Osteoarthritis in the Hand

Recognizing Osteoarthritis in the Hand

Pain and stiffness due to arthritis in a hand(s) can affect a person’s ability to do everything from preparing meals to using a cell phone. Recognizing the symptoms of hand osteoarthritis and getting an accurate diagnosis are the first steps to getting treatment and making everyday tasks easier.

Symptoms of Osteoarthritis of the Hand

• Pain and stiffness. People with hand arthritis often complain of localized pain in the thumbs, knuckles (DIP/PIP), and/or wrists. Stiffness may be worse after periods of inactivity. Everyday tasks such as using a smartphone or buttoning a shirt may become more difficult to perform.
•  Hand weakness.A person with hand osteoarthritis may notice that the affected hand(s) seems weaker than it was before osteoarthritis symptoms occurred. Gripping and pinching objects may be more difficult. For example, a person may have trouble opening jars or turning the ignition key of a car.
• Carpal tunnel syndrome. When arthritis changes the bony and soft tissue structures in the wrist, an area within the wrist called the carpal tunnel can shrink, becoming more narrow. As the tunnel shrinks, it squeezes the nerve that travels through it, causing numbness and/or tingling in the thumb, index finger, long finger, and half of the ring finger.
• Bouchard’s nodes. These bony growths develop in the middle knuckle, or PIP joint, making the knuckle look bigger or swollen. Bouchard’s nodes can make it difficult to get a ring on and off a finger.
• Heberden’s nodes. Like Bouchard’s nodes, Heberden’s nodes are bony growths that develop in the end-most knuckle, or DIP joint.
• Knobby-looking thumb. People who have osteoarthritis at the basilar joint of their thumbs may notice the base of the thumb looks “knobby” or “squared off.” This is a sign that bony growths have developed on the bones of the joint.

If hand pain comes on suddenly, it is more likely to be caused by trauma or another condition, not by osteoarthritis. If fingers, palms and/or wrists feel hot or the skin around a joint turns red, then osteoarthritis is probably not the culprit. An infection, rheumatoid arthritis, or another condition may be the cause, and consultation with a medical professional is advised.

Diagnosing Osteoarthritis of the Hand

There is no single test for osteoarthritis of the hand. Rather, doctors use several approaches to decide whether hand symptoms are caused by osteoarthritis or something else.

• Patient interview. The doctor will ask the person about which joints hurt, what activities make the pain worse, and how long he or she has been experiencing symptoms. Some patients may be asked to fill out a questionnaire about how pain affects their everyday activities. The doctor may also ask if the patient has a family history, previous injury, or job that puts him or her at higher risk for hand osteoarthritis.

• Clinical evaluation. Just looking at the hands can give a doctor an idea whether or not a person has osteoarthritis. Bouchard’s nodes, Heberden’s nodes, and a knobby-looking thumb are all indicators of osteoarthritis. The doctor will also try to trigger pain by palpating the hands—feeling them and pressing on certain areas—and asking the patient to do certain tasks, such as grasping an object.
• Medical imaging. X-rays can show the development of bony growths called osteophytes, loss of joint space caused by the loss of articular cartilage, and other changes.

• Occupational therapy can strengthen the joints in the wrists and fingers, improve hand dexterity, and protect joints from further degeneration. For many patients, hand exercises can be the most cost effective treatment option.
• Periodic rest can give joints as well as the tendons in the hand a needed break. For example, people who type at a computer may need to take regular breaks or divide their work into regular intervals, working for just two or three hours at a time.
• Heat, either warm compresses or paraffin wax hand baths, can soothe affected joints. By warming the viscous joint fluid contained in each joint capsule, heat can help maintain hand flexibility.

When Hand Pain Is Osteoarthritis

Aching, stiff fingers and wrists can be a sign of osteoarthritis in the hands. This type of arthritis occurs when the smooth, slippery cartilage that normally provides a cushion between the small bones of the hand has deteriorated. Most adults over the age of 55 have signs of hand osteoarthritis that can be seen on X-rays, even though not all are Osteoarthritis can affect just one joint, such as the joint at the base of the thumb, or it can affect several joints of the hand at the same time. When it occurs in the fingers, bony cysts may grow, making the knuckles look bigger and making it more difficult to get rings on and off.

Does It Matter If You Are Right-Handed or Left-Handed?

A 2016 study2 of more than 1,000 people found that people developed arthritis in their right and left hands at similar rates regardless of whether they were right-handed or left-handed. However, people were more likely to report pain or difficulty completing tasks when osteoarthritis affected a dominant hand.

How Does Osteoarthritis Affect Hand Function?

People who have osteoarthritis in the thumb, index finger, and/or middle finger tend to report more problems than people who have osteoarthritis in only the ring finger or pinky.3 This is probably because the thumb, index finger, and middle finger are essential for pinching small objects (for example, picking up a quarter) and gripping objects.

One study4 of 387 men and women found that:

• Osteoarthritis in the thumb and middle finger were associated with weaker grip strength
• Osteoarthritis in the thumb and index finger were associated with weaker pinch strength

In addition, research suggests osteoarthritis in the wrist is a risk factor for carpal tunne.

Risk Factors for Hand Osteoarthritis

• Hand trauma. A broken bone, dislocation (for example, when a finger bone separates from the joint), or a previous surgery can cause damage that eventually leads to hand osteoarthritis. Symptoms may not appear until many years after the trauma.
• Malalignment of a joint(s). If the bones in the fingers or wrists do not align properly, there can be excess joint friction resulting in increased cartilage wear. A joint malalignment may exist for years before arthritis develops and becomes painful.

• Female gender and advanced age. According to a study cited by the CDC,7 9% of women and 4% of men over the age of 26 have hand osteoarthritis that causes pain and can be seen on an X-ray. Those numbers increase to 26% in women and 13% in men when considering people age 71 and older.8

• Family history. Similar to height and hair color, the likelihood of a person developing hand osteoarthritis is influenced by genetics. Researchers suspect that the genes A2BP1 and TBGF1 increase a person’s susceptibility to hand osteoarthritis,9 though genetic testing is not necessary or recommended for diagnosis.
• Obesity. Being overweight is regularly considered a risk factor for osteoarthritis in weight-bearing joints, such as hips and knees, but not for the hands. However, some researchers have found links between obesity and arthritis in the hands.10,11This link may have to do with excess fat and its effect on the body’s biochemistry.12More study is needed in this area.

Although these risk factors predispose certain individuals to hand osteoarthritis, some people without any of the above risk factors may develop the condition and some people with all of the above characteristics may never develop arthritis.