Hand and Finger Osteoarthritis: Symptoms, Causes & Treatment

What Is Hand and Finger Osteoarthritis?

Hand osteoarthritis is a degenerative joint condition where the protective cartilage in finger and hand joints breaks down over time, causing pain, stiffness, swelling, and reduced grip strength. It most commonly affects the thumb base (trapeziometacarpal joint), the end joints of fingers (DIP joints), and the middle joints (PIP joints).

Osteoarthritis of the hand is one of the most common forms of arthritis, affecting approximately 40-50% of people over age 60. The condition develops when the cartilage—the smooth, protective tissue that covers the ends of bones in joints—wears away faster than the body can repair it. As cartilage deteriorates, the bones in the joint begin to rub against each other, causing pain, inflammation, and eventually changes in the joint's structure.

The hands contain 27 bones and numerous joints, making them particularly vulnerable to osteoarthritis. The condition typically progresses slowly over many years, and while it cannot be reversed, symptoms can be effectively managed with appropriate treatment. Understanding the nature of hand osteoarthritis is the first step toward maintaining hand function and quality of life.

Hand osteoarthritis differs from inflammatory forms of arthritis like rheumatoid arthritis in several important ways. While rheumatoid arthritis is an autoimmune disease that causes inflammation throughout the body and typically affects joints symmetrically, osteoarthritis is primarily a mechanical condition resulting from wear and tear. This distinction is crucial because the treatment approaches differ significantly between these conditions.

Types of Hand Osteoarthritis

Hand osteoarthritis can be classified based on which joints are affected. Understanding the different types helps doctors plan appropriate treatment and predict how the condition may progress.

Thumb base osteoarthritis (trapeziometacarpal or CMC arthritis) is the most common and often the most debilitating form of hand OA. This joint at the base of the thumb is essential for gripping, pinching, and grasping objects. When arthritis develops here, everyday activities like opening jars, turning keys, or holding a pen become painful and difficult. The thumb may develop a "square" appearance at the base as the condition progresses.

Finger joint osteoarthritis typically affects the distal interphalangeal (DIP) joints—the joints closest to the fingernails—and the proximal interphalangeal (PIP) joints—the middle joints of the fingers. DIP joint arthritis often produces characteristic bony bumps called Heberden's nodes, while PIP joint involvement may cause Bouchard's nodes. These nodes are not just cosmetic; they represent structural changes in the joint that can affect finger alignment and function.

Wrist osteoarthritis is less common but can occur, particularly following previous injuries like fractures. When present, it causes pain and stiffness that can significantly limit wrist movement and hand function.

Who Gets Hand Osteoarthritis?

While anyone can develop hand osteoarthritis, certain factors significantly increase the risk. Age is the strongest predictor—the condition is rare before age 40 but becomes increasingly common with each decade of life. Women are 2-3 times more likely than men to develop hand OA, with risk increasing notably after menopause, suggesting a hormonal component to the disease.

Genetics plays a substantial role in hand osteoarthritis. If your parents or siblings have developed bony nodes on their fingers, you have a higher likelihood of developing them too. Research has identified several genes associated with hand OA susceptibility, though the inheritance pattern is complex and involves multiple genetic and environmental factors.

What Causes Osteoarthritis in Hands and Fingers?

Hand osteoarthritis develops when joint cartilage breaks down faster than it can repair itself. Contributing factors include aging, genetic predisposition, female gender, previous hand injuries, obesity, and repetitive hand use. The exact cause is often unknown, but the condition results from a combination of mechanical stress and biological factors.

The development of hand osteoarthritis involves a complex interplay of mechanical, biological, and genetic factors. Unlike the simple "wear and tear" explanation that was once popular, modern understanding recognizes that osteoarthritis is an active disease process involving the entire joint structure—not just the cartilage, but also the underlying bone, joint lining (synovium), ligaments, and surrounding muscles.

Healthy cartilage consists of specialized cells called chondrocytes embedded in a matrix of collagen and proteoglycans. This matrix gives cartilage its unique properties—the ability to absorb shock and allow smooth, nearly frictionless joint movement. In osteoarthritis, the balance between cartilage breakdown and repair becomes disrupted. The chondrocytes begin producing enzymes that degrade the cartilage matrix faster than it can be rebuilt, leading to progressive cartilage loss.

