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Hand examination, ultrasound and its association with hand pain and function in community-based older adults


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Mattap, SM, Laslett, LL ORCID: 0000-0002-4336-0095, Squibb, K ORCID: 0000-0003-0664-9305, Wills, K ORCID: 0000-0003-3897-2908, Otahal, P ORCID: 0000-0003-4042-1769, Pan, F ORCID: 0000-0002-3403-0094, Aitken, D ORCID: 0000-0001-5685-7634, Keen, H, Cicuttini, F, Winzenberg, T ORCID: 0000-0002-4112-3491 and Jones, G ORCID: 0000-0002-9814-0006 2019 , 'Hand examination, ultrasound and its association with hand pain and function in community-based older adults' , Arthritis Care & Research , pp. 1-28 , doi: 10.1002/acr.24128.

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Objective: To describe cross-sectional associations between features observed on ultrasound (US) or clinical joint examination and hand symptoms amongst community-dwelling older adults (n=519), and determine whether such associations are independent of age, sex, BMI, and other imaging features.Methods: Hand pain, function, and stiffness were assessed using a visual analogue scale (VAS) and the Australian/Canadian hand osteoarthritis (AUSCAN) index. Standardised clinical and ultrasound examinations were performed. Grip strength was assessed using dynamometer. Data were analysed using hurdle and linear models and adjusted for demographic factors and other features.Results: Abnormal findings on joint examination and visualised by ultrasound are common in older adults with and without hand pain. Greater numbers of tender joints were associated with greater pain (VAS, β=2.63 (95% CI; 1.88, 3.39)); AUSCAN pain, β=10.57 (4.00, 17.13)), poorer AUSCAN function (β=4.07 (1.28, 6.86)), and poorer grip strength (β=-0.15 psi (-0.27, -0.03)). Power Doppler imaging (PDI) synovitis was associated with greater pain (VAS β=2.61 (1.03, 4.19), AUSCAN pain (β=13.07 (3.82, 22.32)), but not function. Joint deformity was associated with poorer function (β=4.51 (1.75, 7.26)) and grip strength (β=-0.23 (-0.40, -0.05)) but not pain. Grey-scale synovitis was associated only with poorer grip strength (β=-0.22 (-0.41, -0.04)). Associations with function and grip strength were partially mediated by pain.Conclusion: Joints which are tender on palpation or have US-identified PDI synovitis are potential treatment targets for hand pain. Treating tender joints and preventing hand deformity is required to improve hand function in community-dwelling older adults.

Item Type: Article
Authors/Creators:Mattap, SM and Laslett, LL and Squibb, K and Wills, K and Otahal, P and Pan, F and Aitken, D and Keen, H and Cicuttini, F and Winzenberg, T and Jones, G
Keywords: clinical hand assessment, hand function, hand osteoarthritis, hand pain, physical hand assessment, stiffness, ultrasound
Journal or Publication Title: Arthritis Care & Research
Publisher: John Wiley & Sons, Inc.
ISSN: 2151-464X
DOI / ID Number: 10.1002/acr.24128
Copyright Information:

Copyright 2019 American College of Rheumatology. This is the peer reviewed version of the following article, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

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