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Condition

Hand Osteoarthritis (Finger Joints)

Wear-and-tear arthritis of the small joints of the fingers. Almost everyone develops it eventually, and most people do well without surgery.

What is hand osteoarthritis?

Osteoarthritis (OA) is wear of the smooth cartilage that caps the ends of the bones inside a joint. When it happens in the fingers, it most often affects the joints closest to the fingernail (the distal interphalangeal joints, or DIP joints) and the middle finger joints (the proximal interphalangeal joints, or PIP joints). The base of the thumb is also very commonly involved, and is covered on its own page.

As the cartilage thins, the body forms small bony spurs around the joint. These appear as firm bumps on the sides of the finger — called Heberden nodes at the DIP joint and Bouchard nodes at the PIP joint. The bumps are a normal part of the condition and are not cancers or cysts.

Common symptoms

  • Firm bumps on the sides of the finger joints, most often the joints closest to the nails
  • Aching or soreness, especially after using the hand for demanding tasks
  • Stiffness, often worse in the morning and easing within 10 to 20 minutes of use
  • Gradual loss of the ability to fully bend or straighten the affected joint
  • Occasional flares of warmth and swelling in a single joint, which then settle
  • Sometimes a small fluid-filled bump (a mucous cyst) appears near the fingernail; these are strongly associated with DIP arthritis

Why does it happen?

Hand OA is strongly influenced by family history — if a parent had knobby finger joints, you are likely to develop them as well. Women are affected more often than men, and the symptoms often start in the 50s and 60s. Previous injuries to a specific joint, heavy manual work, and obesity also contribute. It is not caused by cracking the knuckles.

How it is diagnosed

The diagnosis is usually clear from the exam alone — the pattern of bumps, tenderness, and limited motion is distinctive. X-rays can confirm the degree of cartilage loss. Blood tests are not needed for typical hand OA but may be ordered if the pattern suggests an inflammatory arthritis instead (see rheumatoid arthritis).

Treatment options

Non-surgical treatment (first line)

  • Activity adjustments. Using larger grips, lighter tools, and avoiding sustained heavy gripping reduces flares.
  • Topical anti-inflammatories. Topical diclofenac gel applied to the sore joint several times a day is effective for many patients and avoids the stomach side effects of oral anti-inflammatories.
  • Oral anti-inflammatories. Short courses of ibuprofen or naproxen during flares, if safe with your other medications.
  • Warm soaks and paraffin baths. Warmth eases morning stiffness.
  • Hand therapy. A certified hand therapist can teach joint-protection techniques and custom-fit supportive sleeves or splints for specific joints.
  • Steroid injection. A small, targeted injection into an inflamed DIP or PIP joint can calm a flare. Repeated injections into the same joint are limited.

Surgical treatment

Surgery is reserved for joints that remain painful and are limiting function despite the treatments above.

  • Joint fusion (arthrodesis). The best operation for a painful, stiff DIP joint. The two bones are joined together into a single fused unit. Pain is reliably eliminated, and because most patients have already lost most of their motion at that joint, the loss of motion is usually not noticed.
  • Joint replacement (arthroplasty). Considered in selected PIP joints, particularly on the ring and small fingers where motion matters more than stability. A small implant replaces the joint surfaces.
  • Mucous cyst excision. When a DIP arthritis has produced a mucous cyst that is painful, distorting the nail, or threatening to break the skin, the cyst and the underlying bony spur are removed together.

What to expect at your visit

Dr. Barrera will examine the hand, identify which joints are most affected, and review x-rays if needed. Most patients leave the first visit with a topical or oral medication, specific activity advice, and sometimes a steroid injection. Surgery is discussed only when it is the right answer for a specific joint that is not responding to conservative care.

Dr. Barrera's approach

Hand OA is common, it tends to come and go in waves, and most joints eventually settle down on their own even without treatment. The goal of the first visit is to give you the tools to manage flares at home — topical medications, activity strategies, and the occasional injection — and to identify the rare joint that is genuinely a surgical problem. Fusion of a painful, end-stage DIP joint is one of the most reliable, most satisfying operations in hand surgery.

When to call the office sooner

Call us if a single joint becomes acutely red, hot, swollen, and severely painful (which can mean gout, pseudogout, or infection rather than OA), if a mucous cyst breaks open and drains, or if new numbness or severe weakness develops in the hand.

Related

Thumb (CMC) arthritis · Rheumatoid arthritis · Mucous cyst

Questions?

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