you have diabetes that you take care of your feet every day because of the increased risk of developing nerve damage, ulcers and infections. Talk with doctor about how to look after your feet properly if you have diabetes.

Surgery may be required. For some people, surgery may be needed if other conservative treatments haven’t helped. A referral to an orthopaedic surgeon who specialises in feet is usually required.

Contact our free national Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore


glucosamine_small-min.jpg
12/Feb/2020

The jury is no longer out – the evidence is in

For many years, glucosamine has been one of the most commonly used supplements for osteoarthritis (OA). And even though the jury has been out on how well it works, it has been considered safe to use.

When it comes to glucosamine, there’s been a lot of conflicting research with some studies showing positive results and some showing no effect. To add to the confusion, studies have used different preparations of glucosamine – for example glucosamine sulfate, glucosamine hydrochloride, glucosamine sulfate with chondroitin etcetera – and different dosages. Which makes it difficult to determine how effective glucosamine really is for treating the symptoms of OA.

Until recently, despite the evidence indicating that glucosamine has little, if any benefit for people with OA, it’s been seen to be relatively safe for most people.

Now, a recent study has raised some serious concerns about the side effects of glucosamine for people with shellfish allergy.

What is glucosamine?

At the ends of most of our bones we have a slippery cushion called cartilage. It absorbs shocks and helps our joints move smoothly. Glucosamine is a naturally occurring substance found in our cartilage.

For people who have osteoarthritis, this cushiony cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float around inside the joint causing inflammation and pain. The cartilage no longer has a smooth, even surface, so the joint becomes stiff and painful to move.

Treating osteoarthritis

Until recently, treatments for OA have focused on managing the symptoms – controlling pain and reducing inflammation. Medications included analgesics – e.g. paracetamol – and anti-inflammatories – e.g. ibuprofen (*see note). Along with exercise and weight management, these were the mainstays of osteoarthritis treatment. There has been no silver bullet or treatment that worked quickly and effectively.

So when glucosamine first came on the market, with positive reviews, many people were excited at the prospect of this new, ‘natural’ treatment and began taking glucosamine regularly. Glucosamine seemed to provide pain relief for many people with osteoarthritis and improve their joint function.

However over the years as more research has taken place, the evidence for the use of glucosamine has come under more and more scrutiny. Earlier, positive research was mostly funded by pharmaceutical industry, and later research, that showed glucosamine provided limited improvements, was publicly funded. This called into question the potential for bias in the earlier reporting of the benefits of glucosamine.

The peak bodies respond

Based on recent independent evidence, the American College of Rheumatology (ACR) and the Australian Rheumatology Association (ARA) have both responded publicly.

In their latest guidelines for treating OA, the ACR “strongly recommend against” using glucosamine for osteoarthritis. And the ARA has stated that this new information highlights growing evidence that glucosamine doesn’t help people with OA and it‘s a reminder that people with a shellfish allergy shouldn’t take glucosamine.

Safety concerns

It’s been known for some time that glucosamine can interact with blood thinners such as warfarin, and that it may raise blood sugar levels in people with diabetes. Glucosamine may also have a negative effect on cholesterol and chemotherapy drugs and has been linked to worsening asthma

However it’s not been widely known to the general public that many glucosamine supplements are made from shellfish and can cause serious allergic reactions.

Recent research from the University of Adelaide investigated “spontaneous adverse drug reactions [or side effects]…to glucosamine and chondroitin in the Australian population between 2000 and 2011, with a primary focus on hypersensitivity reactions.”

They found that during that period, the Therapeutic Goods Administration (TGA) was notified of 366 recorded adverse reactions. This is more than the combined adverse reactions of other supplements such as echinacea, valerian, black cohosh, ginkgo and St John’s wort. However, hundreds of thousands of people also took glucosamine during that time with no ill effects, highlighting that the risk of a severe reaction was still very low.

A major issue raised is the labelling of glucosamine. Labelling must report that it contains seafood, but not specifically shellfish. And this information is often in small writing. So people who are aware that they have a shellfish allergy may not realise that they’re taking something that’s harmful to them.

In 2016, the TGA changed the rules for this, and required manufacturers to be clear if products contain shellfish. And this information must be easy for consumers to find. However they also gave manufactures until August 2020 to do this. So many products publicly available may still not may it clear to consumers if the product contains shellfish.

So what should you do if you currently take glucosamine?

  • If you have a shellfish allergy stop taking glucosamine immediately and discuss with your doctor.
  • If you have taken glucosamine for some time and haven’t had any negative side effects, and want to continue taking it, then you can do so under the advice of your doctor.
  • Talk to your pharmacist about any potential interactions with other medicines you may be taking.
  • Talk with your doctor about other treatment options – including exercise, weight management, pain management techniques.
  • Call our MSK Help Line weekdays on 1800 263 265 or email helpline@msk.org.au and talk with our nurses about OA and ways you can manage it without glucosamine.
  • Stay up-to-date. As well as being painful, living with a chronic musculoskeletal condition can be confusing and frustrating, especially with so much conflicting information circulating through the news, social media, and our network of family, friends and acquaintances. Follow us on Facebook and sign up for our eNewsletter to stay informed about the latest information, research, events and much more.

* Note

We now know that these medications provide very little benefit for managing the ongoing symptoms of OA. Currently the best evidence is for weight management (maintaining a healthy weight or losing weight if you’re overweight) and exercise. Treatments such as massage, heat and the short term use of anti-inflammatories may provide temporary relief, but the evidence is not as strong.

References




Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

Useful Links


Key Conditions

Copyright by Musculoskeletal Australia 2020. All rights reserved

ABN: 26 811 336 442ACN: 607 996 921