Hand Osteoarthritis – symptoms, diagnosis and treatment

It is relatively common to develop hand osteoarthritis. Osteoarthritis (OA) mostly affects the finger joints closest to your fingertips, the middle joints of your fingers and the joint in the base of the thumb connected to the wrist. Hand osteoarthritis is often easily confused with rheumatoid arthritis (RA) so it is important to get diagnosed as early as possible when experiencing symptoms such as pain, stiffness or reduced mobility of the hand. Both conditions can be treated, but in separate ways. Osteoarthritis occasionally affects the wrist, but this is uncommon.

Symptoms of hand osteoarthritis 

Common symptoms of hand osteoarthritis are pain and stiffness. It often becomes difficult to perform daily activities such as gripping things, opening cans and jars and doing up buttons. You may also lose strength in the hand.

The most common symptoms of hand osteoarthritis include:

  • Pain in the affected joint
  • Stiffness
  • Limited range of motion
  • Swelling of the fingers
  • Reduced grip strength or hand function
  • Joint deformities such as bony lumps (common on fingers)

If you experience any of these symptoms you should schedule an appointment with a physical therapist or a doctor to get a diagnosis. 

Several risk factors play a part

There is no single cause for the development of hand osteoarthritis. Several risk factors tend to contribute to the development of the joint disease. Main risk factors for hand osteoarthritis are female sex, genetics and obesity. The genetic influence of hand osteoarthritis can be as high as 65%. Osteoarthritis of the thumb joint is three times as common in women as in men.  Research has shown that obesity is a major risk factor for osteoarthritis at the base of the thumb.

How osteoarthritis of the hand is diagnosed

Traditionally, osteoarthritis was diagnosed by X-ray. Today, it is still a widespread belief that this method is necessary for diagnosis. However, according to the World Health Organization and extensive international research, osteoarthritis should be diagnosed by a physical therapist or a doctor through an assessment based on the patient’s medical history, joint function and pain level. Advanced hand osteoarthritis is easier to see with the naked eye as the affected joint in the hand is often swollen and deformed.

The healthcare professional will also take risk factors for osteoarthritis into account and keep them in mind when establishing the diagnosis. If you experience pain or stiffness in the base of your thumb, fingers or wrist and suspect that you may have osteoarthritis, a good first step is to contact your primary healthcare center and schedule an appointment with a physical therapist or a doctor to receive the right diagnosis.

Treating osteoarthritis of the hand

First-line treatment for hand osteoarthritis is patient education (learning more about the disease) in combination with individualized hand exercises. These individualized exercises should be coordinated by a physical therapist or an occupational therapist, either physically or digitally. Physical therapists and occupational therapists can also provide practical advice on how to more easily perform daily activities with the use of adapted equipment and braces or splints. There are several adaptive equipment tools that make life easier for someone living with hand osteoarthritis. Such tools include adaptive jar and can openers, utensils, scissors and zipper pulls. Thumb splints and wrist braces may provide pain relief for some patients.

Hand exercises should consistently be adapted to the patient’s abilities based on pain and function level. Individualized exercises can help ease pain, increase grip strength and improve function in the hands. As a complement to first-line treatment, if the pain becomes unbearable, non-prescription painkillers may be used for short periods of time. You should however always discuss the use of painkillers with your doctor to avoid side effects and drug interaction.

Other treatment methods

If first-line treatment isn’t enough to manage your symptoms, other treatments can be offered in addition to the individualized exercises.  On occasion, cortisone injections are used as a complement to treat severe osteoarthritis of the base of the thumb. These injections only offer short-term symptom relief and should be administered by an experienced orthopedic specialist. Cortisone injections should be used with caution and only when symptoms are not alleviated by the exercises, as excessive injections may further damage the joint. 

In rare cases, surgery may be necessary. Although surgery can provide good results for many patients, it is never risk-free. All surgery comes with the risk of developing infections. The most commonly performed surgical procedure for osteoarthritis of the thumb is removing a bone in the joint (also known as a trapeziectomy). Other surgical options for hand osteoarthritis are joint fusion surgery and in certain cases joint replacement surgery. Most hand operations are performed under local anesthesia.

Read more about osteoarthritis of the fingers