Osteoarthritis of the hand is the gradual wearing of the cartilage in the small joints of the fingers, most often the joints closest to the fingertips (DIP) and the middle joints (PIP). It produces pain, stiffness, and the firm bony knobs known as Heberden's and Bouchard's nodes. Arthritis at the base of the thumb is common and important enough that it has its own page.
Like arthritis elsewhere, hand arthritis exists on a spectrum. Many people live comfortably for years with simple measures, and surgery is considered only for specific joints that remain painful or deformed despite them.
How it shows up
Pain and stiffness are usually worst in the morning or after use, and patients often notice firm swelling and enlargement of the affected finger joints. Small fluid-filled mucous cysts can form over an arthritic fingertip joint.
How it is diagnosed
The diagnosis is usually clear from the pattern of joint involvement and the exam, with X-rays confirming the degree of cartilage loss. Importantly, the decision to treat is based on symptoms and function, not on how the X-ray looks.
Dr. Lee manages hand arthritis conservatively for as long as it controls symptoms. Many patients do well for years with activity modification, splinting, hand therapy, anti-inflammatory measures, and selective injections.
When a specific joint stays painful or deformed despite these measures, targeted surgery, such as a joint fusion, a joint replacement, or removal of a painful mucous cyst, can reliably relieve pain. The procedure is matched to which joint is involved and how the hand is used.
Non-surgical treatment
The large majority of hand arthritis is managed without surgery.
- Activity modification and joint-protection techniques
- Splinting for painful joints, especially during provocative activities
- Hand therapy and anti-inflammatory measures
- A selective corticosteroid injection for a painful flare
Surgery
For a joint that stays painful despite conservative care, options include fusing the joint (which reliably removes pain at the cost of that joint's motion), replacing the joint in selected fingers, or removing a painful mucous cyst with the underlying bone spur. Dr. Lee matches the procedure to the joint involved and the patient's hand demands.
Recovery timeline
Most patients never need surgery; when a joint is treated, recovery depends on the procedure:
- OngoingConservative care, splinting, therapy, and periodic injections as needed to keep symptoms controlled.
- Early after surgeryProtection of the treated joint in a splint, with guided motion of the surrounding fingers to prevent stiffness.
- Following monthsProgressive use and strengthening; a fused joint is reliably pain-free once healed, while motion-preserving procedures rehabilitate on their own schedule.
What patients commonly misunderstand
What patients often misunderstand:
- A bad X-ray does not mean you need surgery. The decision to operate is based on pain and function, not on the appearance of the X-ray. Many people with significant arthritis on imaging are comfortable with simple measures.
- Thumb-base arthritis is its own problem. Arthritis at the base of the thumb is common and is treated differently from finger-joint arthritis. It has its own dedicated page and its own reconstruction options.
This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.