As cartilage thins, the underlying bone responds by becoming denser (sclerotic) and forming new bone at the joint margins (osteophytes). These osteophytes are what form the characteristic Heberden's and Bouchard's nodes on arthritic fingers. The synovium may also become inflamed, contributing to joint pain and swelling even though OA is not primarily an inflammatory disease.

Risk Factors for Hand Osteoarthritis

Several factors increase the likelihood of developing hand osteoarthritis:

• Age over 50: Cartilage naturally loses water content and becomes less resilient with age, making it more susceptible to damage
• Female gender: Women are significantly more likely to develop hand OA, particularly after menopause when estrogen levels decline
• Genetic factors: Family history of hand OA, especially Heberden's nodes, strongly predicts individual risk
• Previous hand injuries: Fractures, dislocations, or ligament injuries to fingers can lead to post-traumatic osteoarthritis
• Obesity: While hand joints don't bear body weight, obesity is associated with higher rates of hand OA, possibly due to metabolic factors
• Repetitive hand use: Occupations involving repetitive gripping, pinching, or fine motor movements may increase risk
• Joint hypermobility: People with unusually flexible joints may be at higher risk for developing OA

What Are the Symptoms of Hand Osteoarthritis?

Hand osteoarthritis symptoms include joint pain during activities like gripping or pinching, morning stiffness lasting less than 30 minutes, swollen or enlarged finger joints, reduced grip strength, bony bumps (nodes) on fingers, difficulty with fine motor tasks, and joint warmth or tenderness. Symptoms typically worsen gradually over time.

The symptoms of hand osteoarthritis typically develop gradually over months to years. Initially, you may notice mild aching or stiffness in your fingers or thumb, particularly in the morning or after periods of inactivity. As the condition progresses, symptoms become more pronounced and may significantly impact daily activities.

Pain is the hallmark symptom of hand osteoarthritis. Unlike inflammatory arthritis where joints hurt even at rest, OA pain is characteristically "use-related"—it worsens with activity and improves with rest. You may find that activities requiring grip strength, such as opening jars, turning doorknobs, or writing, trigger or worsen your pain. In advanced stages, however, pain may occur even at rest or disturb sleep.

Morning stiffness is common but typically brief, lasting less than 30 minutes. This contrasts with rheumatoid arthritis, where morning stiffness often persists for an hour or more. The stiffness of hand OA tends to improve quickly once you begin moving your hands and start your daily activities.

Joint Changes and Deformity

As hand osteoarthritis progresses, visible changes develop in the affected joints. Heberden's nodes—bony enlargements at the DIP joints (the joints closest to your fingernails)—are particularly characteristic. These nodes develop gradually, often starting as firm bumps that may initially be tender or inflamed. Over time, they become harder and less painful but remain as permanent features.

Bouchard's nodes are similar bony enlargements that develop at the PIP joints (the middle joints of the fingers). While less common than Heberden's nodes, they indicate more extensive hand OA involvement. Both types of nodes can affect finger alignment, causing deviation toward one side or the other.

The thumb base joint (CMC joint) often develops a squared appearance when affected by OA. This occurs because the metacarpal bone at the base of the thumb shifts position as cartilage wears away. The resulting deformity can significantly impact grip strength and the ability to perform pinching movements.

Functional Impact

Hand osteoarthritis affects daily functioning in numerous ways. Grip strength typically decreases as pain and joint damage progress. You may notice difficulty:

• Opening jars, bottles, or containers
• Turning keys or doorknobs
• Buttoning clothing or manipulating zippers
• Writing or typing for extended periods
• Holding books, phones, or tablets
• Preparing food or using kitchen utensils
• Personal care tasks like brushing teeth or hair

The impact on quality of life should not be underestimated. Hands are essential for nearly every daily activity, and chronic pain combined with reduced function can lead to frustration, dependence on others, and even depression. Recognizing these impacts is important for developing a comprehensive treatment approach.

When Should You See a Doctor for Hand Pain?

