OA

Osteoarthritis of the Hand

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Osteoarthritis of the Hand, Hand Osteoarthritis, Heberden's Node, DIP Bony Joint Enlargement, Bouchard's Node, PIP Bony Joint Enlargement, First Carpometacarpal Joint Osteoarthritis, Thumb Base Osteoarthritis

  • See Also
  1. Osteoarthritis
  2. Knee Osteoarthritis
  • Epidemiology
  1. Hand less commonly affected in Osteoarthritis
  2. Hand Osteoarthritis is most common in postmenopausal women (esp. age over 70 years)
  3. Hand most disabling of joints to be involved
  • Signs
  1. Trapeziometacarpal joint (first carpometacarpal joint at base of thumb, Thumb Base Osteoarthritis)
    1. Most common site for Hand Osteoarthritis
    2. Pain, swelling, weakness and decreased thumb base range of motion
    3. Provoked by repeated gripping, pinching and forceful thumb use
    4. Treated with NSAIDs (oral, topical), occupational therapy, Thumb Spica Splint
    5. First Carpometacarpal Joint Steroid Injection in refractory or severe cases
  2. Heberden's Nodes
    1. Distal interphalangeal joint (ITP) nodular swelling
  3. Bouchard's Nodes
    1. Proximal interphalangeal joint (PIP) nodular swelling
  4. Mucous cysts may develop at interphalangeal joints
  5. First Metacarpal-phalangeal joint (MCP) involvement
    1. Other MCP joints are generally spared
  6. Wrist spared
    1. Contrast with Rheumatoid Arthritis
  • Diagnosis
  • Hand Osteoarthritis Diagnostic Criteria (American College Rheumatology)
  1. Hand pain, aching or stiffness and
  2. Two DIP or PIP joints with hard tissue enlargement and
  3. Less than 3 swollen MCP joints
  4. One of the following
    1. Two DIP joints with hard tissue enlargement or
    2. Deformity of two DIP, PIP, or MCP joints
  5. References
    1. Altman (1990) Arthritis Rheum 33:1601-10 [PubMed]
  • Imaging
  1. See Hand XRay in Osteoarthritis
  2. May demonstrate Osteoarthritis severity (osteophytes, joint space narrowing)
  • Management
  1. See Osteoarthritis
  2. NSAIDs
    1. Oral NSAIDs (caution in older patients, renal disease, Peptic Ulcer Disease)
    2. Topical NSAID (e.g. Diclofenac Gel)
  3. Intermittent Splinting
    1. Thumb Spica Splint for Thumb Osteoarthritis
  4. Moist heat
  5. Occupational therapy
  6. Local Corticosteroid Injection
    1. See Finger injection
    2. See First Carpometacarpal Joint Steroid Injection
  7. Contrast Baths
  8. Surgery for resistant cases
    1. Arthroplasty
    2. Arthrodesis
  • References
  1. Pujalte (2024) Am Fam Physician 110(4): 395-401 [PubMed]