Hand Osteoarthritis
Information on the causes, symptoms, treatments, and prognosis of joint wear and deformity in the hands.
Symptoms and Causes
Hand osteoarthritis, which can also affect the wrist, is the degeneration of the cartilage in the joints that make up the hand. It is characterized by pain, stiffness, and swelling caused by joint effusion, the formation of osteophytes, and the friction between bones as cushioning is lost.
The joints most commonly affected by this type of osteoarthritis are:
- Trapeziometacarpal joint: located at the base of the thumb, where it connects with the wrist.
- Proximal interphalangeal joints (PIP): located in the middle of the fingers, below the knuckles.
- Distal interphalangeal joints (DIP): connect the tips of the fingers.
Hand osteoarthritis is classified into two types according to how it manifests:
- Nodular osteoarthritis: the most common type, usually affecting the distal joints, although it can occur in all of them. Its main feature is the formation of bony nodules.
- Erosive osteoarthritis: more aggressive than the previous type, as it affects both bone and cartilage and often spreads to all hand joints.
It is a degenerative disease closely related to aging, generally not appearing before the ages of 40 or 50, and progressing slowly. Current treatments focus on improving patients’ quality of life, as hand osteoarthritis has no cure.
Symptoms
The most prominent symptoms of hand osteoarthritis include:
- Joint pain that worsens with movement.
- Stiffness after periods of rest, especially in the morning.
- Swelling.
- Redness.
- Sensation of warmth.
- Increased tenderness to touch.
Additionally, nodular osteoarthritis presents with the following signs:
- Joint deformity: bony enlargements (osteophytes) that form visible bumps.
- Heberden’s nodes: commonly found on the DIP joints.
- Bouchard’s nodes: usually appear on the PIP joints and share the same features.
- Nodules at the base of the thumb that do not have a specific name.
- Loss of flexibility: decreased range of motion in the affected joint.
- Crackling or grinding sounds during movement.
Causes
The causes of osteoarthritis are not yet fully understood. Its appearance in the hands is believed to result from a combination of two factors:
- Genetic: a hereditary component is involved.
- Environmental: occupations requiring repetitive hand movements or previous fractures.
Risk Factors
The likelihood of developing hand osteoarthritis increases under the following conditions:
- Age: it is a degenerative condition that usually begins at or after age 40.
- Sex: more common in women.
- Family history.
- Repetitive joint strain.
- Personal history of bone or joint fractures.
- Diabetes.
Complications
The most significant complication of hand osteoarthritis is the total wear of cartilage, which leads to severe pain, deformity, and limited mobility.
Prevention
Hand osteoarthritis cannot be prevented, but adopting the following habits may help delay its onset or relieve symptoms:
- Avoid repetitive movements and pinch grips whenever possible.
- Stay well hydrated.
- Maintain a healthy diet.
- Avoid alcohol and tobacco consumption.
Which Specialist Treats Hand Osteoarthritis?
Rheumatology is the specialty responsible for preventing, diagnosing, and treating hand osteoarthritis. Specialists in physical medicine and rehabilitation, as well as traumatology and orthopaedic surgery, also commonly participate in its management.
Diagnosis
The diagnosis of hand osteoarthritis is mainly clinical and is based on the following steps:
- Medical history: assessment of family and personal history, lifestyle habits, and symptoms.
- Physical examination: observation and palpation of the joints, along with evaluation of movement range, pain, bumps, and crepitus.
- X-ray: used to determine which joints are affected.
In some cases—particularly to assess cartilage condition and osteophyte size—an MRI may be performed.
Treatment
The progression of hand osteoarthritis and some of its symptoms can be slowed through conservative management. The most effective treatments include:
- Splints: stabilize and immobilize the joints to reduce inflammation, relieve pain, and prevent finger deformities.
- Medications: analgesics for pain relief and anti-inflammatory drugs to reduce swelling.
- Hyaluronic acid injections: restore a natural component of the joint lost due to the disease, improving mobility and reducing pain.
- Physical therapy: enhances joint function and relieves pain. It typically includes a combination of stretching, mobility, and strengthening exercises, along with manual therapy to mobilize the joints and release tension in the forearm muscles.
Surgical treatment is indicated when osteoarthritis becomes severe. The most common procedures include:
- Osteotomy: cutting the base of the first metacarpal (thumb bone) to correct deformity.
- Arthrodesis: fusing a joint—either in the wrist or one of the interphalangeal joints—to eliminate instability and pain, although movement is lost.
- Trapeziectomy: removal of the trapezium bone in the wrist to treat rhizarthrosis (osteoarthritis at the base of the thumb).
- Arthroplasty: removal of the damaged joint and replacement with a prosthesis, which relieves pain and restores function.
