Elbow / Hand / Wrist

Carpal tunnel syndrome

In the wrist, the median nerve and the finger flexor tendons pass through a relatively small ‘tunnel’ called the carpal tunnel. Any condition that reduces this space, such as inflammation that thickens the tendon sheaths, leads to compression of the median nerve. Carpal tunnel syndrome affects around 11% of women and 3.5% of men. It tends to appear either in the early fifties or after the age of 75. Symptoms are mild and temporary at first, but intensify over time.

In this case, use a magnetic carpal finger.

Osteoarthritis of the base of the thumb or rhizarthrosis

Although osteoarthritis in general is the most common joint disease, it still does not benefit from significant therapeutic progress. In practice, we have anti-inflammatory drugs and intra-articular cortisone to relieve the symptoms, but little or nothing to prevent the disease, i.e. to delay the destruction of the cartilage.

Structure-modulating treatments have not yet been formally proven to be effective.

In fact, international recommendations for the management of osteoarthritis emphasise non-pharmacological means, in particular orthoses.

Along with osteoarthritis of the distal interphalangeal joints, trapeziometacarpal osteoarthritis is one of the most common conditions affecting the hand. It was given the name rhizarthrosis by Forestier in 1937. It is an essential form of osteoarthritis that classically corresponds to ‘chronic wear of the cartilage’ covering the trapezium and the first metacarpal at the base of the thumb. This is precisely the case for rhizarthrosis... Although the pathogenesis of this condition is still obscure, morphological variations in the joints, ligament hyperlaxity, a hormonal cause (due to its predominance in women after the menopause), and repetitive occupational gestures in a predisposed environment with work using the thumb-index pincer are all factors that have been suggested as contributing to the onset of this condition. More recently, a meta-analysis has shown an association between obesity and digital osteoarthritis: adipose tissue releases mediators, adipokines, which may act on weight-bearing and non-weight-bearing joints.

A disabling disease for pincer movements

Rhizarthrosis is particularly troublesome because the affected joint is the one that allows pinching movements. Pain is most often the first symptom, either spontaneously or during certain everyday movements such as turning a key, peeling fruit or opening a jar. The pain is mechanical, but in the event of a congestive flare-up with inflammation of the synovium, swelling, heat and redness, the pain becomes permanent. This is a fundamental joint in the thumb column, which enables the thumb pad to be oriented in opposition to the other fingers (pollicidigital forceps) for fine gripping movements. This joint is closed by a joint capsule whose reinforcements form the ligaments that ensure its stability with the surrounding muscles.

How is osteoarthritis of the hand treated?

Initially, treatment is always medical, with the aim of :

• reduce pain
• and preserve joint amplitude

It combines rest, paracetamol-based analgesics up to a maximum of 4 grams a day, and anti-inflammatory drugs in the event of a congestive flare-up, but for as short a time as possible to limit side-effects. Corticosteroid infiltration may help to overcome the hyperalgesic inflammatory period, but repeated infiltration may damage the capsuloligamentous system, complicating any surgical procedure. In the world of rheumatology, it is empirically recommended not to exceed 3 corticosteroid infiltrations per year in the same joint.

Numerous studies have shown that hyaluronic acid injections are effective in this condition. However, the number and frequency of injections are not clearly defined, and these studies do not make it possible to specify whether or not it is preferable to offer this treatment at an early stage of rhizarthrosis, as is proposed for knee arthrosis before major joint damage. Lastly, this hyaluronic acid treatment is not covered by the French Social Security system. Slow-acting anti-arthrosics (e.g. glucosamine, chondroitin, diacerhein, avocado unsaponifiables) are often prescribed, but their effectiveness has not yet been proven. Nonetheless, they are a useful way of offering treatment to patients who are suffering and looking for relief... Treatment is usually recommended for a period of at least 4 to 6 months, but these treatments are not reimbursed by the Assurance-Maladie...

According to EULAR (European League Against Rheumatism) recommendations since 2006 [11], topicals (NSAID ointments and capsaicin-based ointments) are a useful aid, applied morning and evening.

Wearing orthoses as a first-line treatment

At the Société Française de Rhumatologie congress in December 2013, an original work was presented. This was a study of patient satisfaction, effectiveness and compliance with hand and wrist orthoses for rheumatological purposes, based on 957 dispensed in pharmacies. The conclusion is twofold: ‘On the one hand, hand and wrist orthoses satisfy patients by providing rapid and significant relief. This satisfaction is all the greater if the orthosis is prescribed early and is adapted and specific, which encourages compliance. On the other hand, orthoses should be considered more as first-line physical treatments than as second-line treatments after medication has failed. Finally, one of the best approaches to treating rhizarthrosis remains non-pharmacological, with the use of an orthosis to keep the thumb in a resting position. It should be remembered that the trapeziometacarpal joint works permanently in compression thanks to a specific ligament system, with the trapezium appearing as a real keystone in the distribution of pressure forces from the tip of the pincer to the wrist: for a force of 1 kg exerted on pollicidigital pressure, the compression force exerted on the trapeziometacarpal joint is 12 kg. Firm support for this joint is therefore preferable to elastic support, which is ineffective given the forces involved.

It therefore seems very interesting to be able to adapt a specific orthosis that is comfortable, respects movement and has a specific original analgesic effect, to be worn day and night if necessary, hence the idea of this work on the Auris magnetic orthosis.

How magnetic fields work

Medical magnets stimulate the secretion of our powerful endogenous opioids to bring us relief.

Permanent magnets re-establish the original magnetic field of the injured area, which can only contribute to a return to normal of the diseased area and therefore help to stabilise an injury or even heal it. This is known as the return to a state of magnetic homeostasis.

In terms of tolerance, magnetotherapy is exceptional.

What can we conclude?

Rhizarthrosis is a common disease, and is usually well tolerated, with 80% of patients responding well to medical treatment for pain. According to the HAS report of January 2010, orthoses have been shown to be effective in reducing pain and improving function. However, there is still a place for surgical treatment if pain management fails.

Auris, with its wealth of experience in the field of magnetic therapy, has developed a suitable orthosis, the magnetic fingerstall. Thanks to its 3D design, the orthosis moulds the thumb perfectly but also envelops the wrist while preserving the opposing movements of the thumb and fingers, the round pollicidigital forceps and the flat thumb and index finger forceps.