The most common type, caused by gradual wear and tear of joint cartilage. It typically affects the base of the thumb, the joints closest to fingertips, and the middle knuckles. Joint space narrowing and bone spurs often develop over time.
Hand Arthritis
Dr Jacqueline Tan
MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)
Hand arthritis occurs when the joints in the hands become inflamed, causing pain, stiffness, and reduced function. This condition affects the synovial joints, which include the knuckles, finger joints, and the joint at the base of the thumb.
Over time, the protective cartilage that cushions the ends of bones wears away due to daily usage or other factors, leading to bone-on-bone contact. This condition commonly affects the wrist, the base of the thumb joint, and distal finger joints, limiting daily activities like gripping objects, opening jars, or writing.
Symptoms of Hand Arthritis
The following symptoms may develop gradually or appear suddenly, depending on the type of arthritis and specific joints affected.
- Pain During Movement: Aching or sharp pain occurs when moving fingers or thumbs, particularly during gripping or pinching activities.
- Morning Stiffness: Joints feel tight and difficult to move upon waking, typically lasting for 30 minutes or longer.
- Swollen Joints: The affected joints become larger than normal and feel warm to the touch due to inflammation.
- Decreased Range of Motion: The joints become less flexible, making it harder to fully bend or straighten fingers.
- Weakness: Hand strength diminishes, making it difficult to perform tasks requiring grip strength.
- Crepitus: The joints make grinding, clicking, or cracking sounds during movement.
- Joint Deformity: Advanced cases may show visible joint irregularities or finger deviation.
Causes and Risk Factors
Hand arthritis results from a variety of factors, including natural joint wear and tear, injuries, and underlying conditions. Common causes include:
Degenerative Changes: Ageing leads to the natural breakdown of cartilage, increasing the risk of osteoarthritis.
Joint Injuries: Trauma or injuries to the hands can accelerate cartilage wear, predisposing joints to arthritis.
Inflammatory Conditions: Autoimmune disorders like rheumatoid arthritis, psoriasis, and gout can inflame and damage joints.
Genetics: A family history of arthritis raises susceptibility by influencing cartilage structure, immune responses, and the likelihood of developing specific types of arthritis.
Occupational Stress: Repetitive hand movements, extensive gripping, or overuse can strain joints, leading to arthritis over time.
Hormonal Factors: Women, particularly after menopause, have a higher likelihood of developing arthritis due to hormonal changes.
Obesity: Excess weight heightens inflammation in the body, affecting all joints, including those in the hands.
Types of Hand Arthritis
Hand arthritis manifests in several distinct forms, each with unique characteristics and treatment approaches:
Osteoarthritis
Rheumatoid Arthritis
An autoimmune condition where the body’s immune system attacks joint tissues. It typically affects the same joints on both hands symmetrically and can lead to severe deformities if untreated. Systemic symptoms like fatigue and fever may accompany it.
Psoriatic Arthritis
Associated with psoriasis, this type can cause swelling of entire fingers (dactylitis), separation of the nail from the nail bed, and pitting of fingernails. It may affect different joints asymmetrically.
Diagnostic Methods
Physical Examination
The doctor evaluates the hand joints for signs of swelling, tenderness, limited range of motion, and visible deformities. Grip strength and the ability to perform basic tasks are also assessed to gauge joint functionality.
Imaging Studies
X-rays reveal changes such as reduced joint space, bone spurs, and erosions. MRI scans detect early joint damage and inflammation not visible on X-rays, while ultrasound provides a detailed view of soft tissue inflammation and fluid around the joints.
Blood Tests
Tests such as rheumatoid factor and anti-CCP antibodies aid in diagnosing rheumatoid arthritis, while additional blood tests help exclude other inflammatory conditions.
Treatment Options
Hand arthritis treatment aims to reduce pain, maintain joint function, and prevent further damage.
Non-Surgical Treatment
Medications
Anti-inflammatory drugs help reduce pain and swelling, while steroid injections provide targeted relief for inflamed joints. Disease-modifying drugs may be prescribed for inflammatory arthritis, such as rheumatoid arthritis, to slow its progression. Topical creams and gels offer localised pain relief with minimal systemic effects.
Splinting
Custom-made splints support affected joints and limit painful movements, particularly during specific activities or at night. They are especially effective for thumb-base arthritis.
Hand Therapy
Tailored exercises help maintain joint flexibility and strengthen surrounding muscles. Therapists provide guidance on joint protection techniques, ergonomic adjustments, and adaptive tools to make daily tasks easier.
Surgical Treatment
Joint Fusion
Permanently joining the affected joint eliminates painful movement and provides excellent pain relief. This is most suitable for end finger joints, where flexibility is less critical.
Joint Replacement
Damaged joints are replaced with artificial ones to preserve motion while relieving pain. This option is commonly used for larger joints, such as knuckles, although it may be less effective for smaller finger joints due to durability concerns.
Joint Reconstruction
Modifying joint surfaces and repairing surrounding tissues can restore function and reduce pain. This approach is ideal for younger patients or those in earlier stages of arthritis to preserve joint mobility.
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Prevention and Management
Adopting healthy habits is key to managing hand arthritis and slowing its progression. Regular hand exercises help maintain flexibility and strength, while using tools with larger grips reduces joint stress. Applying heat before activities and cold afterward can alleviate pain and inflammation. Maintaining a healthy weight reduces strain on all joints, and taking regular breaks during repetitive tasks minimises stress on the hands. Proper ergonomic principles at work and home, such as using gel pads for support, can further protect the joints.
Frequently Asked Questions
Is hand arthritis reversible in its early stages?
Although joint damage caused by arthritis cannot be reversed, early intervention with treatments such as medications, therapy, and lifestyle changes can significantly slow its progression and help manage symptoms effectively, preserving joint function for as long as possible.
Can hand arthritis lead to permanent disability?
Yes, if left untreated, severe hand arthritis can result in joint deformities, chronic pain, and significant loss of hand function, potentially leading to permanent disability that affects daily activities and quality of life.
How often should I see a doctor for hand arthritis?
For stable arthritis, it is advisable to schedule routine check-ups every 6–12 months to monitor the condition. However, more frequent visits may be necessary if symptoms worsen, new issues arise, or adjustments to the treatment plan are needed.
Dr Jacqueline Tan
MBBS (SG)
MRCS (Edin)
MMed (Surgery)
FAMS (Hand Surgery)
Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.
- Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
- Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
- Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
- Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.
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