New York State Medical Treatment Guidelines for Hand / Finger Osteoarthrosis in workers compensation patients

The guidelines provided by the New York State Workers Compensation Board offer fundamental principles for addressing Hand/Finger Osteoarthrosis. These directives are intended to assist healthcare professionals in identifying appropriate therapeutic approaches within the context of a comprehensive assessment.

Healthcare professionals with expertise in managing Hand/Finger Osteoarthrosis can rely on the guidance outlined by the Workers Compensation Board to make well-informed decisions about the most suitable therapeutic methods for their patients.

It is important to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The final decision regarding the management of Hand/Finger Osteoarthrosis should involve collaboration between the patient and their healthcare provider.

Hand / Finger Osteoarthrosis

Diagnostic Studies

X-Rays to Evaluate Hand Osteoarthrosis

• Recommendation: Utilize x-rays selectively to determine objective evidence of hand osteoarthrosis extent.
• Rationale: While most patients can be managed clinically without requiring x-rays for diagnosis, they can be beneficial in certain cases, aiding in diagnosis and treatment planning.

Medications

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Hand Osteoarthrosis Pain

• Recommendation: NSAIDs are recommended for managing acute, subacute, or chronic hand osteoarthrosis pain.
• Indications: NSAIDs are the preferred treatment option for hand osteoarthrosis pain. Over-the-counter agents should be tried first.
• Frequency/Duration: Patients can use NSAIDs on an as-needed basis. Discontinuation is warranted upon symptom resolution, lack of efficacy, or adverse effects development.

NSAIDs for Patients at Risk of Gastrointestinal Bleeding

• Recommendation: Combine NSAIDs with cytoprotective medications for patients at high risk of gastrointestinal bleeding.
• Indications: High-risk patients, such as those with a history of gastrointestinal bleeding, should receive cytoprotective medications alongside NSAIDs.
• Frequency/Dose/Duration: Proton pump inhibitors, misoprostol, sucralfate, and H2 blockers are recommended. Dosage and frequency align with manufacturer guidelines.

NSAIDs for Patients at Risk of Cardiovascular Adverse Effects

• Recommendation: Discuss the risks and benefits of NSAID therapy with patients at risk of cardiovascular adverse effects.
• Preferred NSAIDs: Acetaminophen or aspirin is preferred as the first-line therapy due to their safer cardiovascular profile. Non-selective NSAIDs are preferred over COX-2 specific drugs if needed.
• Interaction with Aspirin: When taken with low-dose aspirin for cardiovascular disease prevention, NSAIDs should be consumed at least 30 minutes after or 8 hours before aspirin.

Acetaminophen for Hand Osteoarthrosis Pain

• Recommendation: Acetaminophen is recommended for managing hand osteoarthrosis pain, especially in patients with NSAID contraindications.
• Indications: All patients with hand osteoarthrosis pain can use acetaminophen.
• Dose/Frequency: Follow manufacturer recommendations; use as needed. Caution should be exercised not to exceed four grams per day due to potential hepatic toxicity.

Topical NSAIDs for Hand Osteoarthrosis

• Recommendation: Topical NSAIDs are recommended for controlling pain associated with hand osteoarthrosis.
• Indications: Suitable for mild, moderate, or severe hand osteoarthrosis.
• Frequency/Duration: Follow manufacturer recommendations. Discontinue use upon symptom resolution, intolerance, adverse effects, or lack of benefits.

Opioids

• Not Recommended: Opioids are not recommended for managing hand osteoarthrosis pain.
• Limited Use: Limited use (not exceeding seven days) is advised for postoperative pain management as adjunctive therapy to more effective treatments.
• Indications: Opioids can be prescribed for brief postoperative pain management, particularly for nocturnal use to aid sleep.