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Health condition · Clinically reviewed

Hand and wrist osteoarthritis, splinting, injections and modern reconstructive surgery.

One of the most common forms of arthritis, and one of the most treatable. A stepped plan of therapy, splinting and, when needed, specialist hand surgery.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BSSH and peer-reviewed hand-surgery sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including trapeziectomy with LRTI, four-corner fusion and total wrist arthroplasty.

Key facts

Hand and wrist OA at a glance.

The essentials, in plain English: what it is, where it strikes and how it is treated in the UK today.

  • What it is

    Osteoarthritis of the joints of the hand and wrist, driven by cartilage loss, bony remodelling and low-grade synovitis.

  • How common

    Hand OA is one of the most common forms of arthritis, with a female predominance and a peak between the ages of 50 and 70.

  • Hand pattern

    Typically the DIP joints (Heberden nodes), PIP joints (Bouchard nodes) and the base of the thumb at the CMC joint.

  • Wrist pattern

    STT, radiocarpal (often post-traumatic SLAC or SNAC wrist), midcarpal, DRUJ and pisotriquetral joints.

  • Foundation therapy

    Splinting, hand therapy, topical NSAIDs and activity pacing form the core of every plan before injections or surgery.

  • When surgery helps

    Trapeziectomy with LRTI is the gold-standard operation for thumb-base OA; four-corner fusion and wrist replacement are options in advanced wrist OA.

Why this guide matters

A stepped plan, not a shrug.

Hand and wrist OA is common, but the pattern of joints involved, and the surgery that helps, differ from hip and knee OA. The three points below shape everything else on this page.

  • Pattern matters more than X-rays

    Thumb-base CMC, DIP nodes and post-traumatic SLAC or SNAC wrist behave differently and need different plans, even when the X-rays look similar.

  • Hand therapy and splints do a lot

    A well-fitted CMC splint, joint protection and topical NSAIDs relieve symptoms for many people for many years.

  • Modern hand surgery is precise

    Trapeziectomy with LRTI, four-corner fusion, PRC and total wrist arthroplasty are matched to the pattern of disease, not offered as a generic operation.

How the diagnosis is made

From first ache to a clear surgical or non-surgical plan.

The steps a UK GP, hand therapist and hand surgeon will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and hand-use profile

    Occupation, sports, past fractures (Colles, scaphoid) and ligament injuries shape the likely pattern of OA.

  2. 02

    Assessing

    Symptom map and functional impact

    Pain, morning stiffness of short duration, grip weakness and difficulty with jars, keys, buttons and writing.

  3. 03

    Assessing

    Focused clinical examination

    Look for CMC squaring, Heberden and Bouchard nodes, deformity, tenderness, range of movement and grip strength.

  4. 04

    Confirming

    Provocation tests

    Grind and shoulder-sign tests for CMC arthritis; Watson scaphoid-shift for scapholunate instability underlying SLAC wrist.

  5. 05

    Confirming

    Plain X-rays

    PA, lateral and oblique views for joint-space narrowing, osteophytes and subchondral change; Eaton-Littler staging for CMC; SLAC/SNAC classification for wrist.

  6. 06

    Planning

    Selective MRI

    For occult wrist OA, early cartilage change, ligament tears or when the X-ray does not explain the pain (see /treatments/wrist-mri/).

  7. 07

    Planning

    Specialist hand review

    Referral to a hand surgeon and hand therapist for advanced disease, failed conservative care, or planning of reconstructive surgery.

Typical timeline: a first visit to a settled plan in weeks, not months.

Symptoms

What hand and wrist OA actually feels like.

The classic mix of thumb-base pain, finger nodes and mechanical wrist pain, plus the features that mean it is time to escalate.

  • Thumb-base pain

    Pain at the base of the thumb (CMC) with pinch, key turning and opening jars, often with visible squaring of the joint.

  • Heberden and Bouchard nodes

    Firm bony swellings at the DIP joints (Heberden) and PIP joints (Bouchard), often with mild deformity.

  • Short-duration stiffness

    Morning stiffness usually lasting less than 30 minutes, in contrast to the prolonged stiffness of rheumatoid arthritis.

  • Grip and pinch weakness

    Loss of pinch and grip strength affecting writing, buttons, taps, jars and lifting a kettle or pan.

  • Wrist pain with load

    Radial-sided pain (STT, scaphoid area) or dorsal pain (radiocarpal, midcarpal) provoked by pressing up, push-ups or racket sports.

  • Ulnar-sided wrist pain

    Pain at the DRUJ or pisotriquetral joint with forearm rotation, often after a previous Colles or ulnar-styloid fracture.

  • Reduced range and deformity

    Progressive loss of movement, thumb adduction contracture, MCP hyperextension and dorsal wrist prominence.

  • Red flag - rapid change

    Sudden severe pain, marked swelling, night pain or a mass warrants urgent review to exclude infection, crystal disease or tumour.

Treatment

How hand and wrist OA is treated in the UK.

Splints, hand therapy and topical NSAIDs first; injections when a joint flares; and specialist hand surgery for advanced disease.

  • Splinting

    Neoprene short opponens or custom thermoplastic splints for the thumb CMC, and wrist rests for radiocarpal OA (see /conditions/hand-and-wrist-splinting/).

  • Specialist hand therapy

    Graded strengthening, joint protection, activity pacing and manual therapy from a hand-trained physio or OT (see /conditions/hand-and-wrist-manual-therapies/).

  • Topical and oral NSAIDs

    Topical diclofenac or ibuprofen gel is first line; short courses of oral NSAIDs with gastric protection when needed.