See a doctor if hand pain persists for more than a few weeks, if joints are visibly swollen or warm, if morning stiffness lasts longer than 30 minutes, if you're having difficulty with daily activities, or if you notice lumps forming on your finger joints. Early diagnosis allows for earlier treatment and better outcomes.

Many people dismiss early hand pain as a normal part of aging, delaying medical evaluation until symptoms significantly impact their lives. However, early diagnosis and treatment of hand osteoarthritis can help slow disease progression and maintain hand function longer. There's no need to wait until you can no longer open jars or button your shirt before seeking help.

You should schedule an appointment with a healthcare provider—either your primary care doctor, an occupational therapist, or a rheumatologist—if you experience any of the following:

• Persistent hand or finger pain lasting more than several weeks
• Joint swelling, warmth, or redness
• Morning stiffness lasting 30 minutes or longer
• Difficulty performing daily tasks that were previously easy
• Visible changes in joint shape or finger alignment
• Lumps or bumps developing on finger joints
• Decreased grip strength or fine motor control
• Over-the-counter pain medications not providing adequate relief

An occupational therapist can often be your first point of contact for hand concerns. These specialists assess hand function, provide exercises, fit splints, and teach joint protection strategies. In many healthcare systems, you can see an occupational therapist without a referral from a doctor.

How Is Hand Osteoarthritis Diagnosed?

Hand osteoarthritis is diagnosed through physical examination of your hands and fingers, review of your symptoms and medical history, and sometimes X-rays. Blood tests may be ordered to rule out inflammatory arthritis but are not needed to diagnose OA. In most cases, a diagnosis can be made based on clinical findings alone.

Diagnosing hand osteoarthritis typically involves a clinical examination rather than extensive testing. An experienced healthcare provider can often make the diagnosis based on your symptoms, the pattern of joint involvement, and physical examination findings. The characteristic Heberden's and Bouchard's nodes, combined with typical symptom patterns, are usually sufficient for diagnosis.

During the physical examination, your doctor will assess each hand joint for tenderness, swelling, warmth, and range of motion. They'll look for bony enlargements, check for crepitus (a grinding sensation during joint movement), and evaluate your grip strength and hand function. The examination also helps rule out other conditions that can cause hand pain.

Imaging Studies

X-rays can show the hallmark features of osteoarthritis: narrowing of the joint space (indicating cartilage loss), osteophytes (bone spurs), subchondral sclerosis (increased bone density beneath the cartilage), and cysts in the bone. However, it's important to understand that X-ray findings don't always correlate with symptoms—some people with severe X-ray changes have minimal pain, while others with early X-ray findings have significant symptoms.

In early osteoarthritis, X-rays may appear normal because cartilage doesn't show up on standard X-rays, and significant cartilage loss must occur before changes become visible. For this reason, a normal X-ray doesn't rule out osteoarthritis, especially if clinical findings are consistent with the diagnosis.

Advanced imaging like MRI is rarely needed for diagnosing hand osteoarthritis but may be used in research settings or when the diagnosis is unclear. MRI can detect earlier cartilage changes, bone marrow lesions, and soft tissue abnormalities that don't appear on X-rays.

Blood Tests

Blood tests are not needed to diagnose osteoarthritis itself, as OA doesn't cause abnormalities in standard blood work. However, blood tests may be ordered to rule out other conditions, particularly inflammatory forms of arthritis:

• Rheumatoid factor (RF) and anti-CCP antibodies: Typically negative in OA, elevated in rheumatoid arthritis
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Usually normal in OA, elevated in inflammatory conditions
• Uric acid: May be checked if gout is suspected
• Complete blood count: To assess overall health and rule out other conditions

How Is Hand Osteoarthritis Treated?

Hand osteoarthritis treatment combines multiple approaches: hand exercises to maintain mobility and strength, splints for support and pain relief, pain medications like acetaminophen or NSAIDs, lifestyle modifications, ergonomic aids, corticosteroid injections for severe symptoms, and surgery for cases not responding to conservative treatment. Treatment is tailored to individual symptoms and needs.

