Hand osteoarthritis: finger and thumb joint pain, nodes and treatment

The NHS says osteoarthritis most often causes problems in the knees, hips and small joints of the hands. Arthritis UK explains the process: cartilage covering the bone ends thins, the joint surfaces become rougher and bony spurs called osteophytes grow, so the joint may not move as smoothly and can feel painful and stiff.

Which joints? Arthritis UK says the index and middle fingers and the thumb are most commonly affected, and many people find the hand they use most is affected more than the other. In the fingers it tends to be the joint closest to the fingernail or the middle joint. The large knuckles where the fingers meet the hand are less commonly affected, and the joint at the base of the thumb and occasionally the wrist can also be involved.

Arthritis UK says symptoms vary between people and over time, with good days and bad days. Joints can look swollen and red and feel warm and tender when inflamed, and pain may be present when using the hands and sometimes at rest. Swelling that stretches the soft tissues around a joint can make the hand feel weak or unstable.

• Firm knobbly swellings at the finger joints.

• Stiffness and an aching joint, often worse in cold weather. Arthritis UK says weather can worsen symptoms but does not change the long-term outlook.

• Reduced grip strength, making it harder to open jars and cans, hold a pen or cutlery, do up buttons and zips, handle money or dry yourself after a shower.

• In the wrist, numbness, weakness or pins and needles if the nerve is squeezed, which is carpal tunnel syndrome and can cause night pain.

Hand osteoarthritis has a better outlook than many people expect. Arthritis UK says it often tends to burn out after a time: it may be painful for a few years and then improve, especially when only the small finger joints are affected. Any firm nodes that have formed will stay, and the range of movement does not always return when the pain eases.

Arthritis UK also reports that people who develop nodes at the finger joints tend to have an increased risk of osteoarthritis of the knee, but that many people with hand osteoarthritis never develop it in any other joint. A family history, being female, previous injuries and repetitive tasks over a long period are among the factors it lists for developing hand osteoarthritis.

Arthritis UK says it is often possible for a doctor to diagnose hand osteoarthritis from the symptoms and a simple examination, without tests, and that X-rays often are not needed to confirm it. NICE guideline NG226 likewise says osteoarthritis is diagnosed clinically without imaging in people aged 45 or over with activity-related joint pain and brief or no morning stiffness.

The pattern matters because other arthritis can look similar. Arthritis UK says gout can affect the hands and mimic osteoarthritis, so a blood urate test may be done. If the large knuckles where fingers meet the hand are painful and swollen, which is less typical for osteoarthritis, a doctor may ask for blood tests to look for rheumatoid arthritis. Psoriatic arthritis can also look similar and is linked to the skin condition psoriasis, so a personal or family history of skin problems is relevant. The NHS adds that prolonged morning stiffness can be a sign of rheumatoid arthritis rather than osteoarthritis.

Arthritis UK says exercise helps ease stiffness and improve grip strength, though it is less clear how much it relieves pain. It advises keeping the hands moving as normally as possible, doing specific hand exercises suggested by a physiotherapist, occupational therapist or hand therapist, and avoiding activities that put heavy strain on the hand joints, such as lifting heavy weights or yoga positions that bear body weight on the hands.

Practical adaptations make a real difference. Arthritis UK suggests gadgets such as electric tin openers and tools with chunkier, softer handles, a backpack or trolley instead of carrying bags, more frequent breaks, using both hands for one-handed tasks and switching taps or door handles for easier ones. The NHS mentions tap turners and says an occupational therapist can advise on aids at home or work.

Heat, such as warm water for stiff morning hands, often helps, and some people prefer an ice pack when joints are swollen, never leaving a pack on bare skin for more than 20 minutes. Paraffin wax baths can ease pain and stiffness for a time. Weight matters less than for the knee, but Arthritis UK says some research links being overweight with more inflammation and pain.

Arthritis UK recommends trying NSAID gels or creams, such as those containing ibuprofen or diclofenac, before tablets, and the NHS says topical NSAIDs can be particularly effective in the hands and knees and help with swelling too. NICE says to consider a topical NSAID for osteoarthritis affecting joints other than the knee. If topical NSAIDs have not helped, the NHS says a GP may prescribe capsaicin cream for hands or knees, which can take some time to work, with pain relief usually in the first two weeks and full effect taking up to a month. A short course of oral NSAIDs may be used with stomach protection when suitable.

Arthritis UK says a steroid injection may help in the thumb or middle finger joints when inflammation is marked and other pain relief has not worked, and may be repeated a few times with several months in between. NICE says injection relief is short term, 2 to 10 weeks.

Splints are worth a note because guidance differs slightly. Arthritis UK says a thumb splint may help pain and function in the longer term, advises not wearing a splint all the time because that could weaken the hand, and describes resting and working splints. NICE says not to offer splints and supports routinely unless there is joint instability or abnormal loading and exercise alone is ineffective, so a therapist's assessment matters.

Operations are for people whose pain and function are not controlled by the measures above. Arthritis UK lists trapeziectomy, which removes a small bone at the base of the thumb and usually gives good pain relief while maintaining grip; fusion of very painful finger or thumb joints, mostly the smallest joints near the fingertips or the index knuckle; synovectomy; joint replacement for the middle and larger finger joints; reconstruction of thumb ligaments; and carpal tunnel release when nerve pressure is the problem.

It adds that wrist joint replacement is not yet common and the movement afterwards may not be as good as before the arthritis. A hand surgeon will explain which procedure fits which joint, and recovery usually involves hand therapy. As with the NHS pathway, hand therapy and splinting are generally tried before surgery is discussed.