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Suggest Treatment For Pain And Muscle Weakness

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Posted on Mon, 6 Apr 2015
Question: Hello
Iam a 55 yr old female and a medical doctor by profession
Within the past 2 yrs I develpoed osteoarthritis of all the ten fingers and and both wrists
More stiff XXXXXXX and slight pain
I also noticed that my extensors of the wrist and fingers had become weak
These muscles cause weakness with prolonged activities
Ex: holding heavy handbag, holding the suitcase up and placing in the flight cabin
And prolonged small activities of finger movements ex: kneading dough also produce fatigue and weakness
I also notice there is some atrophy and flattening in the proximal portion of the palms and my forearms had become thinner than before
All these coincided with onset of OA
Can OA produce muscle weakness of this type?
The proximal muscles are alright and there are no other musculoskeletal problems
An early and detailed reply is appreciated
XXXXXXX
doctor
Answered by Dr. Sunil Kumar Srivastava (29 minutes later)
Brief Answer:
underuse of muscles as aprotective phenomena cause for thinning of muscles?

Detailed Answer:
Hello,

Doctor this must be real hard on you to develop OA within 2 years-which is a fairly rapid development more so that all fingers of both hands have got affected.
It is understandable that pain or stiffness must be limiting your hand movements and finger working with consequent weakening of both flexors and extensors of forearm and thenar and hypothenars of palm as evident, when one is unable to work with stiff joints,the overall activity of muscles in the region fall far below normal and thence thining due to lack of exercise.

I believe you have had tests to rule out rheumatoid also and OA is confirmed

I may suggest,as you may be aware fully, that there are only few options to build muscles and that is through both active and passive exercise of fingers, wrist lower radio-ulnar and elbow joints, supination/pronation exercises,of forearm,flexion/extension exercises of wrist.

All that is possible and easier if stiffness is controlled by hot fomentation, massage, application of muscle relaxant gels/anti-inflammatory gels to all finger joints, taking naproxen tab for short course for reducing inflammation-once pain and stiffness ease, it will help in better exercises and use of hand wrist. You may engage a physical therapist for initiation of all exercises. You may also take neurobion forte every day.

Proximal muscles of forearm may be less affected as nearer joints to affected ones are protectively underused as a reflex first and so wasting of thenars and hypothenars in palm

Since you are a doctor you may consult a regular rheumatologist in your area and try to get other forms of arthritis ruled out if not already done, by testing arthritis profile as a whole

Hope I could be of some help
with best wishes,
Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Sunil Kumar Srivastava (11 hours later)
Hello doctor
thanks for your reply
i have some questions
i do not under use my forearm and finger muscles at all
i work actively with my fingers: gardening, typing, carrying moderately heavy objects
The stiffness is not that much that i limit my activities

can OA cause atrophy without severe pain and stiffness ? is my question

you can forward my question to a rheumatologist if you wish

thanks XXXXXXX

my RA factor is negative, ESR normal and high sensitivity CRP is normal and blood counts normal
I have autoimmune thyroiditis which is now easily corrected by thyroid supplements
doctor
Answered by Dr. Sunil Kumar Srivastava (23 minutes later)
Brief Answer:
Muscle atrophy not a part of OA directly

Detailed Answer:
Thank you for your feedback.
Osteo-arthritis is a primary degenerative disease of the joint leading to wear and tear of cartilage at bone ends in a joint, secondary osseous changes occur with degenerative changes (osteoclasts cause reabsorption of bone causing cystic changes,dissolution,sclerosis) THE SURROUNDING MUSCLES OF JOINT ARE made to bear over-strain as the joint does not absorb that much stress. A reflex guarding takes place but there are no degenerative change directly in muscles or tendon,ligaments, unlike RA where soft tissues are also a part of degenerative process
So any secondary effect in soft tissues in OA is dependent on use or disuse and this may somewhat cause atrophy, but disease process itself doesn't attack soft tissues.
In RA, we often see isolated tendinitis and joint affectation later on or vice-versa and often in both places simultaneously.

As you disclose auto-immune thyroditis ,it may be auto-immune phenomena has varied vague effects in body tissues as we may see with Crohns, Fibromyalgia and other diseases affectation of other body organs accompany in this process.
Yes, you may see an immunology expert also besides an Rheumatologist in your area.
This forum too has several Rheumatologists and that will be an additional help for you.
Best wishes,
Regards.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Sunil Kumar Srivastava (9 hours later)
Thank you doctor
doctor
Answered by Dr. Sunil Kumar Srivastava (26 minutes later)
Brief Answer:
welcome, add arthrovil plus for OA

Detailed Answer:
You are welcome
I may add arthrovil plus(glugosamine -diacerin combination) may be taken twice daily for OA if your treating doctor agrees alongwith physical therapy

Best Wishes,

Regards,
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
Dr.
Dr. Sunil Kumar Srivastava

Orthopaedic Surgeon

Practicing since :1980

Answered : 448 Questions

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Suggest Treatment For Pain And Muscle Weakness

Brief Answer: underuse of muscles as aprotective phenomena cause for thinning of muscles? Detailed Answer: Hello, Doctor this must be real hard on you to develop OA within 2 years-which is a fairly rapid development more so that all fingers of both hands have got affected. It is understandable that pain or stiffness must be limiting your hand movements and finger working with consequent weakening of both flexors and extensors of forearm and thenar and hypothenars of palm as evident, when one is unable to work with stiff joints,the overall activity of muscles in the region fall far below normal and thence thining due to lack of exercise. I believe you have had tests to rule out rheumatoid also and OA is confirmed I may suggest,as you may be aware fully, that there are only few options to build muscles and that is through both active and passive exercise of fingers, wrist lower radio-ulnar and elbow joints, supination/pronation exercises,of forearm,flexion/extension exercises of wrist. All that is possible and easier if stiffness is controlled by hot fomentation, massage, application of muscle relaxant gels/anti-inflammatory gels to all finger joints, taking naproxen tab for short course for reducing inflammation-once pain and stiffness ease, it will help in better exercises and use of hand wrist. You may engage a physical therapist for initiation of all exercises. You may also take neurobion forte every day. Proximal muscles of forearm may be less affected as nearer joints to affected ones are protectively underused as a reflex first and so wasting of thenars and hypothenars in palm Since you are a doctor you may consult a regular rheumatologist in your area and try to get other forms of arthritis ruled out if not already done, by testing arthritis profile as a whole Hope I could be of some help with best wishes, Regards