Managing hand osteoarthritis requires a multimodal approach combining exercise, lifestyle modifications, medications, and supportive devices. The goals of treatment are to reduce pain, maintain or improve hand function, prevent disability, and enhance quality of life. While OA cannot be cured, symptoms can be effectively managed, allowing most people to maintain active, independent lives.

Treatment should be individualized based on which joints are affected, the severity of symptoms, your functional needs, and your preferences. What works well for one person may not be optimal for another. Working with a healthcare team that includes your doctor, an occupational therapist, and possibly a hand therapist ensures comprehensive care.

Stay Active with Your Hands

One of the most important—and counterintuitive—recommendations for hand osteoarthritis is to keep using your hands. While it's natural to want to protect painful joints by avoiding activity, prolonged inactivity actually worsens stiffness, weakness, and overall hand function. The key is to stay active while being smart about how you use your hands.

Continue with normal daily activities, but take regular breaks to rest your hands, especially during tasks requiring sustained gripping or pinching. When pain increases, modify your technique or take a pause rather than pushing through. Learning to listen to your body and finding the right balance between activity and rest is essential.

Avoid positions that put excessive stress on affected joints, particularly the thumb base. For example, try to use your palm rather than your thumb when pushing yourself up from a chair. When possible, distribute loads across multiple joints rather than concentrating force on one joint.

Hand Exercises

Regular hand exercises are one of the most effective treatments for hand osteoarthritis. Exercise programs designed for hand OA have been shown to reduce pain, improve grip strength, and enhance hand function. An occupational therapist or physical therapist can design a personalized exercise program targeting your specific needs.

Exercise programs typically include three components:

Range-of-motion exercises maintain joint flexibility and prevent stiffness from worsening. These gentle movements take each joint through its full available range without forcing beyond comfortable limits. Examples include making a fist and then spreading fingers wide, touching your thumb to each fingertip, and bending and straightening finger joints.

Strengthening exercises maintain or improve the muscle strength needed for gripping and pinching. Squeezing a soft stress ball or therapy putty, pinching exercises against resistance, and finger extension against a rubber band are common strengthening exercises. Start with gentle resistance and gradually increase as tolerated.

Stretching exercises help maintain flexibility in the tissues surrounding joints. Gentle stretches held for 15-30 seconds can reduce stiffness and improve comfort during activities.

Osteoarthritis Education Programs

Education programs, sometimes called "arthritis schools," provide comprehensive information about osteoarthritis and practical strategies for managing the condition. These programs, often led by occupational therapists or physical therapists, teach joint protection techniques, exercise programs, ergonomic principles, and self-management strategies.

Research consistently shows that people who participate in arthritis education programs have better outcomes than those who don't. The knowledge and skills gained help you become an active partner in managing your condition rather than a passive recipient of treatment.

Programs may be offered individually, in groups, or online. Group programs offer the additional benefit of connecting with others who understand what you're experiencing, providing social support and opportunities to share practical tips.

Pain Medications

Medications can help manage pain but should generally be used in combination with non-drug treatments rather than as the sole approach. Starting with the safest options at the lowest effective doses minimizes the risk of side effects.

Acetaminophen (paracetamol) is often the first medication recommended. It's effective for mild to moderate pain and has fewer side effects than other options when used at recommended doses. However, it doesn't address inflammation and requires careful attention to dosing limits to protect the liver.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or diclofenac can be more effective than acetaminophen, particularly when there's joint inflammation. They're available in oral forms and topical preparations (gels or creams) applied directly to painful joints. Topical NSAIDs are particularly useful for hand osteoarthritis because they provide local relief with minimal systemic absorption and fewer gastrointestinal side effects.

Oral NSAIDs should be used at the lowest effective dose for the shortest necessary duration due to potential side effects affecting the stomach, kidneys, and cardiovascular system. People with certain health conditions may need to avoid them or use them with caution.

Splints and Orthoses

Splints provide external support to affected joints, reducing pain during activities and potentially slowing the progression of deformity. An occupational therapist can recommend and fit appropriate splints based on which joints are affected and what activities you need to perform.

For thumb base osteoarthritis, a thumb splint or orthosis stabilizes the CMC joint while allowing finger movement. This can significantly reduce pain during pinching and gripping activities. Some people wear their splint throughout the day, while others use it only during specific activities or at night.

