Treatment Approach for Contracted Hand

Diagnostic Clarification and Treatment Algorithms

The American College of Rheumatology recommends evaluation of activities of daily living ability and provision of assistive devices as needed for patients with hand osteoarthritis, along with education on joint protection techniques and instruction in thermal modalities for pain and stiffness relief 1, 2, 5, 6
The European League Against Rheumatism suggests that topical NSAIDs are preferred over systemic treatments for mild-to-moderate pain in hand osteoarthritis, especially when few joints are affected, and that intraarticular corticosteroid injection can be used for painful flares 1, 2, 6
The American Geriatrics Society recommends that in patients ≥75 years, topical NSAIDs should be used rather than oral NSAIDs for hand osteoarthritis 1, 2, 5
Acetaminophen (up to 4 g/day) is the oral analgesic of first choice for hand osteoarthritis due to efficacy and safety, according to the American College of Rheumatology 6
The American Heart Association advises against using COX-2 inhibitors in patients with cardiovascular risk factors 6
The American Academy of Orthopaedic Surgeons recommends surgery (trapeziectomy, arthrodesis, or arthroplasty) for hand osteoarthritis when structural abnormalities are present, other treatment modalities have not sufficiently relieved pain, or marked pain and/or disability persist despite conservative treatment failure 3, 6

For Dupuytren's contracture, collagenase clostridium histolyticum injection is the primary treatment, with an overall success rate of 59% across all joints treated, although recurrence occurs in 23% of successfully treated joints, typically within 12-24 months 1, 2
For hand osteoarthritis, a combination of topical NSAIDs, joint protection education, and splinting for thumb base involvement is recommended as first-line treatment, according to the American College of Rheumatology 1, 2, 6
For shoulder-hand syndrome, active range of motion exercises should be implemented immediately, along with local heat application and splints for thumb base involvement, and topical NSAIDs or topical capsaicin as first-line pharmacological management, according to the American Academy of Physical Medicine and Rehabilitation 4