Two Completely Different Conditions Called “Hand Arthritis”

Hand arthritis is not one condition — it is a term used for two fundamentally different diseases that require different management. Getting the distinction right is the first step to effective treatment.

• Osteoarthritis (OA): Mechanical cartilage wear over time. Affects specific joints (thumb CMC, finger DIP and PIP joints). More common in women over 50. Morning stiffness <30 minutes. Bony (hard) joint enlargement. No systemic features.
• Rheumatoid arthritis (RA): Immune-mediated inflammatory joint destruction. Affects the MCP knuckles and wrist symmetrically. Morning stiffness >60 minutes. Soft, warm joint swelling. Systemic features (fatigue, weight loss). Managed primarily by a rheumatologist.

This guide focuses primarily on hand osteoarthritis — the most common type seen in a hand surgery practice.

Which Joints Are Affected

Thumb CMC Joint (Most Common and Most Symptomatic)

The carpometacarpal joint at the very base of the thumb where it meets the wrist is the most commonly arthritic joint in the hand and the most functionally limiting. It bears enormous forces during pinch — up to 12 times the applied force at the fingertip — which accelerates cartilage wear. CMC arthritis causes deep aching with pinching, opening jars, and lifting, and eventually weakness of grip. A visible prominence may develop as the joint subluxes. See Thumb Arthritis Treatment →

DIP Joints (Heberden’s Nodes)

The end joints of the fingers (distal interphalangeal joints) are commonly arthritic in women over 50, often with a strong hereditary component. Bony swellings (Heberden’s nodes) develop at the joint margins — firm, hard, and usually painless once fully established. They may be tender and swollen during the active phase of development. Associated with occasional mucous cyst formation (fluid-filled cyst arising from the arthritic joint). Treatment is primarily conservative — topical diclofenac, joint protection, occasional cortisone injection for acute flares.

PIP Joints (Bouchard’s Nodes)

The middle finger joints (proximal interphalangeal joints) develop similar bony nodules (Bouchard’s nodes). More functionally significant than DIP involvement because PIP stiffness limits full finger flexion and grip. PIP joint arthroplasty (joint replacement) is available for severe, functionally limiting PIP arthritis in appropriate patients.

Wrist Arthritis

Post-traumatic wrist arthritis — developing years after a scaphoid fracture, scapholunate ligament tear, or distal radius fracture — is the most common cause of wrist arthritis in younger patients. Primary wrist osteoarthritis develops in older patients. Wrist arthritis causes deep wrist aching, stiffness, and loss of range of motion. Treatment progresses from splinting and injection to partial or total wrist fusion in severe cases. See Wrist Arthritis Treatment →

Non-Surgical Treatment

• Topical diclofenac (Voltaren): Best evidence-based topical treatment. Apply 4 times daily to the affected joint. 2–4 weeks for full effect. Safer than oral NSAIDs for long-term use.
• Thumb spica splint: Immobilises the CMC joint during activities that provoke pain. Particularly helpful for thumb CMC arthritis during cooking, gardening, and gripping tasks.
• Cortisone injection: Significant short-term relief for CMC arthritis and inflammatory DIP flares. 2–3 injections per year maximum to protect remaining cartilage.
• Activity modification: Joint protection techniques reduce cumulative load. Adaptive equipment (jar openers, built-up handle utensils) allows continued independence with less pain.
• Hand therapy: Strengthening exercises, splinting, and adaptive equipment assessment with a certified hand therapist.

Surgical Options

Surgery is reserved for patients who have genuinely failed comprehensive non-surgical management over at least 6 months:

• LRTI (Thumb CMC): Trapeziectomy with ligament reconstruction and tendon interposition — the gold standard for severe thumb CMC arthritis. Highly reliable pain relief. Recovery: 8–12 weeks to full function.
• PIP joint arthroplasty: Silicone or pyrocarbon joint replacement for severe PIP arthritis. Good pain relief and preserved motion. Index finger is less suitable (needs stability for pinch).
• DIP joint fusion: Fusing the end joint in a slightly flexed position — eliminates pain and provides stability. Loss of DIP motion is generally well tolerated.
• Wrist fusion / partial fusion: For severe wrist arthritis — specific patterns determine which bones are fused to relieve pain while preserving the maximum motion possible.

Frequently Asked Questions