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Osteoarthritis of the Hand

by David R. Steinberg, MD

Hand involvement is extremely common in osteoarthritis.

Osteoarthritis affecting the hand may include asymptomatic enlargement of nodules at the proximal interphalangeal joint (Bouchard nodules) or distal interphalangeal joint (Heberden nodes) or angulation at these joints. Pain and stiffness of these joints and the base of the thumb are also common. The wrist usually is spared (unless there was preexisting trauma), and there is usually minimal or no metacarpophalangeal joint involvement unless the patient also has a metabolic disorder (eg, hemochromatosis). Differentiation of hand changes in osteoarthritis from those in RA is discussed in Approach to the Patient With Joint Disease.

Treatment

  • Conservative measures

  • Occasionally corticosteroid injection or surgery

Treatment is symptomatic with analgesics, appropriate rest, splinting, and occasionally corticosteroid injection as needed. Surgical procedures can help relieve pain and correct deformity for severe changes at the base of the thumb and, less commonly, for advanced degeneration of the interphalangeal joints.

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