Hand & Upper Extremity

Do your hands hurt? Have they become stiff and painful?

Do your hands hurt? Have they become stiff and painful? Do you find yourself asking for help with opening jars? Have you started to notice a decrease in your pinch and grip strength? If so, you may have wearing out of the small joints in your hand – a very common condition known as arthritis.

Arthritis literally means “inflamed joint.” Normal joints in the body consist of two bones with a smooth cartilage end caps in between them. Arthritis results when this cartilage begins to wear out and the bone ends become irregular. While arthritis can affect any joint in the body, it is often most noticeable in the small joints in the hand given their relatively minimal soft tissue envelope. This condition can be very painful and disabling – especially when left untreated.

Osteoathritis (OA) is the most common form of arthritis encountered in the hand (others such as Rheumatoid, Psoriatic, and post-traumatic are beyond the scope of this article). It typically results from simple “wear and tear” over time. It is characterized by a degeneration or thinning of those smooth cartilage end caps. This creates direct or “bone on bone” contact causing in pain and deformity.

OA is most commonly found in three areas in the Hand: the base of the thumb (CMC joint), the end joint on the finger (DIP joint), or the middle join on the finger (PIP joint). Pain, stiffness, and swelling are the most common symptoms of all forms of hand arthritis. However, there are some specific symptoms to each of these joints.

The base of thumb joint (CMC) is one of the most common joints to develop arthritis in the hand. This joint is known as a “saddle” joint which allows for a great deal of motion for the thumb. OA in this joint is most commonly seen in women over the age of 40; however, men are unfortunately not immune to it! Pain is typically the first symptom of this potentially disabling condition. This is especially prevalent with opening jars, turning door knobs, and writing. As the arthritis progresses, patients can even develop a bump at the base of the thumb from the deformed joint.

Arthritis is diagnosed from a combination of a clinical exam by your physician as well as X-rays. While X-rays are important in the diagnosis, they only tell part of the story in OA of the hand. As your doctor can explain to you, some patients have very bad arthritis on X-rays, but are not very symptomatic. On the other hand, some patients have relatively minimal arthritis on X-rays, but have a tremendous amount of pain. It is not always clear the reasons for this discrepancy.

Treatment of OA of the hand is aimed at minimizing pain and restoring as much function as possible. Your physician may recommend the use of anti-inflammatory medicines (NSAIDS) like Ibuprofen and Naproxen. There are also topical medications that can be useful. In addition, the use of braces (both soft and hard) can be helpful in managing OA – especially in the base of thumb (CMC) joint. Warming up the joint with water or paraffin wax might help with the symptoms. Hand therapy is often an important part of the treatment algorithm. Cortisone injections can relieve some of the pain and inflammation – at least for a period of time. Finally, if symptoms persist despite these nonoperative modalities, your doctor may recommend surgery – of which there are often good options available when the time comes.