  • Adaptive equipment

    Larger-handled cutlery, jar openers, ergonomic pens and keyboard changes, with Access to Work support for occupational needs.

  • Corticosteroid injection

    Ultrasound-guided intra-articular steroid, particularly useful for the CMC and DRUJ, gives months of relief (see /treatments/cortisone-injection-large-joint/).

  • Hyaluronic acid and PRP

    Selective use in the thumb CMC and early wrist OA; evidence is developing and remains a specialist decision.

  • Trapeziectomy with LRTI

    Gold-standard operation for advanced thumb-base OA - remove the trapezium and reconstruct with a tendon interposition (see /treatments/trapeziectomy/).

  • Wrist reconstructive surgery

    For SLAC/SNAC wrist: four-corner fusion, proximal row carpectomy, total wrist arthroplasty or arthrodesis, matched to the pattern of disease.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist hand-surgery standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, hand therapist or hand surgeon knows your hand and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).

  • British Society for Surgery of the Hand (BSSH). Guidance on thumb-base OA and wrist arthritis.

  • BOA / BSSH consensus on the surgical management of SLAC and SNAC wrist.

  • Cochrane review. Surgery for thumb (trapeziometacarpal) osteoarthritis.

Red flags

When hand and wrist pain needs urgent attention.

Most hand and wrist OA is manageable with a stepped plan. These are the situations that need faster review and, often, a specialist opinion.

  • Sudden hot swollen joint

    A red, hot, exquisitely tender joint suggests septic arthritis or crystal disease and needs same-day assessment.

  • Night pain and rest pain

    Constant pain that wakes you at night is not typical for OA and warrants imaging to exclude other causes.

  • Rapidly progressive deformity

    A swan-neck, boutonniere or ulnar-drift pattern points to inflammatory arthritis rather than OA and needs rheumatology review.

  • Neurological symptoms

    Numbness, tingling or thenar wasting may reflect carpal tunnel syndrome coexisting with CMC OA and needs nerve assessment.

  • Post-traumatic pain that persists

    Ongoing wrist pain after a Colles or scaphoid fracture may reflect SLAC/SNAC wrist and deserves specialist imaging.

  • Systemic symptoms

    Weight loss, fevers or prolonged morning stiffness beyond one hour suggest inflammatory disease, not OA.

  • A mass at the joint

    A firm mass, especially if growing, needs imaging to exclude a giant cell tumour of tendon sheath or other lesion.

  • Loss of function despite therapy

    When splinting, hand therapy and injections fail, a hand-surgery opinion prevents further deterioration and scarring.

  • Bilateral rapid onset

    Simultaneous bilateral joint involvement over weeks is more typical of inflammatory arthritis and deserves early bloods and referral.

Living with it

A treatable condition, with a clear ladder of options.

Four things that make the biggest difference day to day: pacing, adaptive equipment, sensible splint use and knowing when to step up to injections or surgery.

A quiet reminder

Small changes protect the joints that matter.

A neoprene splint, a jar opener and a five-minute rest often do more than another bottle of tablets.

  1. 01 Pace

    Break tasks into smaller pieces

    Chop the ironing, gardening or DIY into shorter bursts with rests, and swap heavy grip for two-handed technique.

  2. 02 Equipment

    Change the tool, not the hand

    Bigger grips, lever taps, electric openers and voice dictation reduce load on the CMC and radiocarpal joints.

  3. 03 Splint

    Wear the splint when it matters

    Use the CMC or wrist splint for the tasks that flare it - gardening, driving, writing - rather than all day every day.

  4. 04 Escalate

    Ask about surgery early enough

    If pain and function keep getting worse despite conservative care, a hand-surgery opinion is a step forward, not a last resort.

Frequently asked

Everything we get asked about hand and wrist OA.

Quick answers on splints, injections, trapeziectomy and wrist reconstruction.

  • What is hand and wrist osteoarthritis?

    It is wear and structural change at the small joints of the hand and wrist, driven by cartilage loss, bony remodelling and low-grade synovitis. The commonest patterns are DIP and PIP nodes, thumb-base CMC arthritis and wrist OA at the STT, radiocarpal and DRUJ joints.

  • Why is thumb-base arthritis so common in women?

    The trapeziometacarpal joint takes very high forces during pinch and is stabilised by soft ligaments. Postmenopausal women are affected most often because of hormonal changes, ligament laxity and cumulative load. It is one of the most common forms of OA in the hand.

  • What is SLAC and SNAC wrist?

    SLAC (scapholunate advanced collapse) and SNAC (scaphoid non-union advanced collapse) are predictable patterns of post-traumatic wrist arthritis. They follow a torn scapholunate ligament or a scaphoid fracture that did not heal, and progress through recognisable stages that guide surgical planning.

  • What does conservative treatment actually involve?

    A combination of splinting, hand therapy, topical NSAIDs, adaptive equipment and activity pacing, with a corticosteroid injection when a specific joint flares. Most people are managed this way for many years before surgery is considered.

  • When is surgery the right answer?

    When pain and function have failed to respond to a proper trial of splinting, therapy and at least one injection, and imaging confirms advanced structural change. Trapeziectomy with LRTI is the gold-standard operation for thumb-base OA; for the wrist, options include four-corner fusion, proximal row carpectomy and total wrist arthroplasty.

  • Will I lose function after surgery?

    Modern hand surgery aims to relieve pain and preserve as much movement as possible. Trapeziectomy usually keeps a functional thumb; four-corner fusion sacrifices some wrist motion for stability and pain relief; total wrist replacement preserves motion in selected patients. Your hand surgeon and therapist will match the operation to your work and hobbies.

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