Finger splints may be used for individual finger joints, particularly if alignment is becoming affected. Ring splints are discrete, jewelry-like devices that prevent hyperextension while allowing normal finger bending.

Ergonomic Aids and Assistive Devices

Numerous products can make daily tasks easier and reduce stress on hand joints. An occupational therapist can assess your needs and recommend appropriate aids:

• Built-up handles: Larger-diameter grips on pens, utensils, and tools reduce the force needed to hold them
• Jar openers: Electric or manual devices that open jars without requiring strong grip or twisting
• Key turners: Extended handles that provide more leverage for turning keys
• Button hooks: Tools that assist with buttoning when finger dexterity is limited
• Ergonomic kitchen tools: Vegetable peelers, can openers, and other utensils designed for arthritic hands
• Electric devices: Electric can openers, jar openers, and scissors reduce manual effort

Workplace adaptations may also be beneficial. Ergonomic keyboards, vertical mice, voice recognition software, and other assistive technology can reduce hand strain during computer work. If your job involves significant hand use, an occupational health assessment can identify modifications to protect your joints.

Corticosteroid Injections

For joints that remain significantly painful despite other treatments, corticosteroid injections directly into the joint can provide relief. The medication reduces inflammation within the joint, often providing weeks to months of pain relief.

Injections are particularly useful for thumb base arthritis and can allow people to delay or avoid surgery. However, they provide temporary relief rather than a cure, and repeated injections may be needed. There are limits to how frequently injections should be given due to potential effects on joint tissues with repeated use.

The procedure involves inserting a needle into the joint space and injecting a small amount of corticosteroid, sometimes combined with a local anesthetic for immediate pain relief. Most people tolerate the procedure well, though brief discomfort at the injection site is common.

Surgery

Surgery is reserved for people with severe symptoms that significantly impact daily life and haven't responded adequately to conservative treatment. Surgical options depend on which joints are affected:

Trapeziectomy is the most common surgery for thumb base arthritis. It involves removing the trapezium bone—one of the small carpal bones at the base of the thumb. A tendon graft may be used to stabilize the thumb. Recovery takes several months, but most people achieve significant pain relief while maintaining reasonable thumb mobility and function.

Joint fusion (arthrodesis) permanently connects the bones on either side of an arthritic joint, eliminating the joint and its pain. While this stops movement at that joint, it provides stability and preserves strength. Fusion is commonly used for the DIP joints (end joints of fingers) where some loss of mobility is acceptable in exchange for pain relief and stability.

Joint replacement (arthroplasty) involves replacing damaged joint surfaces with artificial components. This option aims to maintain joint mobility while relieving pain. It's most commonly considered for PIP joints and may be an option for the thumb base in selected cases.

After any hand surgery, rehabilitation with a hand therapist is essential for optimal outcomes. This may include splinting, exercises, scar management, and gradual return to activities. Full recovery typically takes several months.

What Happens in the Body with Hand Osteoarthritis?

In hand osteoarthritis, the cartilage covering bone surfaces within finger joints breaks down and thins over time. As cartilage wears away, bone responds by becoming denser and forming bony spurs (osteophytes). Eventually, bones may contact each other directly, causing pain, inflammation, and joint damage. This process occurs gradually over years to decades.

Understanding the biological processes underlying hand osteoarthritis helps explain why symptoms develop and how treatments work. Each joint in your hand consists of two or more bones whose ends are covered with articular cartilage—a specialized tissue with remarkable properties that allow smooth, nearly frictionless movement.

Healthy cartilage is composed of cells called chondrocytes embedded in a matrix of collagen fibers and proteoglycans (large molecules that attract and hold water). This structure gives cartilage its unique combination of strength, resilience, and smoothness. The high water content—about 70-80% in healthy cartilage—provides cushioning and allows the tissue to distribute loads across the joint surface.

In osteoarthritis, the balance between cartilage breakdown and repair tips toward destruction. Chondrocytes begin producing enzymes that degrade the collagen and proteoglycan matrix. At the same time, the cells produce inflammatory chemicals that perpetuate the cycle of damage. Cartilage loses water content, becoming thinner, less resilient, and more susceptible to mechanical damage.

