The Hand to Shoulder Solution
Your new resource for hand, shoulder, and elbow pain. Together, we are giving pain the middle finger and gaining knowledge to live a better, pain-free life!
Discover what might be causing pain in your fingers, pain in your hand, pain in your wrist, pain in your arm, pain in your elbow, pain in your shoulder.
Learn about your body, arthritis, tendinitis, tennis elbow, fractures, golfer's elbow, and carpal tunnel syndrome.
Hosted by Carl Petitto, OT, CHT, and Certified Hand Therapist specializing in orthopedic conditions of the hand to shoulder. Also an expert in fabricating custom orthotics.
The Hand to Shoulder Solution
Ep 24 - Why Constant Movement Could Be Making Arthritis Worse - Understanding Arthritis
Arthritis affects many people, often causing inflammation and joint stiffness. Understanding how to manage and cope with this condition can lead to significantly improved quality of life.
• Discussion of osteoarthritis and rheumatoid arthritis
• The role of inflammation in joint health and pain
• Importance of movement but caution due to potential for worsening inflammation
• Manual techniques: self-massage, hot and cold therapies
• Exploring tools like braces and kinesio tape for support
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Hello and welcome to the new show, The Hand to Shoulder Solution, with me, Carl Petitto.
If you are experiencing pain in your arms and hands, this is your resource.
Subscribe, listen, and share to help us give pain the middle finger for good!
This is a resource to help you mitigate pain at home and become more educated on what to ask your doctors and therapists. No medical advice will be given, and you should always see your medical professional for any questions.
Thank you, and welcome to the show!
Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm your host, carl Petito. I'm an occupational therapist and I specialize as a board-certified hand therapist. As a hand therapist, I specialize in the rehabilitation of orthopedic conditions that affect the fingertips through the shoulder.
Speaker 1:Today I want to talk about arthritis. Almost everyone has it. Our bodies are designed to last optimally for about 40 years and then wear and tear starts to take over and even if it's not affecting you outwardly and you're not noticing significant effects of arthritis, that might be present, it's there. It's just the normal wear and tear and that's the osteoarthritis. Rheumatoid arthritis is when your body's immune system attacks your joint surfaces and sees your cartilage basically as a foreign body and tries to destroy it. But let's talk about arthritis in general. It's inflammation, so itis means inflammation. And whether we're talking about let's take the word tendonitis Tendonitis, that's inflammation of a tendon. Tendons connect muscle to bone. So back to arthritis. Arthro means joint, so arthro, arthritis, it's inflammation of the joints.
Speaker 1:What I want to make clear is that this is not treatment, advice. This is not treatment. This is information sharing, so that way you understand what might be going on with your body. And also I want you to understand the need of being seen by a physician or by a therapist so that you can really be taught what would be optimally, what would be optimal for you to do at home in order to reduce your inflammation, reduce your pain and reduce your stiffness. Today I want to talk about the do's and don'ts, some optimal things that I usually recommend to my patients, and that includes lists of things not to do.
Speaker 1:Something that needs to be discussed is the hands are right here, handy, they're right in front of us all the time. We can always rub one hand with the other. We can continuously move them, and doing anything frequently or habitually or continuously really aggravates the inflammation, and aggravating that inflammation causes more tightness of the joints, because now the inflammation takes up space. So when things get inflamed and swell and expand, it takes up space within the joints and patients say that you know, my joints feel tight, I just have to keep them loose, I have to keep them moving and you know it does feel good while you're doing it and it feels like they're getting loosened up. Then the after effect, the immediate after effect, is and it feels like they're, they're getting loosened up. Then the after effect, the immediate after effect is now increased inflammation because they're aggravated, and then that leaves some more tightness, and then a person naturally remembers that it felt great when I was moving. It felt a lot looser, so now I just have to keep moving it some more. Then, of course, that leads to just continuous range of motion and patients will come in the office and they're sitting there talking to me and I'm taking a history.
Speaker 1:When did it start bothering you? What did it start with? Did you have any trauma? Did you fall on your hand? Did you shut it in the door? You know anything? And while I'm asking them questions, they're sitting there and they're moving or they're rubbing their hands. Deep pressure, as I mentioned in previous videos, actually releases chemicals that slow the pain response to the brain. So if you hit your shin on the coffee table, for example, you want to reach down and rub it. That's natural because the body wants that deep pressure to soothe it and make it feel better.
Speaker 1:The problem with the wrists and hands is that the tendons, the bones, the ligaments it's just right below the skin. So when that joint is inflamed and irritated and you're rubbing it, it'll feel great while you're rubbing it, but then the after effect is now. The inflammation has increased and it hurts more. Your pain level will go up a couple of notches and then again naturally remember it felt great when I was rubbing it, so now I'm going to rub it some more. What a vicious cycle. So I usually have that talk with patients who one of my first questions always is are you rubbing your hand, are you massaging yourself? And they usually are and do you find yourself sort of just trying to keep it loose? And patients usually are. So it's very important to me to bring that to the intention of the general public, just so you know, at a minimum. At least you know. Let's not make it worse.
