Hand osteoarthritis, like generalized osteoarthritis, is considered a degenerative disease that is caused by the breakdown of cartilage [Cartilage is a covering on the bone in the joint] resulting in pain, stiffness, tenderness, and swelling in the affected joints.
Hand osteoarthritis most often develops in three sites
- The base of the thumb where the metacarpals form a joint with carpal bone (the trapezio-metacarpal, or basilar joint)
- Distal interphalangeal joint [distal most joint of the finger]
- Proximal interphalangeal [first joint beyond the knuckles]
It also often develops in the wrist.
Heberden node is a bony deformity at the distal interphalangeal joint and is one of the early signs of hand osteoarthritis. The deformity is a result of the bone spurs from the osteoarthritis in that joint. A similar deformity at proximal interphalangeal joints is called Bouchard node. Often, these nodes develop gradually, with little or no discomfort.
However, they may present acutely with pain, redness, and swelling, which sometimes triggered by minor trauma.
These nodes may not be painful but can cause limitation of motion of the joint.
Types of Hand Osteoarthritis
Hand osteoarthritis can develop as a separate entity or may occur as part of generalized osteoarthritis. Hand osteoarthritis can be of three types
Generalized Hand Osteoarthritis
Generalized osteoarthritis is characterized by the involvement of three or more joints or groups of joints (distal interphalangeal and proximal interphalangeal joints are counted as one group each). Heberden and Bouchard nodes are prominent.
Symptoms may be episodic, with marked by soft tissue swelling, redness, and warmth. The erythrocyte sedimentation rate may be elevated, but serum rheumatoid factor tests are negative.
Erosive Hand Osteoarthritis
In erosive osteoarthritis, distal and proximal interphalangeal joints of the hands are most prominently affected. Erosive osteoarthritis tends to be more destructive than typical nodal Osteoarthritis.
Radiographic imaging shows collapse of the subchondral plate and bony ankylosis may occur.
In erosive arthritis, joint deformity and functional impairment may become very severe. There is a history of pain and tenderness. The synovium is much more extensively infiltrated with mononuclear cells than in other forms of Osteoarthritis.
Thumb Base Osteoarthritis
Thumb base is the second most frequent area of involvement in osteoarthritis. Swelling, tenderness, and crepitus on the movement of the joint are typical.
In contrast to Heberden nodes, which usually do not interfere significantly with function, thumb base osteoarthritis frequently causes loss of motion and strength.
Pain with pinch leads to adduction of the thumb and contracture of the first web space, often resulting in compensatory hyperextension of the first metacarpophalangeal joint and swan-neck deformity of the thumb.
Presentation of Hand Osteoarthritis
Patients may be symptomless in spite of the disease. Stiffness, swelling, and pain are common symptoms that patients complaints of.
Clinical examination may reveal Heberden’s nodes and/or Bouchard nodes.
Pain at the base of the thumb is a common presentation of the base of thumb osteoarthritis. Pain and decrease in the motion of the joints may cause problems in daily activities like opening jars or turning of keys.
Diagnosis of hand osteoarthritis is based on history, examination, and routine x-rays. Blood investigations are usually normal.
Treatment
Treatment may not be necessary for hand osteoarthritis with minimal or no symptoms. Treatment is designed to relieve pain and restore function.
Treatment of hand osteoarthritis includes
Anti-inflammatory Medications
Pain medications like acetaminophen are helpful in relieving the symptoms of mild hand osteoarthritis. Other commonly prescribed drugs are ibuprofen, ketoprofen, naproxen, and other nonsteroidal anti-inflammatory drugs.
Food Supplements
Food supplements like glucosamine and/or chondroitin can be added in therapy. These medicines do not benefit all the patients though.
Local Therapy
Local heat/cold applications and topical pain creams are helpful for relieving pain. Steroid injections at the site receive the symptoms.
Splints
Finger or wrist splints may be added especially in the night to provide the rest to affected joint(s).
Surgery
Surgical options include fusion of the affected joint or joint reconstruction.
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Hello,
I have osteoarthritis in my hands and feet. During the past year, I have begun playing the Native American flute and love it. It is similar to a recorder. Will playing be likely to make my arthritis proceed more rapidly or is it good for it? Are there some good hand exercises I can do to avoid stiffness, develop strength, etc.?
