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Hand and Joint Involvement in Systemic Sclerosis (SSc/Scleroderma)

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Sclerodactyly and Scleroderma
Joint Contractures
Joint Inflammation and Carpal Tunnel Syndrome
Treatments

Overview

Hand and joint involvement in scleroderma includes the fingers, knuckles, wrists, knees, and other joints. Hand involvement includes sclerodactyly, joint contractures, inflammation and carpal tunnel syndrome.

On this page we cover joint contractures, joint inflammation, and carpal tunnel syndrome. We also provide information on how to treat some of these problems through exercise and non-medicinal means.

Scleroderma of the Hand: Evaluation and Treatment. The spectrum of hand manifestations seen in patients with scleroderma will be reviewed with the focus on evaluation and management. PubMed, J Am Acad Orthop Surg, 2020 Aug 15;28(16):e686-e695.

Musculoskeletal (MSK) Hand Involvement in Systemic Sclerosis (SSc). The purpose of this review is to provide an overview of the MSK hand complications in patients with SSc, highlighting the breadth and burden of pathology relevant to clinical practice. PubMed, Semin Arthritis Rheum, 2020 Apr;50(2):329-334. (Also see Musculoskeletal Involvement)

The Glittre Activities of Daily Living Test in women with scleroderma and its relation to hand function and physical capacity. The Glittre Activities of Daily Living Test may be used in clinical practice to evaluate the performance of activities of daily living by people with scleroderma. PubMed, Clin Biomech (Bristol, Avon), 2020 Jan 11;73:71-77.

Sclerodactyly and Scleroderma

Photo of severe sclerodactyly in a systemic scleroderma patientSclerodactyly is when the skin on the fingers can become tight, stretched, wax-like, and hard. This can cause the fingers to curl inward and become frozen in a clawed position (as shown in the picture). Sclerodactyly is commonly associated with atrophy of the underlying soft tissues. (See Scleroderma Photos) ISN

Joint Contractures

Joint contratures are recognized by the loss of joint motion or a high resistance to a passive stretch. In scleroderma, joint contratures can be due to fibrosis of the tissue supporting the muscles or joints, such as tendons and ligaments, or the muscles themselves.

Joint Contractures, Ulcerations, Severe Raynaud’s Linked to Impaired Hand Function in Scleroderma. The presence of moderate or severe small joint contractures, finger ulcerations, and the severity of Raynaud’s phenomenon show the strongest association with impaired hand function in scleroderma patients, a study reports. Scleroderma News, 11/06/2018. (Also see Raynaud’s)

Photo of Finger Contracture

Joint Inflammation and Carpal Tunnel Syndrome

Scleroderma can also cause joint inflammation (pain, redness and/or swelling) which is usually treated with NSAIDS or other anti-inflammatories. Carpal tunnel syndrome (CTS) is often an initial symptom of scleroderma (usually along with Raynaud's), preceding the development of other symptoms by months or years.

Effect of a monocyte chemoattractant protein-1 synthesis inhibitor on fibroblasts from patients with carpal tunnel syndrome (CTS). These results suggest that Bindarit in combination with SD208 may be beneficial as medical therapy for the subsynovial connective tissues fibrosis associated with CTS. PubMed, J Orthop Sci, 04/18/2020. (Also see Fibroblasts)

Median neuropathy at the wrist (MNW) in patients with systemic sclerosis (SSc): two–year follow–up study. MNW commonly has high incidence in SSc patients and therefore, SSc patients should be followed up in both clinical and electrodiagnostic studies for MNW screening. PubMed, Reumatologia, 2018;56(5):294-300.

Treatments

Physical and occupational therapies are also very helpful to minimize impairments and disabilities, and should be started at the first stages of hand involvement to prevent or ameliorate finger contractures. Likewise, physical and occupational therapies are also necessary at the first stage of skin tightening on the legs.

For optimum results, make every effort to seek out a physical or occupational therapist well-versed in scleroderma (few are, since scleroderma is so rare) — and diligently follow their advice.

An out-of-print 32-page pamphlet, Scleroderma Caring for Your Hands and Face by Jeanne L. Melvin, MS, OTR, FAOTA, is full of exercises for your hand and face to help maintain mobility. It also shows how to measure your mouth and hands to see how much the exercises are helping. It explains the importance of relaxing the hands before stretching. Also there are general tips for dealing with Scleroderma. It was originally published by the American Occupational Therapy Association, however they no longer distribute it, and it is not available on Amazon even as an out-of-print publication. Some people have been able to find it (sometimes by specially requesting it) through their local library. We highly recommend trying to get it that way.

Because scleroderma is a type of arthritis, exercises and stretching suggested for rheumatoid arthritis and other types of arthritis may prove to be beneficial. Remember, never stretch to the point where it becomes painful!

Hand and wrist joint procedures in patients with scleroderma: a systematic review. The application of joint procedures in scleroderma hands and wrists seems to be associated with low morbidity. PubMed, J Hand Surg Eur Vol, 2018 Sep 3:1753193418795632.

Case Report: Imaging Helps Guide Physical Therapy Treatment in a Patient With Diffuse Systemic Sclerosis (Scleroderma). Because finger joint spaces appeared normal, joint mobilization, which would have been contraindicated by bone or joint destruction, was considered appropriate to help increase range of motion. PubMed, J Orthop Sports Phys Ther, 2018 Mar;48(3):226.

Telemedicine Applied to Kinesiotherapy for Hand Dysfunction in Patients with Systemic Sclerosis and Rheumatoid Arthritis: Recovery of Movement and Telemonitoring Technology. Telemonitoring of self-administered kinesiotherapy programs is a promising approach to the rehabilitation of hand functions in patients with rheumatic disease. PubMed, J Rheumatol.

Hand Exercises for Rheumatoid Arthritis. 7 hand-stretching exercises to ease rheumatoid arthritis symptoms. Denise Mann, Web MD.

The Mayo Clinic's Slide Show: Hand exercises for people with arthritis. Hand exercises may help improve muscle strength and joint range of motion in people who have arthritis. You can do hand exercises daily or, preferably, several times a day. Mayo Clinic.

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