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

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.