Thanks you,
Cynthia Unowsky
Cynthia,
My opinion is based on the little information that you have provided about yourself.
It does not matter if you have osteoarthritis of the hands ; you can go ahead and play the instrument.
In no case motion should be restricted in OA. It is unlikely that playing a flute would aggravate or accelerate your problem.
However, if your pain worsens after playing the flute, you must consult a physician.
There are various kinds of exercises available for strengthening the hands, but it would be better to see a physiotherapist who should supervise you initially.
Hello Dr. Singh,
I am a 55-year-old white female with erosive osteoarthritis of the hands. I also have arthritis in both feet, more on the right foot.
The onset for the hand arthritis was July 1991 and affected only the DIPs. In 2006, I developed Bouchards in my left little finger and a small nodule on my right index finger.
I have noticed more pain in my joints since the onset of menopause in 2002. And if my estrogen levels sink too low, I experience considerable pain in both sets of hand bones.
Considering my current situation, I would like your advice about typing on a computer keyboard.
My former occupation required long hours at keyboard and now I use it less for writing and searching the Internet.
I am concerned about doing anything that would further erode the cartilage in my PIPs.
Overall my health is good and I get plenty of exercise, eat right and watch my weight. I also do hand and finger exercises regularly.
Thanks, in advance, for your advice.
Kind regards,
Michele Picozzi
Michele,
There are some questions which can not be answered with certainty.
I hope you understand me.
If you have OA of hand and you were a professional computer user, I would have asked you to desist from using keyboard on regular basis.
But, it appears that you are using computer just for personal work and occasionally. If that is the case, I do not find any harm in continuing that.
But if my guess is wrong and you type a lot, repetitive usage may aggravate the symptoms. Then there are two things you can do depending on whether you have pain or not
If you have pain, do not continue with the work and if probable get some assistance.
If you don't have pain then do not use keyboard continuously. Take frequent breaks.
I hope that would help.
Dear Dr. Singh,
Thank you for your prompt reply to my question.
I do understand what you are saying, and it goes along with my instinct and experience. That is, if I don't type too much, I will be fine. On the few recent occasions I have typed a lot, I have experienced pain and have stopped. Soaking my hands in a hot paraffin bath brings relief, as well as resting, as you suggested.
Besides aggravating symptoms, will typing break down cartilage more rapidly, or compromise it in any negative way, when there is erosive osteoarthritis?
Thanks again for your sending your advice.
Best wishes,
Michele Picozzi
Michele,
The damage to joint occurs only with repetitive continuous usage.
In that also we cannot commend upon the degree of damage caused by certain activities. It is only the association which has been noted.
I am yet to find a study that says mild to moderate daily typing or other activity aggravates the disease.
In my own view, it should not.
Just for your knowledge, cartilage does require optimum level of motion in the joint for deriving its nutrition. Otherwise, it goes into atrophy.
Just focus on things that make you uncomfortable and avoid them.
Do the things that you enjoy within limits of your comfort.
Take care.
Dear Dr Singh, I have inflammatory erosive arthritis of my hands.In particular I have significant pain in my right hand .I have recently had surgery to repair the damage at the base of the (r) thumb. Shortly I will be returning to work.I am a cake decorator in an extremely fast paced and busy bakery.At times it can be quite stressful. Will this type of very repetitive work worsen the cartilage destruction that can occur with this type of arthritis?
I have also had a partial knee replacement and have ongoing pain in both knees and when at work ankle and foot pain.
I appreciate your advice on this matter.Many thanks,ClareMcKie.
Clare,
I am looking into your query. I might need to check few references before I advise.
I was diagnosed with osteoarthritis about 15 years ago. I am now in my late 50's. I have been taking glucosamine with clondrotin 1500mgs per day which I believe keeps the pain at bay although I do not have pain only on the very odd occasion.
Both my thumb joints are swollen and I have a small spur growth on my left index finger metacarpal joint. I am about to take up a job for 18 hours of which will involve typing letters/discharge summaries and I am concerned that lots of typing may cause damage. At present I have no problem or pain from moderate amounts of typing invoices and computer work at present.
