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Hands Stiff in the Morning

Causes & Treatment Options

Hand stiffness can make simple tasks overwhelming.  Why are my hands stiff in the morning?  What are the treatment options for hand stiff in the morning?  Are there new, natural treatment options to treat hands that are stiff in the morning?   Let’s dig in.

Why are My Hands Stiff in the Morning?

Our hands are central to virtually everything we do.  Stiffness can compromise function and cause pain.  What are the causes of hand stiffness in the morning?  There are many which include:

  • Excessive daily wear and tear
  • Medications can cause hand swelling and stiffness.  Common examples include hormones, calcium channel blockers for high blood pressure, steroids, anti-depressants, and NSAIDs.
  • Diets high in salt
  • Alcohol
  • Trauma with injury to bones, tendons, and muscles
  • Neck injury with irritation or compression of spinal nerves that provide important signals to fingers can lead to hand and finger stiffness.
  • Medical conditions such as gout and diabetes (1).
  • Osteoarthritis:  A joint disease that involves the breakdown of the joint cartilage that occurs gradually over time.  Fingers and thumb joints are the most commonly involved (2).  Joint stiffness is common in osteoarthritis.
  • Chronic Inflammation.  A cascade of toxic chemicals that erode the joint cartilage, and weaken muscles, tendons, and ligaments.

Specific Conditions Associated with Hand Stiffness

Basal Joint Arthritis or CMC / Carpometacarpal Arthritis

The thumb is also referred to as the CMC joint. It is composed of two bones. The Carpal bone is denoted by the letter C. The second bone, the MC is the MetaCarpal bone. So your thumb is made up of the Carpal and MetaCarpal bones that come together and form a joint. The joint is lined with cartilage which allows the two bones to slide smoothly against one another. The thumb joint is held together by multiple thick ligaments. Ligaments are thick pieces of connective tissue that connect one bone to another. This joint is a saddle-shaped joint that experiences significant forces through activities of daily living.

Read More About Basal Joint Arthritis or CMC / Carpometacarpal Arthritis

TFCC tear

TFCC stands for Triangular Fibrocartilage Complex. It’s basically a triangular-shaped spacer with ligaments that lives on the pinky finger (ulnar) side of your wrist (1). This complex of ligaments stabilizes the bones on that side and adds cushioning. The TFCC can become torn with a fall on an outstretched hand, other trauma, or just wear and tear. Instability is another feature of TFCC tears (2). The TFCC is part of an extensive group of ligaments that help stabilize both the small wrist bones and the ulna bone. If these become stretched and allow too much movement, this is called instability.

Read More About TFCC tear

Treatment Options for Hand Stiffness in the Morning

There are multiple treatment options for hand stiffness in the morning which are outlined below. Which treatment is best for you depends upon the underlying cause of stiffness, how long it has been present and the severity of any cartilage or ligament injury.

Physical Therapy

  • Typically the first treatment of choice with emphasis on the range of motion and strength.

Diet Modifications

  • reduce inflammatory foods and start or increase good quality fish oil and Tumeric.  Inflammatory foods such as those rich in sugar and trans fats can aggravate hand stiffness.

Pain Medications

  • Nonsteroidal anti-inflammatory medications such as Motrin, Advil, and Diclofenac have significant side effects and should be avoided. Side effects include increased risk of sudden death from a heart attack, increased risk of stroke, increased risk of injury to the small bowel and potentially make your arthritis worse.

 Injections

  • Steroids are power anti-inflammatory agents that have significant side effects that include increased risk of spinal fracture, bone death and toxicity to your repair cells (stem cells).
  • Hyaluronate Acid.  A WD 50 type of medication that can increase the lubricant in the joint and potentially reduce pain.

Surgery

  • When conservative treatments fail, surgery is often recommended.  Common hand surgeries include tendon repair, nerve repair, fusion, and joint replacement.  Surgery has risks that include bleeding, infection, failure, escalation in pain, tissue death, nerve injury and loss of range of motion (3).

