Osteoarthritis of the hand and wrist

Osteoarthritis is the most common form of arthritis, and the hand and wrist joints are among the most commonly affected. A joint is a part of the body where two or more bones meet. The ends of the bones are covered in a smooth and slippery surface, known as cartilage. This allows the bones to move smoothly against each other and protects the joint from stress.

Everyone's joints go through a cycle of damage and repair, and often the repair process is quite effective. But sometimes it can cause changes in the shape or structure of the joints.

Osteoarthritis causes the cartilage in your joints to thin and the surfaces of the joint to become rougher, which means that the joints may not move as smoothly as they should, and they might feel painful and stiff.

You may have firm, knobbly swellings at the finger joints. These are known as Heberden's nodes or Bouchard's nodes depending on which joints are affected. They're caused by the growth of bony spurs called osteophytes.

Osteoarthritis can affect anyone at any age, but it's more common in women over the age of 50.

Some of the factors that can make you more likely to develop osteoarthritis in your hands include:

• being female
• the genes you inherit
• previous injuries
• carrying out repetitive tasks over a long period of time.

The index and middle fingers and the thumb are the parts of the hand most commonly affected. Many people find that the hand they use most is affected more than the other.

When the fingers are affected, it may be in the joints closest to the fingernails or the ones in the middle of the fingers. It's less common to have osteoarthritis in the large knuckle joints, where the fingers meet the hand.

The joint at the base of the thumb can also be affected by osteoarthritis. And occasionally the wrist joint may be affected.

The symptoms of hand osteoarthritis can vary between different people and over time. You'll probably have good days and bad days. You may find this depends on what you're doing, but sometimes there may not be any obvious reason.

If the joints are inflamed then they're likely to look swollen and red and to feel warm and tender to the touch. You're likely to have pain, especially when using your hands but sometimes even while resting. Swelling can also cause the soft tissues around a joint to stretch, which can make your hands feel weak or unstable.

As we use our hands such a lot in daily life, pain, stiffness or poor grip strength can cause problems with a wide variety of tasks and activities including:

• opening jars and cans
• holding a pen or cutlery
• doing up buttons or zips
• handling money
• shaving, brushing your teeth, or drying yourself after a bath or shower.

Hand osteoarthritis often tends to 'burn out' after a time. It may be painful for a few years and then the pain may improve, especially if only the small finger joints are affected. Any firm, knobbly swellings or nodes that have developed will remain though. And the range of movement in the joints doesn't always improve even when the pain does.

Sometimes the weather, especially cold weather, can make your symptoms worse. However, the weather won't affect the long-term outlook or how the condition progresses.

People who develop knobbly swellings or nodes at the finger joints tend to have an increased risk of developing osteoarthritis of the knee as well. However, many people with hand osteoarthritis will never develop it in any other joints.

A condition called carpal tunnel syndrome can sometimes develop as a result of osteoarthritis of the wrist. This is where a nerve to the hand is squeezed by swelling in the wrist joint or in the tendons next to the nerve. This can cause weakness, numbness or pins and needles in the hand. It can also cause pain, especially at night. If you have these symptoms regularly you should see your GP.

It's often possible for your doctor to diagnose osteoarthritis of the hand from your symptoms and a simple examination, without any need for tests. Although x-rays will show changes in the shape or structure of the joint, they're often not needed to confirm the diagnosis. Blood tests are sometimes helpful if there's any doubt about whether it's osteoarthritis or another type of arthritis that's causing your symptoms.

Sometimes gout can affect the hands and this can look very much like osteoarthritis. If your doctor thinks it may be gout then they'll want to check your urate levels through a blood test. Urate is a waste product which is normally flushed out of the body through the kidneys. But if it builds up it can form crystals in the joints, leading to sever pain and swelling.

It's less common for the joints where your fingers meet your hand to be affected by osteoarthritis, so if you have pain and swelling in these joints your doctor may ask for blood tests to check for rheumatoid arthritis.

Psoriatic arthritis can also affect the hands and may look similar to osteoarthritis. There are no blood tests et present for psoriatic arthritis, but this type of arthritis is linked to the skin condition psoriasis. Your doctor may therefore ask if you or anyone in your family have a history of skin problems.

There's no cure for osteoarthritis, but there are treatments and things that you can do yourself that might improve your symptoms and make a difference to how the condition affects you.

Exercise

Joints need to be exercised regularly to keep them healthy. Exercise can help ease stiffness and improve grip strength, although it's less clear how much pain may be eased by exercise.

Activities that put a lot of strain on your hand joints are probably best avoided – for example, lifting or carrying heavy weights, or yoga or Pilates movements where a lot of your body weight is supported by your hands.

You should try to keep moving your hand joints as normally as possible and do some specific hand exercises.

A physiotherapist, occupational therapist or hand therapist will be able to suggest exercises for you, but we've included a few suggestions at the end of this webpage. These should help to maintain as much range of movement and strength as possible, which should help to make everyday tasks easier.

Some people find that a soft squeezy 'stress ball' helps to ease discomfort in the hands. Or you may like to try some of these simple exercises for the fingers, hands and wrists.