Can you tell me if Honeygar (wine vinegar and honey) helps. My friends cousin took this for years and her osterarthritis never progressed any further. Her GP swears by it.
@Clare,
I cannot quantify it but repetitive use of the joint has been linked with damage to the cartilage.
If you are using your thumb joint in a way that it puts stress on it, likelihood of worsening cannot be ruled out.
You would be warned by the symptoms though. I you feel pain after you use your hand in your decorative work and it gets better on rest, it is an early sign.
Take care. I hope that helps.
G Wright,
Your concern is right. Excessive computer and typing work does involve repetitive use of the joints of hand and it has been associated with worsening of OA.
Even if you are in such a job and can't avoid it, you would be helped by frequent breaks in between.
As for as Honeygar is concerned, I have no idea. But I suspect the relief may be from wine than other things.
Dear Doctor,
I am doing extensive typing on computer for around 9 hours a day. My finger joints ache a lot during and at end of work. Quite unfortunately, I earn my daily bread by typing and cannot afford to take leave or be off work. Kindly advise on how to reduce the stress to hand, fingers, and please suggest some exercises.
Thanks,
Dear Penny,
I would advise you to take frequent breaks in between and do stretch exercises of the joint.
A warm compresses in the evening would help.
If your condition worsens with time, you might need to rearrange your priorities.
Take care.
I had a MRI of the wrist 10/10/08 it stated fluid surrounding the tendor of the 2nd extensor compartment.
effusion within the distal radial ulner joint, 4mm subcortical cyst at the palmar aspect of the waist scaphoid is associated with bone marroe edema. small focus of bone edema at the palmar aspect of the distal pole. Its worker comp and no one telling me anything. I work on the computer and the mouse all day. I believe am geeting worse I been PT for 30 visit and hand continue to swell with great pain.
Help with advice
Sherin,
What is your exact problem. From your MRI finding I can only make that you have inflammation of tendons and cyst in scaphoid. You need to give me more information about yourself and your problem in detail.
What did your physician tell you?
Hi,
I usually sit in front of a computer for about 9 hours in a day and my job involves a good amount of typing.
I would like to know if touch typing (typing using 10 fingers) put lesser impact on hands than typing using 2-3 fingers.
@Vipul,
I do not know about that. In either case you should take frequent breaks in between.
Dr. Singh:
I am 42 and have heberden's nodes on my pinkies. I want to have them removed, mainly for cosmetic purposes. Is this possible?
Thank you for your help.
I have been diagnosed with EOA. The first and long fingers of both hands show sympyoms, but my right hand is much worse. On the right hand my fingers are grossly swollen, painful, and have a very distinct bend to the side (similar to ulnar shift). I worked as a programmer and used a keyboard and mouse almost constantly for many hours each day for 35 years. My fingers finally hurt so badly I could not perform my job. My orhtopedic surgeon said that repetitive motion trauma would worsen the condition. In order to delay surgery to fuse my fingers (I'm just 61 and otherwise healthy and active), he referred me to a rheumatologist for possible pain control. However, when queried by Worker's Comp, the rheumatologist said that repetitive motion trauma would only cause pain, not a worsening of the EOA. What is your opinion and is there a written study that suggests a worsening of EOA by continued repetitive motion trauma?
Thanks,
Dave
@Dave May,
You would need to update me. I cannot get the meaning of EOA.
I have been diagnosed with Erosive Osteo-Arthritis. The first and long fingers of both hands show sympyoms, but my right hand is much worse. On the right hand my fingers are grossly swollen, painful, and have a very distinct bend to the side (similar to ulnar shift). I worked as a programmer and used a keyboard and mouse almost constantly for many hours each day for 35 years. My fingers finally hurt so badly I could not perform my job. My orhtopedic surgeon said that repetitive motion trauma would worsen the condition. In order to delay surgery to fuse my fingers (I’m just 61 and otherwise healthy and active), he referred me to a rheumatologist for possible pain control. However, when queried by Worker’s Comp, the rheumatologist said that repetitive motion trauma would only cause pain, not a worsening of the EOA. What is your opinion and is there a written study that suggests a worsening of Erosive Osteo-Arthritis by continued repetitive motion trauma?
Thanks,
Dave
@Dave,
You have not mentioned what caused erosive osteoarthritis. It could be rheumatoid arthritis or any other inflammatory disease.