New Nonsurgical Treatment for Hands Stiffness in the Morning

A novel technique that uses a precise injection of platelets and or bone marrow concentrate is now available.  PRP is rich in growth factors that can increase blood flow and reduce inflammation.  On a cellular level, for degenerative conditions such as osteoarthritis, PRP has been found to stimulate cartilage producing cells while turning down inflammatory signals (4).  Multiple studies exist that demonstrate the effectiveness of PRP in the treatment of early hand osteoarthritis.

  • In a 2016 study, patients who underwent PRP injection into their thumbs reported both a reduction in pain and increase in function with no significant complications (5).
  • In comparison to steroid injections, PRP provided longer pain relief in patients with hand arthritis  (6)

Bone marrow concentrate contains many different cells that can repair local damage and inflammation in addition to signaling other remote cells to come and assist in the repair.  To learn more about precise PRP and bone marrow concentrate injections please click on the video below which reviews treatment of thumb arthritis. Similar treatments have been successfully used in the treatment of hand arthritis.

PRP and bone marrow ultrasound-guided injections into the hands and fingers is a technically challenging procedure that your Primary Care Physician (PCP) or orthopedic surgeon can not perform.  It takes years of training to inject PRP and bone marrow concentrate into the different parts of the hand.  At the Centeno-Schultz Clinic, we have extensive experience in the treatment of hand injuries.  To watch an advanced hand procedure at Centeno-Schultz Clinic please click on the video below.

In Conclusion

There are multiple causes for hands stiff in the morning which include excessive wear, trauma, medications, inflammatory diets, and osteoarthritis.  Treatment depends on the severity of the stiffness, range of motion and the severity of underlying cartilage, tendon and ligament injuries.  Treatment options include physical therapy, diet modifications, oral medications, steroid injections, and surgery.  Steroids and NSAIDs both have significant side effects and should be avoided.  Surgery is associated with multiple complications including the need for additional surgeries. Injection of PRP and bone marrow concentrate is a novel new, nonsurgical treatment option.  In multiple studies, PRP has been demonstrated to be effective in the treatment of mild hand osteoarthritis.  Precise, image guided PRP and bone marrow injections can treat the issue using the healing mechanisms of the patients own platelets and stems cells and avoiding the risks associated with oral NSAIDs, steroids and surgery.

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1.Rosenbloom AL. Limitation of finger joint mobility in diabetes mellitus. J Diabet Complications. 1989;3(2):77-87. DOI: 10.1016/0891-6632(89)90016-0.

2.Makkouk AH, Oetgen ME, Swigart CR, Dodds SD. Trigger finger: etiology, evaluation, and treatment. Curr Rev Musculoskelet Med. 2008;1(2):92-6. doi: 10.1007/s12178-007-9012-1.

3.Hustedt JW, Chung A, Bohl DD, Olmschied N, Edwards SG. Comparison of Postoperative Complications Associated With Anesthetic Choice for Surgery of the Hand. J Hand Surg Am. 2017;42(1):1-8.e5.doi: 10.1016/j.jhsa.2016.10.007.

4.Kazemi D, Fakhrjou A (2015) Leukocyte and platelet rich plasma (L-PRP) versus leukocyte and platelet rich fibrin (L-PRF) for articular cartilage repair of the knee: a comparative evaluation in an animal model. Iran Red Crescent Med J 17(10), e19594.

5.Loibl M, Lang S, Dendl LM, et al. Leukocyte-Reduced Platelet-Rich Plasma Treatment of Basal Thumb Arthritis: A Pilot Study. Biomed Res Int. 2016;2016:9262909. doi:10.1155/2016/9262909

6. Malahias MA, Roumeliotis L, Nikolaou VS, Chronopoulos E, Sourlas I, Babis GC. Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial. Cartilage. 10.1177/1947603518805230.

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