Speaker 1:Let's talk about the anatomy and let's specifically talk about the wrist and hand. Of course, arthritis affects all joints of the body, but what's unique about the wrist and hand is that 15 bones make up the wrist, for example, is that 15 bones make up the wrist, for example. So the back of the elbow is the tip of the ulna, which stays stationary when your palm is up. The radius here is the right hand, just like this. When it's turned palm up, the radius is parallel with the ulna. When you turn it palm down, the radius flips over the top of the ulna. So there's that rotation which occurs. Let's go back and forth a few times at the wrist Now let's turn it palm up, so there's palm up and then there's palm down. So that is called the distal radial ulnar joint, druj, the drudge, we call it for short. So palm down, palm up, so there's all that rotation.
Speaker 1:Now we have eight carpal bones and those carpal bones form the carpal tunnel, which we've discussed in previous videos. Every one of these small tiny bones has a name and these carpal bones, small tiny bones, has a name. And these carpal bones, when they're assembled, there are in this whole region. Right here there are 24 contact surfaces, meaning articular surfaces where the bones articulate or come together. So talk about wear and tear. Right, there's all those surfaces in the wrist. When people are told, or people talk about, that they have a wrist fracture, well, there's 15 bones that make up the wrist, so it's really important to know what bone or what combination of bones are fractured. But getting back to arthritis, we also have the five bones in the hand and then we have every finger has three bones, except for the thumb has two. So you can really appreciate that there's a lot going on here and when this whole area gets inflamed, there is not a lot of forgiving space for that inflammation to occupy. Therefore, things get very, very tight.
Speaker 1:To decrease inflammation, to shrink it down, we want to use heat or cold. Here's how to remember it. Heat expands, so I used to work as a welder and a machinist in the Navy. Used to fabricate parts for aircraft, and when I weld something, I know that the steel is going to expand. When for aircraft, and when I weld something, I know that the steel is going to expand. When it cools it's going to shrink. That's important because we don't want our steel to warp. We don't want things to get misshapen with the, with the wrist and hand, the body and everything in nature. Things that cool down shrink, so inflammation is hot, it's expanded down. Shrink, so inflammation is hot, it's expanded, it's angry, it's spreading Cold. We need to shrink it down with cold.
Speaker 1:There's something that's very quick and easy either a direct ice cube on the skin, just gliding it around on the skin, or cold running water, just until it's deeply cold. And these items they take 10 to 20 seconds. So right, when it's deeply cold, you're done. And I have patients stick their wrists under cold running water, their hands, their fingers, only until it's deeply cold 10 or 20 seconds Midday at the end of the day at a minimum. Some people who come in and they're just terribly inflamed and they're moving repetitively and they're rubbing their hand. I'll tell them to stop everything. Just use a cold running water every one to two hours until it's deeply cold. It's quick and easy. Other people I'll have them. Take an old water pitcher or a Tupperware container or something and fill it with water, keep it in the refrigerator, pull it out. You know what is that? 34 degrees Fahrenheit, 36 gets cold quickly.
Speaker 1:So submerge your whole wrist and hand in there, just past the. You see that bone right there. You just want to get the bony wrist and hand, not the muscles of the forearm. Oftentimes the muscles of the forearm, which control the wrist, control the fingers, become tight. So when you're shrinking tissues, you'll take tissues that are already tight and now you're going to shrink them and tighten them up more, and then that can lead to tendonitis and other problems within the wrist.
Speaker 1:Now in the morning is the time when inflammation is going to be at its lowest point. Now here's the way to remember that All night long. When you're sleeping, you're just resting and not doing anything and the hands are, the inflammation is calming down, it's shrinking down. Now, when people with arthritis get up in the morning, they'll find that their joints are very, very stiff. They're very, very tight. Well, because they haven't been moving. Movement, you know, increases. It squashes around and moves around, lubricating fluid. Movement increases blood flow. But everything has its limits and we talked about movement a few minutes ago, how too much of it is not good. Now in the morning, a person has to resist the urge to get up and just force it to get moving because, remember, it'll feel extra tight in the morning. So you just let it wake up, naturally using your hands, and then that's the time where we can have the benefits of a low heating pad.
