Sclerodactyly and Scleroderma
|Joint Inflammation and Carpal Tunnel Syndrome
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.
The Modified Hand Mobility in Scleroderma Test (mHAMIS) and Skin Involvement - A Followup Study. The mHAMIS reflects disease activity in fibrosis in early stages of SSc. In later stages it can be regarded as a measure of damage arising from fibrotic and vascular involvement, making it suitable as an endpoint in followup examinations. PubMed, J Rheumatol, 2016 Jul;43(7):1356-62
Joint and tendon involvement predict disease progression in systemic sclerosis (SSc): a EUSTAR prospective study. Joint synovitis and tendon friction rubs are independent predictive factors for disease progression in patients with early SSc and these easily detected clinical markers may be useful for the risk stratification of patients with SSc. PubMed, Ann Rheum Dis, 2016 Jan;75(1):103-9. (Also see Tendon Friction Rubs)
Sclerodactyly 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 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)
Hand Impairment in Systemic Sclerosis: Various Manifestations and Currently Available Treatment. Overall management of hand impairment for all patients with SSc should include occupational hand therapy techniques such as range of motion exercises, paraffin wax, and devices to assist in activities of daily living. PubMed, Curr Treatm Opt Rheumatol, 2016 Sep;2(3):252-269.
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.
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.
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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