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The Health Brief
Hands

Every doorknob in this house is now a lever

The first thing on the guideline list is not a drug. It is your kitchen.

3 min read

Live well

It took me a Saturday and eleven dollars a door to stop dreading the back porch.

A round doorknob asks your thumb and fingers to pinch and twist at once. That is the exact movement a worn thumb base hates most. Our back door had a stiff one.

A lever handle asks nothing of the thumb. You lean on it with the side of your hand… or your forearm. Or an elbow, if your hands are full.

Carol pointed out that I had spent months reading trials and about four minutes looking at my own house. She was right. So that is today's letter.

The first line of the guideline

I want to show you something about how this is meant to be treated, because it surprised me.

The 2018 EULAR recommendations for hand arthritis run to ten items. The first one is not a pill and not a splint. It reads: education and training in ergonomic principles, pacing of activity, and use of assistive devices should be offered to every patient.

Ergonomic principles is a clumsy phrase for a simple idea. Change the object, not the joint. Exercise comes second on that list. Topical rubs come fourth… the first drug the panel reaches for, ahead of any pill you swallow. Ask your own doctor about that one.

So the dull kitchen stuff is not a consolation prize for people who cannot manage the real treatment. It is the top of the list. By the way, that ordering was deliberate.

Four swaps that cost almost nothing

None of these need a catalogue of gadgets. Three of the four are just a different way of using what you already have.

 

Swap the pinch for the palm

A pinch between thumb and finger loads the thumb base hardest. Carry a bag on your forearm, not in your fingers. Lift a plate with a flat hand under it. Push a door with the heel of your hand. The rule is short. Use the biggest part of you that will do the job.

 

Make the handle bigger

A fat handle needs less grip than a thin one. Slide a length of foam pipe insulation onto a pen, a peeler, a garden tool. Lever handles instead of round knobs. A jar opener that grips the lid so your thumb does not have to.

 

Let the counter do the work

Rest the jar against your body or in a drawer edge and turn with a flat palm. Slide a heavy pot along the counter rather than lifting it. Fill the kettle to the line you need, not to the top, because water is the heaviest thing in most kitchens.

 

Pace it, do not push it

Pacing is on that guideline list for a reason. Break the long jobs into short ones. Peel half the vegetables, put the kettle on, come back. A hand that is asked for ten minutes at a time keeps going all day. A hand asked for forty pays for it that evening.

 

The keys took me longest. A small key in a stiff lock is the worst pinch in the house… and I could not swap the lock.

So I bought a key turner for six dollars. It is a plastic handle you clip the key into, the size of a walnut, and it turns the lock with a whole hand instead of a thumb and a finger.

So that is the pattern, if there is one. Nobody sells you a cure for this. What is on offer is a hundred small refusals to load the joint. They add up to a day that does not end in an ache.

Eleven dollars a door, six for the keys, four for the pipe insulation. My whole hand budget for the year is under fifty, and it has done more than the splint did.

When to stop and call your doctor

Changing how you hold things should ease pain, never add it. See your doctor if a hand joint is hot, red and swollen, if your grip fails suddenly or you drop things without meaning to, if you get numbness or pins and needles at night, or if a finger locks and will not straighten. Sudden weakness in a hand needs same day advice.

Here is to a door you can open,
Walt

One useful thing a day

Start with tomorrow morning.

A stretch, a sleeping position, a heat trick for a stiff hour. Short enough to read with your coffee. If one does not fit, skip it. The next one might.

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