Weight management and diet

Although the link between your weight and osteoarthritis of the hands may be less clear than for weight-bearing joints such as the knees, some research shows that being overweight increases inflammation and therefore pain. Therefore, if you have osteoarthritis of the hand or wrist, it still makes sense to try to maintain, or achieve, a healthy weight.

Reducing the strain on your hands and wrists

We use our hands a lot in daily life. If you have osteoarthritis in your hands or wrists, taking some time to think about how you use them, and how you could reduce the strain on them, can bring great benefits. This doesn't mean you shouldn't use your hands, just that you should think about ways of using them differently.

It may be helpful to see an occupational therapist or hand therapist, who will be able to offer a lot of useful advice on this. But many people discover for themselves different ways of doing things that help to ease the strain on their joints. Examples include:

• using gadgets such as electric tin openers or tools with softer, chunkier handles that don't need such a tight grip
• using a backpack or shopping trolley to avoid carrying heavy bags in your hands
• taking more frequent breaks from tasks that put more strain on your joints or switching between harder and easier jobs
• using both hands for some of the tasks that you normally do one-handed
• having taps or door handles changed for those that are easier to use
• looking out for easy-to-handle fastenings when choosing clothing or shoes.

Find out more about looking after your joints.

Pain relief

Several things can help relieve symptoms of pain and inflammation in the hands:

Heat

Applying warmth to painful joints often helps to ease pain. Sometimes just putting your hands in warm water can help, especially if they tend to feel stiff in the morning.

Some people find using an ice pack more effective, especially if the joints are swollen. When applying packs to your skin, make sure you don't put them on your bare skin, and never leave them on for longer than 20 minutes.

A paraffin wax bath can also ease pain and stiffness for a time. The wax is heated in a container until it's soft and you dip your hands into the wax. Wax baths are mainly used in hospitals, although they are available to buy. Combining warmth with some hand exercises will give the best results.

Splints and supports

Several types of splints are available. It's best not to use a splint all the time, as this could weaken your hands. You should also do some gentle hand exercises when you take the splint off.

The main types of splints available are:

• Resting splints – which keep you wrist and hand still in the right position while you're resting
• Working splints – which are used mainly to support the wrist while you're using your hands. There are different types which provide either light support for everyday tasks or firmer support for more strenuous activities. There are also working splints to support the joint at the base of the thumb.

If you have osteoarthritis in the joint at the base of your thumb, a splint can be helpful. Although you may not notice the benefit straight away, research shows a thumb splint may help with pain and function in the longer term.

You can buy splints and supports in pharmacies, sports shops or from mobility equipment suppliers. If you're not sure what type of splint would be best for you, an occupational therapist or hand therapist will be able to offer advice or may even have a splint made up to suit your particular needs.

Read more about hand and wrist splints.

Drug treatments

Drugs can be used to help ease the pain and stiffness caused by osteoarthritis, but they won't prevent or cure the condition itself. You'll have the best results if you use the drugs to help you keep active, and also follow the above tips to reduce the strain on your hands.

Some of the drugs and treatments you can try include:

• NSAID creams and gels: Non-steroidal anti-inflammatory drugs (NSAIDs) are available as gels or creams and as tablets or capsules. NSAID gels and creams, which are applied directly to the hands, can be particularly helpful and it's usually recommended that you try these first. Gels containing ibuprofen or diclofenac are widely available from pharmacies and supermarkets but others, such as ketoprofen, are available on prescription.
• NSAID tablets and capsules: A short course of NSAIDs, such as ibuprofen, can help reduce any pain, inflammation and swelling. Ibuprofen is widely available at pharmacies and supermarkets. Other NSAIDs and higher doses of ibuprofen are available on prescription.
• Painkillers: Simple over-the-counter painkillers such as paracetamol may help. Your doctor may prescribe stronger painkillers if you need them and if they're suitable for you but these are usually only given for short-term use. 
• Steroid injections: A steroid injection may be helpful if you have osteoarthritis of the thumb or the middle joints of the fingers, especially if there's a lot of inflammation and if other forms of pain relief haven't helped. Steroid injections may be repeated a few times if necessary with several months in between.

If you're taking over-the-counter medicines, make sure you're taking them safely and as directed by your doctor or the patient information leaflet included with the drug. Make sure whoever is treating you knows all the medications you're taking.

Get further information about painkillers and NSAIDs or steroid injections.

Surgery

If you have osteoarthritis of the hand and wrist and the treatments above aren't helping, there are several types of surgery that may help. These include:

• Trapeziectomy: This involves removing a small piece of bone at the base of the thumb. The operation usually gives good pain relief and helps you maintain a good grip.
• Joint fusion: Very painful finger or thumb joints can be permanently fixed in a slightly bent position. This is mostly done for the smallest joints near the tips of the fingers or for the knuckle of the index finger, so it shouldn't affect your ability to grip things. 
• Synovectomy: This is where the inflamed lining of the joint capsule, called the synovium, is removed.
• Joint replacement: This operation can be done for the middle and larger joints of the hand. Wrist joint replacement isn't yet common – it can help improve movement at the wrist, but the movement may not be as good as before your arthritis started.
• Reconstruction of thumb ligaments: This can help to improve strength and grip.
• Carpal tunnel release: This is sometimes needed to relieve pressure on the nerve.

Learn more about hand and wrist surgery.