An Overview of Hand Arthritis

Hand arthritis can be painful and debilitating. Your hands are made up of a complex network of bones, joints, muscles, ligaments, tendons, nerves and blood vessels that work intricately and harmoniously to bring together the alignment, coordination, and strength allowing you to perform fine motor tasks. This article explains the symptoms, diagnosis, and treatment of hand arthritis.

There are 27 bones in the wrist and hand. The eight small bones in the wrist are called carpals. In the palm of the hand, several of the carpals connect to five metacarpals. Each metacarpal connects to one of the fingers or the thumb. The phalanges are bones that align to form each finger and thumb (i.e., the finger bones). Knuckle joints form where the phalanges connect to the metacarpals and are referred to as the metacarpophalangeal (MCP) joints. The MCP joints work as hinge joints to bend and straighten the fingers and thumb.

Each finger has three phalanges that are separated by two joints, known as interphalangeal (IP) joints (the exception to this is the thumb, which has only two phalanges separated by one joint.) The IP joint that sits closest to your MCP joint (knuckle) is known as the proximal interphalangeal (PIP) joint. The IP joint that is located closest to the end of your finger is known as the distal interphalangeal (DIP) joint. 

The joints of your hand, fingers, and thumb are covered with articular cartilage which absorbs shock and allows for friction-free movement. Articular cartilage covers the ends of bones that come together to form joints. If cartilage loss develops in the joints of the hand, you may experience significant pain. Initially, the symptom of hand pain is vague. You may first suspect an injury, but hand pain can be caused by disease, too, such as arthritis.

Typically, the first sign of hand arthritis involves pain that develops after extensive use of the hand. Increased use of the hand can cause increased pain while rest can relieve it, especially in the early stages. As hand arthritis advances, even simple activities, such as opening a jar or door knob, can cause hand pain. Morning stiffness may become more pronounced.

General symptoms associated with hand arthritis include:

• Swelling
• Warmth due to inflammation 
• Crepitus
• Fingers that snap or lock
• Cysts or nodules on the fingers.

Signs and symptoms of rheumatoid arthritis of the hand commonly include:

• Firm nodules along the fingers
• A soft lump on the back of the hand
• Drifting of the fingers away from the thumb (ulnar deviation)
• Tendon rupture which causes a sudden inability to bend or straighten the fingers
• Joint deformity
• Sometimes, there is numbness or tingling of the hand (i.e., carpal tunnel syndrome).

Symptoms of hand osteoarthritis include:

• Bouchard's nodes: Bony nodules that develop at the PIP joint
• Heberden's nodes: Bony nodules that develop at the DIP joint
• Pain at the base of the thumb.

Other signs include redness and telangiectasia (dilation) of nail fold capillaries which is often linked to connective tissue diseases, such as lupus. Sclerodactyly, or tightening of the skin over the fingers, and digital ulcers are often signs of scleroderma. Dactylitis, or swelling of an entire digit, is associated with one of the spondyloarthropathies, such as psoriatic arthritis.

There are three main tests used to determine whether someone has hand arthritis:

1. A physical examination: With your hands open, your doctor can check the alignment of your fingers, as well as look for any visible abnormalities. Your doctor also can test the function and strength of your hand by having you pinch or grip objects. Your doctor will also feel your hand to determine if there is joint tenderness.
2. X-rays gather information about joint space narrowing, the development of osteophytes, and the appearance of bone along the joint margins.
3. Blood tests are taken if rheumatoid arthritis is suspected: rheumatoid factor, sedimentation rate, CRP, and anti-CCP may be ordered to help confirm the diagnosis.

The goal of treatment for hand arthritis is to relieve pain and improve function. Treatment may include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesic (pain) medications. Rest, heat, cortisone injections, and splints may also be used.

Exercises help to maintain movement and function of the hand. A few sessions with a hand therapist will allow you to learn about the exercises that are best for your individual situation.

Surgery is considered only as a last resort when all other treatment options have failed. Hand surgery is not generally performed for purely cosmetic reasons. The main purposes of hand surgery are pain relief and to preserve or restore function.