Osteoarthritis of the Hands
Hand OA is very common and can be debilitating.
About half of all women and one-quarter of all men will experience the stiffness and pain of hand OA by the time they are 85 years old.
Also known as "wear and tear" arthritis, OA causes the smooth, protective cartilage on the ends of your bones to break down and wear away. Over time bones rub together, causing pain. The 29 bones of your hands and wrists come together to form many small joints that can be affected by OA.
Along with cartilage loss, OA also causes bone spurs to form. Bone spurs in and around the joints increase your stiffness and pain. With worsening OA, daily activities can become difficult and your finger joints may lose their normal shape.
OA most commonly affects three parts of the hand:
- The base of the thumb, where the thumb and wrist join (the trapeziometacarpal [TMC] or carpometacarpal [CMC] joint)
- The joint closest to the fingertip (the distal interphalangeal [DIP] joint)
- The middle joint of a finger (the proximal interphalangeal [PIP] joint)
Causes of Hand OA
Osteoarthritis usually occurs later in life, with no specific cause. But several factors can play a role, including:
- Age: the older you are, the more likely you are to have hand OA.
- Sex: women are more likely to be affected than men.
- Race: whites are more often affected than African Americans.
- Weight: obese people are more likely to have hand OA than thinner people.
- Genes: some people inherit the tendency to develop osteoarthritis, usually at a younger age.
Sometimes OA will develop as a result of an injury. Fractures and dislocations are among the most common injuries that lead to arthritis. Even when properly treated, an injured joint is more likely to develop OA over time. Joint infections, overuse, loose ligaments, and poorly aligned joints can also lead to hand or wrist arthritis.
Symptoms of Hand OA
Symptoms of hand OA can include:
- Pain: At first, pain will come and go. It worsens with use and eases with rest. Morning pain and stiffness are typical. As the arthritis advances, the pain becomes more constant and may change from a dull ache to a sharp pain. It may start waking you up at night.
- Stiffness and loss of motion: As arthritis progresses, you may lose the ability to open and close your fingers completely.
- Crepitus: When damaged joint surfaces rub together, you may feel grinding, clicking or cracking sensations.
- Swelling: Your body may respond to constant irritation and damage to the tissues surrounding the joint by swelling and becoming red and tender to the touch.
- Nodules: Bony lumps may form on the middle joint of the finger (Bouchard’s nodes) or at the joint near the fingertip (Heberden’s nodes).
- Joint deformity: Bone changes, loss of cartilage, unstable or loose ligaments, and swelling can make your finger joints large and misshapen.
- Weakness: The combination of joint pain, loss of motion and joint deformity can leave your hands weak. Activities that once were easy, such as opening a jar or starting the car, become difficult.
Diagnosing Hand OA
Your doctor will examine how your hands look and work, and may check other joints for signs of arthritis. X-rays may show loss of space in your joints – indicating cartilage loss – and formation of bone spurs. She’ll make a diagnosis by combining this information with your medical and family history.
Treatments for Hand OA
Osteoarthritis is a chronic disease. There is no cure, but treatments can help manage your symptoms and keep you active.
Start with the basics of self-care to manage your symptoms.
- Reduce strain on joints. Carry your grocery bags over your forearm instead of grasped in your fingers, for example.
- Perform hand exercises. A hand therapist can help you maintain your finger motion and function and teach you ways to protect your joints.
- Use splints. When your hands are especially painful, a splint can help support the joints. Soft, snug gloves can be worn when rigid splints are too restrictive.
- Try ice or heat. Icing your sore fingers can help reduce swelling and numb the pain. Heat from a warm compress or paraffin bath can help keep your joints mobile.
Medicines to ease OA symptoms are available as pills, syrups, creams or lotions, or they are injected into a joint. They include:
- Pain relievers like acetaminophen and anti-inflammatories like nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken to ease pain.
- Topical analgesics such as NSAID gels, capsaicin or counterirritants can be rubbed into the shoulder to reduce pain.
- Corticosteroids combined with a numbing medicine can be injected into joints of the hand. These injections provide relief for weeks to months. The number of injections you get over time will be limited due to side effects, like tendon damage.
If nonsurgical treatment fails to give relief, surgery may be an option.
- Joint fusion involves removing the damaged cartilage and fusing the bones together. The joint will not move but it will not hurt.
- Joint replacement involves removing the damaged joint and inserting an implant.