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

ABSTRACT

OBJECTIVE: 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. METHODS: 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. RESULTS: 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 ß = 2.63 [95% confidence interval (95% CI) 1.88, 3.39]; AUSCAN pain ß = 10.57 [95% CI 4.00, 17.13]), poorer AUSCAN function (ß = 4.07 [95% CI 1.28, 6.86]), and poorer grip strength (ß = -0.15 [95% CI -0.27, -0.03]). Power Doppler imaging (PDI) synovitis was associated with greater pain (VAS ß = 2.61 [95% CI 1.03, 4.19]; AUSCAN pain ß = 13.07 [95% CI 3.82, 22.32]), but not function. Joint deformity was associated with poorer function (ß = 4.51 [95% CI 1.75, 7.26]) and grip strength (ß = -0.23 [95% CI -0.40, -0.05]), but not pain. Gray-scale synovitis was associated only with poorer grip strength (ß = -0.22 [95% CI -0.41, -0.04]). Associations with function and grip strength were partially mediated by pain. CONCLUSION: 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.