What helps hand osteoarthritis?

What is hand osteoarthritis?

Hand osteoarthritis is a common condition in which the cartilage and bone in the finger and thumb joints change, causing pain, stiffness, swelling and bony enlargements. It most often affects the end and middle joints of the fingers and the joint at the base of the thumb.

Bony swellings at the end joints are called Heberden's nodes, and those at the middle joints are called Bouchard's nodes. Symptoms often start in middle age, and hand osteoarthritis tends to run in families.

Which treatments are recommended?

European recommendations for hand osteoarthritis advise education and training in ergonomic principles, pacing of activities and assistive devices, together with exercises to improve function and muscle strength. Orthoses are recommended for symptom relief in thumb base osteoarthritis 1.

A guideline from the American College of Rheumatology and the Arthritis Foundation strongly recommends exercise and hand orthoses for osteoarthritis at the base of the thumb, and conditionally recommends orthoses for other hand joints 3.

Do hand exercises help?

A Cochrane systematic review of exercise for hand osteoarthritis pooled up to five trials with 381 participants 2. Low-quality evidence showed that exercise may improve hand pain, function and finger joint stiffness compared with no exercise. Effects were small, and adverse events were very few and not severe 2.

Typical exercises include gentle range-of-motion movements such as making a fist and spreading the fingers, thumb opposition exercises, and strengthening with therapy putty or light grip tools. Warm water can make exercises more comfortable.

What about splints and joint protection?

A splint for the base of the thumb supports the joint during activity or at night and can reduce pain. Joint protection involves using larger joints and both hands to carry objects, avoiding sustained tight gripping, and using tools with thicker handles.

Assistive devices such as jar openers, tap turners and electric can openers reduce strain on painful joints.

Which medicines help?

Topical non-steroidal anti-inflammatory gels are recommended as a first pharmacological option for hand osteoarthritis in the European recommendations. Oral anti-inflammatory medicines may be considered for limited periods, taking into account side effects. Chondroitin sulfate may be used for pain relief and improved function 1.

Steroid injections are not generally recommended but may be considered for painful finger joints 1. Disease-modifying drugs used for inflammatory arthritis are not recommended for hand osteoarthritis 1.

When is surgery considered?

Surgery may be considered when the base of the thumb is severely painful and other treatments have not been effective. The European recommendations support considering surgery when other treatments have not relieved pain enough 1. Options include removing the small bone at the base of the thumb or joint fusion.

Surgery for finger joints is less common and is considered for severe pain, instability or deformity that limits function.

How can hand osteoarthritis affect work and hobbies?

Hand osteoarthritis can make gripping, pinching and fine tasks harder, affecting activities such as typing, cooking, gardening, knitting or playing instruments. Adjusting how tasks are done often allows people to continue activities they value.

Occupational therapists can suggest adapted tools, changes in technique, pacing and splints for specific tasks. Employers may be able to provide adapted keyboards, voice software or changes to duties to reduce strain on painful joints.

When should hand symptoms be checked?

Seek assessment for a hot, red, very swollen joint, rapid onset of swelling in several joints, prolonged morning stiffness, or swelling of the knuckles and wrists, which may suggest inflammatory arthritis.

Numbness or tingling in the fingers may indicate carpal tunnel syndrome, which is managed differently.

Frequently asked questions