Speaker 1:I like the electric heating pad because it has a thermostat. It's a low, steady temperature. I usually tell my patients to just put it on the lowest setting on the thermostat on the heating pad first thing in the morning for about 15 minutes. That stays at a low, steady temperature. What you don't want to do is attack it right up front with a lot of heat. That intense heat is going to now. It's going to ramp up your inflammation so they feel great when it's on. And I've had people tell me yeah, you know, I get up and jump in the shower in the morning, I make that shower extra hot and boy, it feels good. Sure, it'll feel great, but then the after effect is now increased inflammation. Just normal shower temperature, just normal bathing water. Um, but if you're using the heating pad first thing in the morning, it's the lowest temperature. For 15 minutes you can overdose on heat. Now there's exceptions to every rule.
Speaker 1:I live up North, uh, and it's very, very it gets, you know, punishingly cold in January, february, below zero Fahrenheit, and days like that when it's just really cold and you say to yourself well, carl must be crazy, I'm not going to put my hand under cold. Running water Days like that you can use a low heating pad two or three times per day. Running water Days like that you can use a low heating pad two or three times per day. Again, 15 minutes at a time, the lowest setting, and skip the cold. But the rule of thumb no pun intended is the after effect. So you always pay attention to how does my body respond afterward. I used the heat, felt great when it was on, but now, five or 10 minutes later, wow, things are worse. Now your body is talking to you. You have to decrease the frequency and or the intensity of the heat. Also, you know those cold, rainy November days, october, when the barometric pressure decreases and the storm is coming through. And, by the way, it's how people can predict the weather, with their joints are aching when the barometric pressure decreases and the storm is coming through and, by the way, it's how people can predict the weather, with their joints are aching. Oh boy, it must be, it's going to rain soon. There's something to that. So very interesting.
Speaker 1:If you look at the joints, every joint where the bones come together, if you take saran wrap and wrap that joint, that's the capsule of the joint. So under the capsule, look at this material, thick, lig Under the capsule is lubricating fluid and there's pressure in there, just normal barometric environmental pressure, and that is pushing out. Because it's pressure, it's pushing on the inside of that capsule. So now picture there's barometric pressure all around us right now. Nice high-pressure system, and it's a bright, sunny day, it's great weather, and the high pressure is an equalizing force on the joints out here. Okay, Now let's talk about a storm is coming in, now this equalizing pressure is being removed and you still have the pressure in the joints, but now that's pushing out harder out of the joints, okay, so that's pushing on the inside of that joint capsule.
Speaker 1:It's aggravating the inflammation a little bit. So that's the basic science behind why do my joints hurt when a low barometric pressure system is coming in? So that's a little bit about heat and cold. Let's talk about vibration. Some people their arthritis is so intense that when they're driving their car, after driving for a bit, their hands hurt a lot worse. And that's the little micro vibrations that's coming through the wheel After, after driving. You know it's a good idea to reduce the inflammation with use of cold that we talked about. People in the summer of course they're on their lawnmowers and of course that's more vibration. I have some patients obtain vibration absorbing gloves. You can see the little pockets of gel material that absorbs the vibration. Also, vibration absorbing small neoprene mats that you can wrap around handles of equipment, handles of even a hammer. You know the picture of hammering. I mean, that's a lot of vibration that's going through, going through the joints. So if you can absorb that vibration, that would, that would be great.
Speaker 1:Now stabilizing joints. I want to mention the base of the thumb. That is called a saddle joint. So that base of the thumb is one of the most common places of osteoarthritis in the whole body. So when you think of osteoarthritis from wear and tear, we always think about the knees and the hips because they're weight-bearing joints. That makes them wear out a little bit quicker. But the base of the thumb we can have so much range of motion because it's like two horses saddles. They move in a couple of different directions and the price we pay for that is more wear and tear.
Speaker 1:So what I like to use is a neoprene thumb stabilizing brace that does not have any stiffer bars. I rarely use an over-the-counter brace for anything, but I really like these and they're made by Comfort Cool and it's easy to just secure around the wrist first and then this piece goes right around the base of the thumb and that provides a stabilizing force right there. I also use Kinesio tape. You've probably seen on the Olympics and other sporting events where there's different color tape on shoulders and knees. It's the same stuff and I like to cut just a small thin strip and make a little sling around the base of the thumb to really support that.
Speaker 1:My point is that there's a lot of tools, there's a lot ofing around the base of the thumb to really support that. My point is that there's a lot of tools. There's a lot of tricks to the trade and it's really important to be seen by your physician, by your hand therapist, to really find out what's optimal for you. Every situation is different. There's combinations of different situations.
Speaker 1:Usually I'll see a patient just once or even two times and really get them to understand what is optimal for their body. How do they self-manage their osteoarthritis, and that's really important. We do have some other tools in our toolbox in the office, in the clinic, such as cold laser to penetrate the tissues with a bright red light to reduce inflammation when they're in the office. I like to use that just as a matter of course, just to give it a kickstart to reduce the inflammation. But you really need some targeted information to get that optimized. Thank you for listening. I really appreciate you subscribing to the channel. I want to continue to produce content that's very usable, but always know you really need to be seen by a professional. Thank you.