Introduction

Geriatric Essentials

• Many hand symptoms (eg, acroparesthesias, coldness, cramps, unexplained dropping of objects) are often treated symptomatically without definitive diagnosis.

The elderly may report certain nonspecific changes in the hands. For example, many elderly people describe mild acroparesthesias (ie, "pins and needles" sensation, tingling, numbness in the hands). Other symptoms and signs indicating a peripheral neuropathy or a nerve entrapment syndrome are absent. The course is frequently intermittent. Reassurance is helpful, but most patients can cope without treatment. Troublesome symptoms may be alleviated with pyridoxine (vitamin B₆) 50 mg po bid, warm soaks, or topical analgesic creams. Wearing nylon-spandex stretch gloves during the night or heated mittens when symptoms occur may help.

Some elderly people are genetically predisposed to develop Heberden's nodes at the distal interphalangeal (DIP) joints and Bouchard's nodes at the proximal interphalangeal (PIP) joints. Radiographically, these nodes have the characteristic features of osteoarthritis, including joint space narrowing, bony sclerosis, and osteophytes. The nodes are large and knobby and rarely cause pain, but the hands and fingers may feel clumsy and may be difficult to close. Warm soaks and flexion-extension exercise of the fingers in warm water followed by a 2- to 3-min massage with a topical analgesic balm (eg, methyl salicylate) are sometimes useful. Built-up handles on tools or sports equipment help improve grip.

Some patients report unaccountable dropping of objects despite adequate pinch between the thumb and index finger, grip, and muscle strength. This problem may represent altered proprioception, but the cause is unknown. Caution is required when handling valuable, heavy, or sharp objects. Treatment involves reassurance.

Elderly people may have cold hands for no discernible reason. The palms in particular may feel cool, but color changes and other symptoms are absent. Examination, including a vascular evaluation, discloses no abnormalities. Some elderly people also describe a diminished sense of touch, but true numbness or paresthesias are absent. Strong reassurance and smoking cessation may be useful.

Muscle cramps in the hands, similar to writer's cramp, may awaken patients from sleep repeatedly. Warm soaks before bedtime relieve the cramps; wearing nylon-spandex stretch gloves while sleeping may help. Occasionally, Ca supplements help prevent cramps.

More elderly people are reporting overuse syndromes. This increase likely results from the widespread use of computers and other technical devices requiring repetitive hand motion. Why overuse syndromes affect only some people is unknown. Treatment includes simple measures such as rest, splinting, and moist heat. Pain can be controlled with acetaminophen or, if acetaminophen is ineffective, NSAIDs or opioids. Stretching and isometric strengthening exercises help restore mobility and function. Recurrence is prevented by modifying the work or home environment and by avoiding any activity that provokes discomfort.

Function is assessed by asking the patient to open and close the hand so that range and smoothness of motion can be evaluated in the small joints and by evaluating pinch and grip strength and ability to perform basic skills (eg, opening jars, manipulating zippers or buttons). Consultation with an occupational therapist may be useful. Hand function is not always predicted by the presence or absence of hand deformities.

This topic was last updated May 2006.