As cartilage thins, the underlying bone experiences altered mechanical stresses. The bone responds by becoming denser (sclerosis) and forming new bone at the joint margins (osteophytes). These osteophytes are what form the characteristic Heberden's and Bouchard's nodes visible on arthritic fingers. While often called "bone spurs," osteophytes actually represent the bone's attempt to stabilize the damaged joint by increasing its surface area.

The joint lining (synovium) often becomes inflamed in osteoarthritis, though not to the degree seen in inflammatory arthritis like rheumatoid arthritis. This synovial inflammation contributes to pain and swelling and may accelerate cartilage damage through production of additional inflammatory chemicals.

In advanced osteoarthritis, cartilage may wear through completely in some areas, allowing direct bone-to-bone contact. This causes severe pain and further accelerates joint damage. The joint capsule may stretch and weaken, contributing to joint instability and deformity. These late-stage changes explain why severely arthritic joints can become significantly deformed over time.

How Can You Manage Daily Life with Hand Osteoarthritis?

Living well with hand osteoarthritis involves protecting joints during activities, using ergonomic tools and aids, pacing activities to avoid overuse, maintaining hand strength and flexibility through regular exercise, applying heat or cold for symptom relief, and working with healthcare providers to optimize treatment. Most people maintain independence with appropriate adaptations.

A diagnosis of hand osteoarthritis doesn't mean giving up the activities you enjoy or becoming dependent on others. With appropriate strategies and adaptations, most people maintain active, independent lives. The key is working smarter, not harder—using techniques and tools that accomplish tasks while minimizing stress on your joints.

Joint Protection Principles

Joint protection involves modifying how you perform activities to reduce stress on affected joints. While these changes may feel awkward at first, they become second nature with practice:

• Use larger, stronger joints when possible: Carry bags over your forearm rather than in your hand; push doors open with your body rather than your hand
• Distribute loads across multiple joints: Use both hands to lift objects; spread your fingers wide when pushing or lifting
• Avoid sustained gripping: Take breaks during activities requiring prolonged grip; use adaptive devices that reduce grip force
• Maintain good posture: Poor positioning can increase strain on hand joints
• Use tools with padded, ergonomic handles: Built-up handles require less grip strength
• Slide objects rather than lifting: Sliding a pot across the stove is easier than picking it up

Pacing Activities

Rather than pushing through tasks until pain forces you to stop, pacing involves alternating activity with rest before symptoms worsen. This approach maintains productivity while protecting your joints.

Break large tasks into smaller segments with rest breaks between them. If you're gardening, for example, work for 15-20 minutes, rest for 5-10 minutes, then continue. Alternate between tasks requiring grip strength and those that don't. Listen to your body—mild aching during activity is often acceptable, but sharp pain or significantly increased symptoms signal the need to stop or modify what you're doing.

Heat and Cold Therapy

Temperature therapy can provide symptom relief when used appropriately. Heat increases blood flow, relaxes muscles, and reduces stiffness—making it ideal before activities or exercise. Warm water soaks, heating pads, and paraffin wax baths are common heat treatments for hands.

Cold reduces swelling and numbs pain, making it useful after activities or during flares. Ice packs wrapped in a towel, cold gel packs, or even a bag of frozen vegetables can be applied to painful joints for 15-20 minutes at a time.

Individual preferences vary—some people find heat more helpful, others prefer cold, and many use both depending on the situation. Experiment to find what works best for you.

Maintaining Quality of Life

Beyond physical management, maintaining emotional well-being and staying engaged with activities you value are essential. Chronic pain and functional limitations can lead to frustration, anxiety, and depression if not addressed.

Stay connected with friends and family. Maintain hobbies and interests, adapting them as needed—many crafts, sports, and activities can be modified for people with hand limitations. Consider joining a support group where you can share experiences and learn from others managing similar challenges.

If you're struggling emotionally with your diagnosis or its impact on your life, don't hesitate to seek support. Mental health professionals can help you develop coping strategies and address any depression or anxiety that may develop.