Anyway, I would come to your question. The answer is not straightforward. So you would need to understand few details.
Per se there is no evidence that erosive or inflammatory arthritis gets worsened with repetitive trauma.
But few studies have suggested that repetitive trauma leads to degenerative osteoarthritis.
With EOA, your joints are already showing degeneration. So if you apply those studies to your case, there is a risk that your degeneration gets worsened by repetitive usage.
Here is an article for you that says repetitive usage is a risk factor for degenerative osteoarthritis as suggested by few studies.
http://rheumatology.oxfordjournals.org/cgi/conten…
I hope that helps
Maybe you should change the webpage subject title Osteoarthritis of Hand — Bone and Spine to something more generic for your blog post you write. I loved the the writing all the same.
@Team Roster,
Thanks for the suggestion. I am initiating the changes.
Hello
I have been diagnosed with Erosive Osteo Arthritis in both hands but my index finger and little finger on my right hand are the worst. Similar on left hand but not as bad or painful.
Have nodes close to the fingertip which are on 4 fingers on left hand but only on 3 fingers on right hand and less noticeable.
Is taking anti infammatories really the only solution?
@kjl,
It is one part of the treatment. Other measures like local heat, antiinflammatory gel application can also be considered.
Hello,
I have been diagnosed with OA in both hands. I have had two operations on the right thumb (trapezium arthroplasty and a revision). At the time of my original diagnosis and subsequent surgery the left thumb exhibited the same symptoms as the right thumb but I did not have any pain in it. I am currently training to upgrade some of my IT certifications so that I can return to my job as a network engineer (great job but long hours and massive amounts of keyboarding) and have had to switch the load to my left hand. I am now having the same pain in the left as I did in the right. I was seen by my doctor this past week and x-rays showed that I am bone on bone at the base of the left thumb. I used to have a very active life style….cycling, golf, softball, weights, etc. All of those activities are now long gone and the only thing left is my job activities. Even during retraining I am really working the left hand 8-10hrs per day and am in a lot of pain and discomfort now. I am not sure why but my doctor seems to be reluctant to associate my issues with the keyboarding, cabling, server racking, etc that are all part of my job. I am really becoming nervous and depressed over this. Can you shed any light on why this might be happening to me. I have also had carpal tunnel releases in both hands back in 2001-2002. We are trying splinting and anti-inflammatory medication for 30 days but possible surgery had been discussed as well. This would be my fifth hand surgery and i am just not up for any more of this. Anything you can share with me would be appreciated….Thanks
@dano,
If there is no other pathology, you seem to have repetitive strain injury and from your description there seems a definite link with your profession.
You can discuss it more with your treating physician.
Try restricting your activities and try shifting to ergonomic gadgets.
If you have RSI, you must reduce further insult tp the involved area.
I have just been diagnosed with OA of the thumb joint in right hand. Do you think this has been caused by being a typist for years, or can it just occur out of the blue to joints please?
Overuse can cause changes in joints but age and predisposition are more important. Not all typists would get that but yes, it is a risk factor.
Dear Dr Singh,
i am looking for recent articles and studies about the link between keyboard and mouse use and base of thumb osteoarthritis. Can you provide some references for me?
Thank you.
Pat
Sorry for delay in reply. You can easily get through Google Scholar or something similar. Take care.
Hi Dr Singh
I’m only 50 and was diagnosed with osteoarthritis a couple of years ago, having had symptoms for quite some years before that. My symptoms are Heberdens nodes on both index fingers with curvature on the last joint of both index fingers as well as restricted movement in the both index and little fingers.
Initially I was tentatively diagnosed with Psoriatic Arthritus due to my age and gender, however the Methotrexate made no difference so a diagnosis of osteoarthritis was reached.
I’ve subsequently had steroid injections in both index and little fingers which was a great relief and indeed enabled me to act as if no condition existed. I’ve attended quite a fiew hand therapy classes, and now that the steroid injections have worn off ( only 5 months after receiving them), I’m having to put them into practice.
I’ve been a computer programmer for nearly 30 years and for a time an avid game player and from reading your web page I can see there are several other programmers experiencing similar symptoms.
I believe that there is a generational timebomb waiting to happen regarding computer usage,