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Osteoarthritis in the Hand: Observed Response to PEMF
By: Editorial team of Prevention101 (from interview with Patient's Physical Therapist (?))
Images contributed by: Dr. Robert L. Bard & (?) X-ray facility
The patient reports showed that this was a long-standing illness of about 1 year’s duration with little therapeutic improvement from standard physical therapy and steroid injections. The patient elected to personally explore other therapeutic modalities and elected to purchase a commercially accessed PEMF on the hands. Following the advice of the manufacturer’s clinical advisors, she applied the treatment on both hands twice a day for three weeks and documented her settings at medium power of 7/20 and 8/20 respectively.
This1 year old x-ray shows narrowing of the thumb bone- (the base of the thumb with the beginning of the wrist bones) to be narrowed and arthritic. The arthritis shows up as a decrease in the joint space and an increase in the whiteness of the reactive cortical bone. The First Metatarsal with the carpal bone (scaphoid). Classic SCR arthritis of the hand: Physical therapy and cortisone injection of the inflamed tendon.
In essence, bone-on-bone is not the main cause of symptoms; it is the abnormal bony alignment that causes the tendons and the joint and the tendon linings to become inflamed. This change in the inflamed tendon lining was demonstrated by the before-and-after high resolution ultrasound of the extensor pollicis tendon (or the flexor pollicis)- the longest tendon in the thumb.
If this therapeutic technology in fact associated with improved mitochondrial function (the body’s healing process) as PEMF reports have claimed to perform- it may answer for the decrease in inflammatory reaction resulting in a “normalizing” or swelling reduction of the tendon sheath.
Fig-3: The right thumb is visibly able to position up to a 90 degree angle whereas the limited flexion of the left is at a 70 degree angle, which has improved from previously being at a 50 degree angle (from prior reports) demonstrating 20 degrees improvement – reportedly from the PEMF therapy in combination with the patient’s regularly scheduled PT treatments. Within the 30 days of this self-induced PEMF treatments, the patient stated that immediate response of “mild, gradual” pain relief then progressive reactions of more range of motion and less struggle (by __ to___ percent)- adding to progressive improvement in hand function and range of motion. The pain reduction was noted in the left hand as compared to the right because there was increased ability to grasp and perform finer motor functions like sewing due to the improved range of motion due to the decreased inflammatory picture.
Both hands appear to show improvement but the left hand is symptomatically much worse.
The right hand improves slightly the left hand improved at a greater pace than the right hand. Essentially, normal range of motion and the left hand showed improving range of motion. The left improved from a 50 to a 70 degree angle over the over the course of ___ visits every three months.
Edema vs pain; the inflammation of a tendon can be in the tendon or the sheath of the tendon, or both. In the case of this patient, the two millimeter thick tendon showed almost two millimeters of synovial fluid, which is inflammatory debris from the active arthritis, tenosynovitis in the thumb. As the fluid restricting the joint decreases, the motion will improve and of course the tension in the joint which is painful will improve as well.
Afterthought: While you can't repair arthritis without major surgery to the bone, the symptomatology which is what is limiting for every day routine functions and housework can be dramatically improved so functionality of the hands can be managed with an aspirin instead of a months of long surgical recovery.
The results from this limited exploratory treatment and logic dictates that with additional and continued exposure to this PEMF therapeutic modality, further improvement and prevention or the formation of further inflammation may be possible. Managing the existing disorder may address further potential re-injury or progressive symptoms from this abnormal thumb joint.
This concept of prevention also links to managing serious impairment and prolonged damage to the tendon which can result in scarring and further degradation of the hand function.
RLB has other x-ray angles to offer.