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Arthritis in the hand is common, especially after 50 and in women. Most often it is wear and tear in the finger joints and at the base of the thumb; sometimes it is inflammation, which needs different and earlier treatment. Telling the two apart comes first — and most hand arthritis can be managed well without an operation.
Hand arthritis is not one condition. Three kinds account for most of it, and they look different, behave differently, and are treated in different ways — which is why the first step is working out which it is.
| Wear and tear osteoarthritis | Inflammatory arthritis rheumatoid, psoriatic | Gout | |
|---|---|---|---|
| Which joints | The finger end and middle joints, and the base of the thumb | The knuckles and wrists, often both hands alike | Often a single joint |
| How the joints feel | Hard, bony knobs; aching with use | Soft, warm, puffy swelling | Sudden, red and very painful attacks |
| Morning stiffness | Under half an hour | Over an hour | Not the main feature |
| Who treats it | Here — splints, injections and, if needed, surgery | A rheumatologist, with early medicines that protect the joints; we will refer you | See gout |
Warm, puffy joints in both hands, with morning stiffness lasting over an hour, should be seen within a few weeks — early treatment of inflammatory arthritis protects the joints. A single hot, swollen, very painful joint with a fever needs seeing the same day: call the clinic and come in, or go to an emergency department if we are closed. Numbness or tingling in the fingers is usually a trapped nerve rather than arthritis.
Each joint in the hand has a smooth layer of cartilage covering the bone ends. In wear-and-tear arthritis the cartilage thins, and the bone beneath grows small spurs at the edges — which is what makes the hard knobs over the finger joints.
What a picture cannot show is why the thumb base troubles people most. That small joint at the bottom of the thumb takes a surprising amount of force every time you pinch, grip or turn a key, so when it wears, everyday tasks become painful.
It also explains why the X-ray and the pain do not always match. Some knobbly, worn-looking fingers hurt very little, and some hands with mild changes hurt a great deal. Treatment is guided by how your hand feels and works, not by the picture alone.
For wear-and-tear arthritis, treatment aims to ease the pain and keep the hand working. Most people are helped by the first steps; surgery is kept for pain that persists. Inflammatory arthritis is treated by a rheumatologist, alongside anything here that helps.
A splint for the thumb base, worn at night or for heavier tasks, can ease thumb arthritis considerably. Simple gadgets — for opening jars, turning keys, or holding pens — take strain off the joints.
Gentle hand exercises keep the joints moving and the grip strong. Soaking stiff hands in warm water in the morning often loosens them up for the day.
A steroid injection into the thumb base or a painful finger joint can settle a flare, often for weeks to months. It eases the pain but does not stop the arthritis, so it is used for flares rather than routinely.
For thumb base pain that persists, removing one small wrist bone relieves the pain and keeps the thumb working. A painful finger joint can be fused so it no longer moves and hurts, or, for some joints, replaced.
Hand arthritis here is seen by Dr Palanisamy Arul Murugan, an orthopaedic surgeon whose practice covers the hand and wrist, and who treats the full range of hand conditions with both non-surgical and surgical techniques. He holds the MRCS (Edinburgh), a Master of Medicine and the FRCS in orthopaedics, and consults in English, and in Tamil or Hindi if preferred.
Not usually in themselves. They are a common sign of wear-and-tear arthritis and often stop hurting once they have formed. What matters more is how the hand feels and works.
The pattern usually tells. Rheumatoid arthritis tends to affect the knuckles and wrists of both hands, with soft, warm swelling and morning stiffness lasting over an hour. Blood tests help confirm it, and if it is suspected you will be referred to a rheumatologist.
Wear-and-tear arthritis in the hand does not spread in the way an infection does, though more joints can become affected over the years. Inflammatory arthritis can affect more joints, which is one reason early treatment matters.
Often, yes. A thumb base splint, worn at night or for heavier tasks, is one of the most effective simple treatments for arthritis there.
Most people do not. Surgery is for pain that persists despite splints, exercises and injections, or for a joint that is badly damaged or out of line.
No. Bring any hand X-rays or blood test results, and be ready to say how long the morning stiffness lasts.
Wrist pain · Gout · Carpal tunnel syndrome · De Quervain's tenosynovitis · Ganglion cysts
Be ready to say how long the stiffness lasts in the morning. It is one of the clearest clues to which kind of arthritis it is.
