Hand Examination, Ultrasound, and the Association With Hand Pain and Function in Community-Based Older Adults

To describe cross-sectional associations between features observed on ultrasound (US) or clinical joint examination and hand symptoms among community-dwelling older adults (n = 519), and to determine whether such associations are independent of age, sex, body mass index, and other imaging features.

Hand pain, function, and stiffness were assessed using a visual analog scale (VAS) and the Australian/Canadian Hand Osteoarthritis (AUSCAN) index. Standardized clinical and US examinations were performed, and grip strength was assessed using a dynamometer. Data were analyzed using hurdle and linear models and adjusted for demographic factors and other features.

Abnormal findings on joint examination and on US imaging 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% confidence interval (95% CI) 1.88, 3.39]; AUSCAN pain: β = 10.57 [95% CI 4.00, 17.13]), poorer AUSCAN function (β = 4.07 [95% CI 1.28, 6.86]), and poorer grip strength (β = -0.15 [95% CI -0.27, -0.03]). Power Doppler imaging (PDI) synovitis was associated with greater pain (VAS: β = 2.61 [95% CI 1.03, 4.19]; AUSCAN pain: β = 13.07 [95% CI 3.82, 22.32]), but not function. Joint deformity was associated with poorer function (β = 4.51 [95% CI 1.75, 7.26]) and grip strength (β = -0.23 [95% CI -0.40, -0.05]), but not pain. Gray-scale synovitis was associated only with poorer grip strength (β = -0.22 [95% CI -0.41, -0.04]). Associations with function and grip strength were partially mediated by pain.

Joints that 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.